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LIMIT IS ALSO NOT APPLIED EVEN WHEN PRODUCT BENEFIT SPEC HAS LIMIT PARAMETER (Doc ID 2785503.1)

Last updated on JUNE 22, 2021

Applies to:

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

Goal

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_BL used in benefit spec. DED consumed on the claim line but no counters are created for DED and OOP even when product benefit have DED, OOP parameter.
Also benefit limit has max value of $140 and claim line covered amount is $150 which is going in DED bucket, so limit is also not applied even when product benefit spec has limit parameter.
 

Solution

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In this Document
Goal
Solution
References


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