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LIMITS NOT APPLIED ON OVERRIDING BENEFIT SPECIFICATIONS (Doc ID 2747518.1)

Last updated on FEBRUARY 01, 2021

Applies to:

Oracle Health Insurance Claims Adjudication - Version 3.20.2.0.0 and later
Information in this document applies to any platform.

Symptoms

Problem Summary
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Limits are not applied on overriding benefit specification as specified on
the product benefit specification

Problem Description
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If an overriding benefit specification is used on a claim line the line
applies the correct coverage regime with the correct parameters, but any
limit parameters specified on the product for the benefit specification are
ignored and no limits are consumed.

The expectation is for the system is to count the limits specified on the
product benefit specification.

Cause

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In this Document
Symptoms
Cause
Solution
References


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