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Oracle Health Insurance تطبيق Ed 1

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Oracle Health Insurance تطبيق Ed 1

4 أيام

12 محاضرة

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دورة المحتوى

OHI Introduction

  • Objectives
  • Background and Business Benefits
  • Health Care Payer Challenges
  • Oracle Health Insurance
  • Summary
  • The Application Landscape
  • Oracle Health Insurance Ecosystem
  • A Componentized Health Care Payer Application Landscape Which functions does a
  • payer require? The Oracle Health Insurance perspective
  • A Componentized Health Care Payer Application Landscape Which functions does a
  • payer require? The Oracle Health Insurance (OHI) Vision
  • OHI Components Ecosystem Claim Processing
  • OHI Components Ecosystem Eligibility and premium calculation
  • OHI Analytics Dashboards
  • Functional Overview
  • Highly Configurable Rule-Based Components
  • Functionality out of the box
  • Flexibility
  • Multilinguality
  • Coverage in Different Countries
  • Code System Independence
  • Straight Through and Continuous Processing
  • Summary

Extensibility

  • Objectives
  • Introduction
  • Fixed Fields Versus Extensibility
  • Main Concepts
  • Example 1
  • Example 2
  • Dynamic Fields and Usages
  • Dynamic Field Example
  • Flex Codes
  • Flex Code Example
  • Dynamic Records
  • Reference Sheet
  • Reference Sheet Example
  • Summary

Dynamic Logic

  • Objectives
  • Fixed Versus Dynamic Logic
  • Types of Dynamic Logic
  • Dynamic Logic Page
  • Signatures
  • Subtypes
  • Subtype: Validation
  • Subtype: Condition
  • Subtype: Function
  • Oracle Health Insurance Object Model
  • Object Model
  • Object Model: Methods
  • Reference Sheets
  • Summary

OHI Enterprise Policy Administration Introduction

  • Objectives
  • Architecture
  • Policies Ecosystem Premium Calculation
  • Functional Overview
  • What else? (1/8) Premium Calculation Methods and Scenarios
  • What else? (2/8) Keeping track of changes
  • What else? (3/8) Generating source files for member collateral
  • What else? (4/8) Integration. RESTful.
  • What else? (5/8) Cafeteria-style benefit plans
  • What else? (6/8) Savings Accounts
  • What else? (7/8) User-defined Processing Rules
  • What else? (8/8) Group Clients and Group Accounts
  • Summary

Policy Administration

  • Objectives
  • Creating a Policy
  • Action Oriented Policy Page
  • Policy Wizard
  • Group Accounts
  • View Member Page
  • Policy Maintenance
  • Validate and Submit
  • Policy Maintenance
  • Policy Activities
  • Activity Processing
  • Financial Flow
  • Calculate Premium
  • Financial Processing
  • Financial Message
  • Summary

Product Configuration

  • Objectives
  • Introduction
  • Enrollment Products
  • Enrollment Products & Products
  • Enrollment Products and Premium Schedules
  • Enrollment Products and Surcharge and Adjustment Rules
  • Enrollment Products and Add-ons
  • Schedule Definitions
  • Schedule Definitions and Dimension Types
  • Dynamic Field Dimension
  • Parameter Dimension
  • Generic Dimension
  • Group Clients and Group Accounts
  • Group Clients
  • Group Accounts
  • Summary

Policy Rules

  • Objectives
  • Policy Process Steps
  • Activity Processing
  • Bulk Updates
  • Generate Output
  • Generate Fee (a.k.a. Incidental Charge)
  • Generate Policy Mutations
  • Summary

OHI Claims Introduction

  • Objectives
  • Introduction
  • What Is Pricing?
  • What Is Adjudication?
  • OHI Claims Pricing and Adjudication
  • Standard Integration Points
  • Claim Model
  • Pricing the Claim
  • Finding the Benefit
  • Process rules
  • Accumulators
  • OHI Claims Pricing
  • Extensible Provider Data Model
  • Pricing Worksheets: Configure executed contracts
  • Reimbursement Methods
  • Out-of-the-box Pricing Rules
  • OHI Claims Pricing
  • OHI Claims Adjudication
  • Extensible Claim Data Model
  • Benefit Selection
  • Benefit Calculation
  • Financial Preprocessing
  • Authorization Matching
  • OHI Claims Adjudication
  • Summary

Processing Claims and Flow Overview

  • Objectives
  • Claims Flow Overview
  • The Step-by-Step Claims Flow
  • Summary

Pricing Configuration

  • Objectives
  • Pricing Components
  • Pricing the Claim
  • How Do We Support Pricing in OHI?
  • Provider Pricing Clauses
  • OHI Claims Pricing Configuration Model
  • Provider Pricing Clauses
  • Pricing’s Main Instrument: The PPC
  • Selecting Provider Pricing Clauses
  • Pricing Methods and Rules
  • Methods and Rules
  • Reimbursement Methods
  • Out-of-the-box Pricing Rules
  • Claim Classification
  • Claims Classification
  • Classification components
  • How Classification Fits in With the Other Parts of Pricing
  • Pricing Templates
  • The Need for Configuration Efficiency
  • Overview of Features
  • Pricing Options
  • Pricing Templates
  • Pricing Worksheets
  • Pricing Worksheets: Advanced Editing
  • Pricing Worksheets: Validation and Build
  • Summary

Benefits Configuration

  • Objectives
  • Benefits Components
  • Products
  • What Is a Product?
  • Schedule of Benefits Example
  • What Are the Main Components of a Product?
  • Benefit Specifications
  • What Is a Benefit Specification?
  • High-Level Product
  • Coverage Regimes
  • Coverage Regime
  • Adjudication Limits
  • Linking the Limits
  • Authorization and Waiting Period Regimes
  • Authorization Regimes
  • Authorization Matching
  • Waiting Period Regimes
  • What Happens After the Benefits Are Calculated?
  • Claim Finalization
  • Summary

Configuration Migration

  • Objectives
  • Introduction
  • Configuration Migration in a Nutshell
  • Building a Migration Set
  • Selecting Items for Migration
  • Selecting items for migration
  • Selecting Items for Migration
  • Exporting a Migration Set
  • Importing a Migration Set
  • Summary

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