Automatic Completion of Delinquency Process
A delinquency business object can have end statuses such as Cancelled, Completed, Customer Terminated, or Customer Reinstated. If a delinquency process exists in Customer Terminated or Customer Reinstated or Cancelled status, the status is prone to change even after several months. To prevent further updates after a defined period, the delinquency process should be moved to Completed status, which is the final end status.
Therefore, ORMB introduces a new business rule category named Delinquency Process Auto Completion Business Rule that allows separate business rules to be configured for each of the above statuses, with a period in days for automatic completion.
A new business rule category named Delinquency Process Auto Completion Business Rule is shipped with the product.
This new enhancement is generic and available across all the health care line of businesses.
A delinquency process residing in Customer Terminated, Customer Reinstated, or Cancelled status can transition to the Completed status after a configured period. Once the delinquency process transitions into any of the above mentioned statuses, a counter begins till the configured period is reached.
The counter is effectively reset on each status transition because the design uses the existing delinquency STATUS_UPD_DTTM value, which is updated whenever the current status changes. The Delinquency Process Monitor (C1-DPMON) batch then monitors delinquency processes in Cancelled, Customer Reinstated, and Customer Terminated statuses. If auto-completion is enabled for the delinquency process type and current status, the batch uses STATUS_UPD_DTTM value to determine how long the process has remained in that particular status. Once the configured period has elapsed, the delinquency process is moved to Completed status.
For the Fully-Insured Individual Memberships that are billed to the same account, the derived state and region attributes used in business rules must be consistent across all memberships to prevent multiple conflicting criteria(s) from getting matched.
For the Fully-Insured Individual line of business, state or region (jurisdiction) is captured in the health plan and membership attributes, whereas for Fully-Insured Group line of business, state or region (jurisdiction) is captured in the policy, policy plan, or membership attributes.