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Claims Update IP - Original Messages Are Not Retained (Doc ID 2542531.1)

Last updated on FEBRUARY 11, 2020

Applies to:

Oracle Health Insurance Claims Adjudication - Version 3.18.3.0.0 and later
Information in this document applies to any platform.

Symptoms

Claims Update HTTP requests are not retaining original messages on claim line when overwrite message is set to 'N'. Here is a sample: claims update request to resource '/api/claims/update/181024M28I83' is not retaining original messages on claim line - 0010 and also SKIP TAG is not updated.

{
      "claimTagActionList": [
      {
         "claimTagAction": [
 
            {
               "action": "H",
               "tag": "<tag>"
            }
         ]
      }
   ],
 
   "claimUnfinalizeReasonList": [
      {
         "code":"CLP_TECHNICAL",
"sourceReference" : "TEST"
      }
   ],
   "claimLineList": [
      {
         "overwriteMessages": "N",
         "claimLineMessageList": [
            {
               "code": "<code>"
            }
         ],
         "code": "0010"
      }
   ]
}



SOAP request on OHI 2.16.1 for same claim works fine, retains original messages and SKIP TAG is also updated. Attachment has details for this too.

This is an issue with callout rule response as well on OHI 3.18.3 which is using SOAP version of claims update (V10).
 

Claims Update should retain original messages as per details in implementation guide:

"If the update specifies a messages element, processing depends on the indicator
overwriteMessages. If this is set to Y(es) (or not specified), all existing messages that originated
from either a manual edit or an external source are removed and replaced with the messages
specified in the request. If overwriteMessages is set to N(o), existing messages are retained and
the messages specified in the request are added to the claim or claim line"

Also, SKIP TAGS should be updated as requested in UPDATE request


Changes

 

Cause

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In this Document
Symptoms
Changes
Cause
Solution
References


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