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Claim Line Applied Provider Pricing Clauses Not Updating After A Product Category Changed (Doc ID 2770066.1)

Last updated on APRIL 22, 2021

Applies to:

Oracle Insurance Claims Administration Cloud Service - Version NA and later
Information in this document applies to any platform.

Goal

On : NA version, OCI Cloud Ops

Claim Line Applied Provider Pricing Clauses not updating after a Product Category changed

We have noticed that if you have a claim line processed against a Provider Pricing Clause that is associated with a Product Category, then change the Product Category (i.e. remove the product that was on the claim line).
Then unfinalise and re-submit the Applied Pricing still picks up the PPC as if the change had not occured.

Note this has been verified in our environment and also by an Oracle consultant on a virtual box.

Pre-requisites:
Provider Pricing Clause linked to
- Product Category with Products dimension used
- Provider Group with a provider on it

Steps:
Claim Line processed with same product and provider as above
Remove the product from the Product Category
Unfinalise and Re-Submit
Observe that the claim line is not correctly calculating the Applied Provider Pricing Clauses

Work around:
remove the provider from the Provider Group
unfinalise and re-submit
add the provider back into the Provider Group
unfinalise and re-submit expected
observe the claim line is now correctly calculating the Applied Provider Pricing Clauses
 

Solution

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In this Document
Goal
Solution
References


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