Data Intake record Processing Details

A record is part of a larger organizational unit called the Family Neutral Record (FNR). Each record contains information pertaining to a member, either the employee or one of the dependents of the employee. A record has a process order, indicating the order of processing for the record in the FNR. This section describes the steps involved in processing a single record in OIPA. Each step in the processing is described in detail with requirements.

Validate Fields

Field Validation evaluates the fields on the record against the validation configuration that is defined in the Rules configured in the Intake Profile Definition. The following requirements apply to field validation:

  1. Constraints can be defined for each field that is expected to come in on a record.
    1. Example constraints are required, valid value, length, range, and pattern.
  2. The kinds of constraints need to be configurable in the Rules Palette for the Intake Profile Definition.
    1. This is the definition of default constraints. Perhaps some fields are, by default, required. Other fields should, by default, be a certain value.
  3. Constraints can be overridden or added in the application when Intake Profiles are created.
    1. For example, the user may change the list of valid values for a field constraint, or mark a particular field as required.
  4. Each constraint can result in an error or warning when evaluated.
    1. Part of the configuration for each constraint will be to specify if an error or warning should be returned upon failure of the constraint. If an error is returned processing will be halted, if a warning is specified processing will not be impeded.
  5. All validation errors and warnings are stored in the system, and available for reporting.
  6. All validation errors and warnings are available for processing.
    1. For example, all warnings that are generated during field validation are available to the intake transaction for evaluation. This would allow the configuration in the intake transaction to choose to ignore warnings or stop processing.

Calculate Changes

Changes Calculation evaluates the data coming in on a record against either the prior record for the member or the current system data for the member. The purpose of changes calculation is to determine what information has changed. These changes are then made available to downstream processing to determine what to do with the changes.

  1. Changes Calculation will only be performed if it is configured to run. For use cases outside of Group member processing, it may never be appropriate to calculate changes.
  2. OIPA can support comparing record information to a prior record for the member.
    1. If comparing the first record for the member for the current file, OIPA will compare the current record against the last Active record for the member.
    2. In the event that this is the first time this member is coming into OIPA, the record will be marked as "New To File", and the changes calculated will simply be that the member is new.
    3. Only the last "Active" successfully processed record for a member will be used for calculation. Reversed or Failed records will not be used for changes calculation.
  3. OIPA can support comparing record information to the current system state for the member.
    1. OIPA will only compare against system state for the first occurrence of a member within an FNR. If the same member occurs multiple times within the same file and FNR, subsequent records to the first record will be compared against the previous record within the same FNR.
  4. Changes that are calculated under either method are saved in the system.
  5. Changes that are calculated are available for processing downstream in the record process.
  6. Changes that are calculated for a record will be visible in the user interface and available for reporting.

Process Intake Record Transaction

The Intake Record Transaction provides a robust configuration mechanism to exercise a record. Here, it is up to the implementer to determine how to process the record. The following features are available in the Intake Record Transaction.

  1. Math is processed in order to calculate variables that are used downstream in the transaction.
    1. All record information, including field errors and changes are provided to Math for purposes of evaluation and determining what to do with the record.
    2. Math will have the ability to create Activities at any level in the system (on a Client, Policy, Group Customer, Plan, Company, or Client Relationship).
  2. Business rules are executed against the record to determine if it is valid. Complex expressions can be used to cross check field values and evaluate any of the variables that were calculated in Math.
    1. If a record fails validation, the record is saved in an error status.
    2. The error information that is generated will be saved with the record and available for reporting and in the OIPA user interface.
  3. Supplementary record fields can be set.
    1. For example, if a record is to be marked as an "Auto-Cancel", an Auto-Cancel supplementary record field can be set to True.
  4. An Activity Sequence Process can be created to impart the changes for a record into the system.
    1. The Activity Sequence Process contains an ordered sequence of entities and activities that need to be executed in the system.
    2. If the record fails validation, the activity sequence process will not be created.
    3. The Activity Sequence Process creates the activities, but does not process them. The activities are processed after the threshold processing completes for the file.
  5. When the Data Intake Transaction completes, all information is stored in the system in a single transaction, including all warnings and changes.
    1. This includes the activities that were created, and any updates to the record itself.
    2. If the record is not in error, the record enters into a "Pending Validation" status waiting for threshold processing to complete.

Wait for Threshold Processing

Threshold Processing is part of the File Processing defined above. Here, the record remains in a Pending Validation status until all records complete processing, and the File Level Validation can execute.

  1. If file validation fails, all records should be moved into a "File Validation Failed" status.
  2. If file validation passes, all valid records are presumed to move into execution where all activities for all records will be processed. Valid records are those that are in a "Pending Validation" status. Any records that failed pre-processing in an error status will not be processed.

Execute Activities

After file validation succeeds, all records that are in a "Pending Validation" status are moved into a "Pending Execution" status, where they are scheduled for execution in the grid.

  1. Records are processed in record groups according to the Family Neutral Record they belong to. Records are processed according to the order in which they were submitted to OIPA by the insurance carrier's file receiving system.
  2. Only records in "Pending Validation" status will be processed. Any records that failed in an error status during pre-processing will not be executed.
  3. If any activity fails in a business or system error, all subsequent activities for that record are not processed. The record is marked with an error status, and the error information is saved on the record.
  4. If the record fails in an error status, blocking rules are consulted to determine if downstream records (records subsequent to the current record based on process order) should be blocked. If any records should be blocked, those records will be updated to have a "Blocked" status.
  5. Once a record completes processing all activities, it will be saved in an "Active" status.

 

 

 

 

 

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