Defining a Specific Stop-Loss Pricing Rule for a Bill Group Using a Pricing Group
Prerequisites
To define a specific stop-loss pricing rule for a bill group using a pricing group, you should have:
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Business Object C1-PricingRule defined for pricing rule.
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Business Object C1-PricingRuleSSL defined for specific stop-loss pricing rule.
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Pricing rule type defined in the application.
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Pricing group defined in the application.
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Policy status defined in the application.
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Price item defined in the application.
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Rate option defined in the application.
Procedure
To define a specific stop-loss pricing rule for a bill group using a pricing group:
- Search for the account, person, or policy whose pricing details you want to view in the Customer 360° View screen.
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In the Search Results section, click
the View (
) icon corresponding to the account, person, or policy whose pricing details you want to view.
The Account, Person, or Policy tab in the Customer 360° Information screen appears. -
Click the Pricing tab and then click
the Add link in the upper right corner of the Bill Group ASO Policy Pricing Rules zone.
The Pricing Rule screen appears. It contains the following fields:
Field Name Field Description Mandatory (Yes or No) Person Name Displays the person name. Not applicable Person Type Displays the person type. Not applicable Pricing Rule Type Used to indicate the pricing rule type to create the pricing rule. Note: You can create a specific stop-loss pricing rule using the Pricing Rule Type for specific stop-loss.Yes Pricing Group Used to indicate the pricing group. Yes Policy Status Used to indicate the policy status for pricing rule. The valid values are: -
In Force/Active
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Post Runout
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Runout
Note: Specific stop-loss pricing rule cannot be created for Runout or Post Runout policy status where the policy run out End Date is missing.Yes -
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Click OK.
The Specific Stop-Loss (SSL) Pricing Rule screen appears. It contains the following sections:
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Customer Information – Displays the customer information for bill group using pricing group.
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Main – Used to specify basic details about the claim pricing rule.
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Markup or Markdown Values – Used to define the markup or markdown values for billable charge line for each rule.
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Line Items – Used to associate line items eligible for billing for each rule.
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Characteristics – Used to define the characteristics for the claim pricing rule.
The Customer Information section contains the following fields:
Field Name Field Description Mandatory (Yes or No) Bill Group Information Displays the bill group information. Not applicable Policy Start Date Displays the policy start date. Not applicable Policy End Date Displays the policy end date. Not applicable Policy Status Indicates the policy status for pricing rule. The valid values are: -
In Force/Active
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Post Runout
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Runout
Not applicable Pricing Group Displays the pricing group. Not applicable Pricing Rule Type Indicates the pricing rule type. Not applicable The Main section contains the following fields:
Field Name Field Description Mandatory (Yes or No) Price Item Used to indicate the price item. Note: Once an option is selected for this field, the field appears disabled.Yes Parent Customer’s SSL Pricing Rules Used to indicate the pricing date range derived from the parent customer’s specific stop-loss pricing rule. Note: This field is enabled for selection when an option from Price Item field is selected.Yes Pricing Start Date Displays the pricing rule start date. Yes Pricing End Date Displays the pricing rule end date. Yes Rate Option Used to indicate the rate option to define the specific stop-loss pricing rule for the price item. Note: Rate options in this field appears for selection, when you select an option from the Price Item field.Yes -
- Enter the required details in the Main section.
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Define accumulation criteria for each rule in a specific
stop-loss pricing rule pricing rule, if required.
Note: The Accumulation Criteria section appears in the rule section and the rule section appears when an option from Parent Customer’s SSL Pricing Rules field is selected.
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Define stop-loss eligibility for claim line items, if required.
Note: The Pricing Information section appears in the rule section and the rule section appears when an option from Parent Customer’s SSL Pricing Rules field is selected.
- Define characteristics for a specific stop-loss pricing rule, if required.
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Click Save.
The specific stop-loss pricing rule for a bill group using a pricing group is defined.Note: A price list and price assignment is created, the price list created is assigned to the specific stop-loss pricing rule.
Related Topics
For more information on... | See... |
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Customer 360° Information – Pricing tab | Customer 360° Information - Pricing Information |
Bill Group ASO Policy Pricing Rules zone | Bill Group Self-Funded Policy Pricing Rules |
How to define Accumulation Criteria in a specific stop-loss pricing rule | Defining Accumulation Criteria in a Specific Stop-Loss Pricing Rule |
How to define claim pricing information in a specific stop loss pricing rule | Defining Claim Pricing Information in a Specific Stop Loss Pricing Rule |
How to define a characteristic for a specific stop-loss pricing rule | Defining a Characteristic for a Specific Stop-Loss Pricing Rule |