Pre-requisites
To setup the Self-Funded Billing feature, you need to do the following:
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Define the parent customers and bill groups in the system.
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Define the required pricing rule types for different pricing rule type categories, such as Claim, Specific Stop-Loss, Aggregate Stop-Loss, Retention Type Claim Based, Retention Type Enrollment Based, Flat Fees, and Ancillary.
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Map the transaction fields appropriately in the primary pricing rule types.
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Attach an algorithm created using the C1_TXNBGDRV algorithm type to the Bill Group Derivation system event of the pricing rule type where the pricing rule type category is set to Claim or Retention Type Enrollment Based.
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Attach an algorithm created using the C1_ACCPRIDRV algorithm type to the Account and Price Item Derivation system event of the pricing rule type where the pricing rule type category is set to Claim, Retention Type Claim Based, Retention Type Enrollment Based, or Ancillary.
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Attach an algorithm created using the C1_ACCPRISL algorithm type to the Account and Price Item Derivation system event of the pricing rule type where the pricing rule type category is set to Specific Stop-Loss or Aggregate Stop-Loss.
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Attach an algorithm created using the C1_BAFTDRV algorithm type to the Bill After Date Determination system event of the pricing rule type where the pricing rule type category is set to Claim, Retention Type Claim Based, Retention Type Enrollment Based, or Ancillary.
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Attach an algorithm created using the SA_DERV_POPC algorithm type to the TFM - Contract Derivation algorithm spot of the required divisions.
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Attach an algorithm created using the C1-VRPR_POPC algorithm type to the TFM - Verify Pricing Post-Processing algorithm spot of the required divisions.
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Attach an algorithm created using the C1_BCHG_POPC algorithm type to the TFM - Billable Charge Post-Processing algorithm spot of the required divisions.
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Map each transaction record type to either the required rule type or primary pricing rule type.
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Define the pricing groups for the required bill groups.
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Define the required pricing rules for the parent customer and bill groups.
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Define the rate schedules with the following calculation algorithms for different price items:
Price item related to.... Calculation Algorithm Claim C1-CLAIMCALC Specific Stop-Loss C1-SSLRTCALC Aggregate Stop-Loss C1-ASLRTCALC Retention Type Enrollment Based None Flat Fees None Ancillary C1-ANCICALC -
Attach an algorithm created using the C1-RETFLAT algorithm type to the TFM – Rate Pre-Processing algorithm spot of the required divisions.
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Define the TFM information in the rating option for different price items in the following manner:
The following table lists the TFM information which must be defined in the rating option for the respective type of price items: Price item related to.... Rate Option Aggregate Transaction Aggregation Schedule Ignore Transaction Rating Criteria Claim Yes As Required No RITA Specific Stop-Loss No - Yes RITX Aggregate Stop-Loss No - Yes RITX Retention Type Claim Based Yes As Required No RITA Retention Type Enrollment Based Yes As Required No RITA Ancillary Yes As Required No RITA -
Define the derivation and pricing parameters for each bill group.
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Set the following option types in the C1-ASOBLLNG feature configuration:
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Person Relationship Type
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Bill Group Policy Person Role
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Invoice Type Characteristic Type
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Pricing Group Rule Parameter
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Billable Charge Line Type Parameter
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Pricing Arrangement Parameter
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Related Topics
For more information on... | See... |
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How to set up the C1-ASOBLLNG feature configuration | Setting the C1-ASOBLLNG Feature Configuration |