My Oracle Support Banner

ER: Fee Schedule Line Update Should Disable Line Except If Consumed (Doc ID 2686860.1)

Last updated on JULY 02, 2020

Applies to:

Oracle Health Insurance Claims Adjudication - Version 3.19.2.0.0 and later
Information in this document applies to any platform.

Goal

Enhancement Request:

When a fee schedule line in OHI is update via fee schedule integration point OHI checks the existence of fee schedule line in OHI and updates the line based up on rules defined under section “7.16.2.1.2 Update Mechanism” of integration guide in 3.19.2.

Existing logic: If the Start Date matches, but End Date, Amount, Percentage and/or Enabled Indicator do not match, the fee existing schedule line is updated with the new End Date, Amount, Percentage and/or Enabled Indicator

Requested change: If the Start Date matches, but End Date, Amount, Percentage and/or Enabled Indicator do not match, the fee existing schedule line is updated with the new End Date, Amount, Percentage and/or Enabled Indicator if any claim line have not consumed that fee schedule line, if any claim line have consumed that fee schedule line disable the existing fee schedule line and insert the new line.

Use case: There are situations were HPHC need to make correction to a rate under a fee schedule by keeping all other parameters like start date, procedure code etc. same but do not want to reprocess the claim due to various reasons like dollar difference is not significant or any other reason but still want to have auditability to understand and explain (in audit) the processing of claim with old rate.
 

Solution

To view full details, sign in with your My Oracle Support account.

Don't have a My Oracle Support account? Click to get started!


In this Document
Goal
Solution
References


My Oracle Support provides customers with access to over a million knowledge articles and a vibrant support community of peers and Oracle experts.