Defining a Claim Pricing Rule Type
Prerequisites
To define a claim pricing rule type, you should have:
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Business Object C1-PricingRuleTypeClaim defined for pricing rule type.
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Business Object C1-PricingRuleClaim defined for pricing rule.
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Pricing rule type category for claim defined in the application
Procedure
To define a claim pricing rule type:
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Click the Admin link in the Application toolbar.
A list appears.
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From the Admin menu, select P and then click Pricing Rule Type.
A sub-menu appears.
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Click the Add option from the Pricing Rule Type sub-menu.
The Select Business Object screen appears. It contains the following field:
Field Name Field Description Mandatory (Yes or No) Pricing Rule Type Business Object Used to indicate the business object using which you want to create the pricing rule type. Note: You can create a claim pricing rule type using the Claim Pricing Rule Type business object.Yes Tip: Alternatively, you can access this screen by clicking the Add button in the Page Title area of the Pricing Rule Type screen. - Select the Claim Pricing Rule Type business object.
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Click OK.
The Claim Pricing Rule Type screen appears. It contains the following sections:
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Main – Used to specify basic details about the claim pricing rule type.
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Related Pricing Rule Types – Used to define the pricing rule types which are related to the parent pricing rule type.
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Transaction Field Mapping – Used to specify the transaction related data mapped to the pricing rule type
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Algorithms – Used to define the algorithms used for the pricing rule type.
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Additional Data – Used to specify the additional information about the pricing rule type.
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Price Items – Used to define the price items assigned to the pricing rule type.
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Price Item Parameters – Used to define the price item parameters in the pricing rule type.
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Characteristics – Used to define the characteristics for the pricing rule type.
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Claim Templates – Used to define the pricing rule type for claim template.
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Claim-Specific Additional Data – Used to specify the claim specific additional data.
The Main section contains the following fields:
Field Name Field Description Mandatory (Yes or No) Pricing Rule Type Used to specify the pricing rule type. Yes Description Used to specify the description for the pricing rule type. Yes Detailed Description Used to specify additional information about the pricing rule type. No Related Transaction Business Object Used to indicate the pricing rule business object. The valid values are: -
Claim Pricing Rule
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Aggregate Stop-Loss (ASL) Pricing Rule
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Specific Stop-Loss (SSL) Pricing Rule
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Retention Type Claim Based Pricing Rule
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Retention Type Enrollment Based Pricing Rule
Yes Business Object Indicate the pricing rule type business object for claim. Not applicable Status Used to indicate the status of the pricing rule type. The valid values are: -
Active
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Inactive
Yes Primary Used to select the checkbox if the pricing rule type is primary. No Pricing Rule Type Category Used to indicate the pricing rule type category for the pricing rule type. The valid values are: -
Claim
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Aggregate Stop-Loss
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Specific Stop-Loss
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Retention Type Claim Based
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Retention Type Enrollment Based
Yes -
- Enter the required details in the Main section.
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Add the related pricing rule types in the primary pricing
rule type, if required.
Note: Related Pricing Rule Types section appears when the pricing rule type is primary.
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Define the transaction field mapping in the primary pricing
rule type, if required.
Note: Transaction Field Mapping section appears when the pricing rule type is primary.
- Associate algorithms with the pricing rule type, if required.
- Define additional data for the pricing rule type, if required.
- Add pricing items in the pricing rule type, if required.
- Add price item parameters in the pricing rule type, if required.
- Define characteristics for the pricing rule type, if required.
- Add claim templates in the claim pricing rule type, if required.
- Add the claim-specific data in the pricing rule type, if required.
- Define claim handling fees indicator in the claim pricing rule type, if required.
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Click Save.
The claim pricing rule type is defined.
Related Topics
For more information on... | See... |
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Pricing Rule Type screen | Pricing Rule Type |
How to add the related pricing rule types in the primary pricing rule type | Adding Related Pricing Rule Types in a Primary Pricing Rule Type |
How to define the transaction field mapping in the primary pricing rule type | Defining Transaction Field Mapping in a Primary Pricing Rule Type |
How to associate algorithms with the pricing rule type | Associating Algorithms with a Pricing Rule Type |
How to define additional data for the pricing rule type | Defining Additional Data for a Pricing Rule Type |
How to add pricing items in the pricing rule type | Adding Price Items in a Pricing Rule Type |
How to add price item parameters in the pricing rule type | Adding a Price Item Parameter in a Pricing Rule Type |
How to define a characteristic for the pricing rule type | Defining a Characteristic for a Pricing Rule Type |
How to add claim templates in the claim pricing rule type | Adding Claim Templates in a Claim Pricing Rule Type |
How to add the claim-specific data in the pricing rule type | Adding the Claim-Specific Data in a Pricing Rule Type |
How to define the claim handling fees indicators in the claim pricing rule type | Adding Claim Handling Fees Indicator in a Claim Pricing Rule Type |