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Question Regarding Claim Dollar Access Restriction (Doc ID 2804467.1)

Last updated on SEPTEMBER 03, 2021

Applies to:

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


When a user does not have an claim access restriction for an amount larger than the claim covered amount, on the UI the claim stops in Manual Adjudication step. The Accept and Submit buttons are hidden. However, it does not set a message or pend. Is there a way to configure a message and/or pend code to be set? We would like this to pend with a code that can route the claim to a more senior user with a higher amount limit.


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