My Oracle Support Banner

Claims Stuck on NPE Because Product Change During Claim-Span Not Taking Copays Correctly (Doc ID 2926570.1)

Last updated on FEBRUARY 17, 2023

Applies to:

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


OHI Product: Oracle Health Insurance Claims Adjudication
OHI Version:

If the claim dates of service span dates with a change in the member’s product, duplicate cost-share is getting applied.
There are three claims which a Classification of OUTPT_SURGERY_SDC and all three claims have the Surgical Day Center Copay expected to max out at $250.
The copay shouldn’t be applied twice. For all three examples two copays where applied for a total of $500 on each claim.

Example: Claim had dates of service before and after 7/1, the member’s anniversary and windchill date change.
The service/operation room procedure took place on 6/30 and SDC Copay of $250 was applied, additional ancillary services were billed with a date of service 7/1.
The Product changed on 7/1 and the SDC was again applied for those services such as Lab Chemistry, Lab Hematology, etc..

This could happen with other service with the same type of counters/case logic such as emergency room care.

Note: This was getting detected on claims that were previously stuck on Null Pointer Exception for members changing products during duration of claim which was fixed in

There should not be two SDC Copays applied even when the windchill is getting changed.





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

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