Guidelines to Use Benefits Billing Processes

The benefits billing processes are available in the Evaluation and Reporting work area, Processes tab, Billing Processes section.

Consider the following points before you run the processes:

• Prerequisites to prepare and generate charges for multiple participants

• Process sequence to prepare and generate charges

• Process for allocating and reconciling payments

Prerequisites to Prepare and Generate Charges for Multiple Participants

You must create a benefits group and assign it to participants whom you want to generate charges for a billing period:

1. Create benefit groups using the Benefit Groups task in the Plan Configuration work area.

2. Use the Upload Person Benefit Groups task in the Evaluation and Reporting work area to assign that benefits group to multiple participants. When you run the processes, you select the benefits group to process all the participants in that group.

Process Sequence to Prepare and Generate Charges

You must run the processes in the following order:

1. Prepare Benefit Coverage Charge Data process

2. Generate Benefit Coverage Charges process

Before you run the Generate Benefit Coverage Charges process for a participant, you can still review the charges and make changes using the Benefit Coverage Charges task.

Process for Allocating and Reconciling Payments

After you record and upload payments or adjustments using the Upload Billing Payments workbook, you must run the Allocate and Reconcile Payments process. This process allocates and adjusts the payments appropriately for all the records that were uploaded using the workbook. You can verify the updated payment records using the Benefit Coverage Payments task.