Pricing Vs Passthrough Charges

ThePricing Vs Passthrough Charges zone allows you to view the difference (if any) between the calculated and passthrough benefit amount of the membership for a coverage period. It contains the following two sections:

• Search Criteria - The Search Criteria section contains the following fields:

  Field Name	Field Description	Mandatory (Yes or No)
  Membership ID	Used to search for coverage periods of a particular membership where the calculated and passthrough benefit amount is different. Note: The Search () icon appears corresponding to the Membership ID field. On clicking the Search icon, the Search Membership window appears. This field is applicable for both fully insured group and fully insured individual lines of business.	No
  External Membership ID	Used to search for coverage periods of a membership with a particular external membership ID where the calculated and passthrough benefit amount is different. Note: This field is applicable for both fully insured group and fully insured individual lines of business.	No
  Health Plan	Used to search for coverage periods of all memberships belonging to a particular health plan where the calculated and passthrough benefit amount is different. Note: The Search () icon appears corresponding to the Health Plan field. On clicking the Search icon, the Health Plan Search window appears. This field is applicable only for the fully insured individual line of business.	No
  Coverage Start Date	Used to search for coverage periods that begin on or after the specified date. Note: The coverage start date cannot be later than the coverage end date. You can either manually specify the date or select it using the Date Picker () icon corresponding to the field.	Yes
  Coverage End Date	Used to search for coverage periods that end on or before the specified date. Note: The coverage end date cannot be earlier than the coverage start date. You can either manually specify the date or select it using the Date Picker () icon corresponding to the field.	Yes

  Note:

  You must specify at least the membership ID, external membership ID, or health plan while searching for discrepancies within the coverage period.

  The coverage date range should neither be less than one month nor exceed beyond one year.

• Search Results - On clicking the Search button, the search results appear based on the specified search criteria. The Search Results section contains the following columns:

  Column Name	Column Description
  Membership Information	Indicates the membership where there is difference between the calculated and passthrough benefit amount for the coverage period. Note: It has a link. On clicking the link, the Membership screen appears where you can view the details of the respective membership.
  External Membership ID	Displays the corresponding membership ID which is maintained in the external source system.
  Price Item	Indicates the price item using which the membership benefit charge is created for comparison.
  Coverage Start Date	Displays the date from when the membership benefit coverage is effective.
  Coverage End Date	Displays the date till when the membership benefit coverage is effective.
  ORMB Calculated Amount	Displays the benefit amount calculated for the membership in the system.
  Passthrough Amount	Displays the passthrough benefit amount received for the membership from the external system.
  Difference	Displays the difference between the calculated and passthrough benefit amount.
  Billable Charge Source	Indicates whether the billable charge is created using the calculated or passthrough benefit amount. The valid values are: ORMB Calculated Passthrough Charge
  Billed Status	Indicates whether the billable charge is billed to the respective account. The valid values are: Billed Not Billed
  Billable Charge	Indicates the billable charge created for the membership benefit. Note: It has a link. On clicking the link, the Billable Charge screen appears where you can view the details of the respective billable charge.

  Note: Pagination is used to display limited number of records in the Search Results section. You can use the navigation links, such as Previous and Next to navigate between pages.

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