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No Parameter Applied From Product Benefit Spec And Same Is Visible In Applied Benefit Rules Screen (Doc ID 2785472.1)

Last updated on JUNE 22, 2021

Applies to:

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


Detailed Description: Scenario - Override with product B from product A, subscription date and cover spec (From product B and this benefit spec is not available in product A)
Outcome: Claim is finalized. Regime PRD_DE_CP used in benefit spec. DED consumed on the claim line but no counter is created for DED and OOP, even when product benefit spec have DED, OOP parameter.
As coverage regime has hard coded % value for DED parameter, claim line consumed DED but no parameter applied from product benefit spec and same is visible in Applied Benefit Rules screen.


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