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Enhancement: Ability to Match A Single Claim Line To Multiple Reservations Lines (Doc ID 2605069.1)

Last updated on NOVEMBER 01, 2019

Applies to:

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


The ability to match a single claim line to multiple reservations lines is needed. The claim line should consume from the matched reservation lines until either the claim line quantity or amount is fully covered or until the end of the matched reservation lines has been reached.
There are scenarios where a provider submits a reservation for the same service across multiple lines. However, the claim is submitted with a single line with multiple quantities – which would need to consume from multiple reservation lines. To accommodate these scenarios a one (claim line) to many (reservation lines) association is needed.


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