Pricing Rule Type
The Pricing Rule Type zone displays the details of the pricing rule type for claim, aggregate stop-loss, specific stop-loss, retention type enrollment based, retention type claim based, one-time flat fee, bill period based recurring flat fee, and frequency based recurring flat fee. This zone contains the following sections:
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Main – This section provides basic information about the pricing rule type. It contains the following fields:
Field Name Field Description Pricing Rule Type Displays the pricing rule type. Description Displays the description for the pricing rule type. Detailed Description Displays additional information about the pricing rule type category. Pricing Rule Business Object Indicates the pricing rule business object. In addition, a context menu appears corresponding to this field which helps in navigating to other screens in the application. 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
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Flat Fee Pricing Rule
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Ancillary Pricing Rule
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Discount Arrangement Pricing Rule
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Level Funded (LF) Pricing Rule
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Minimum Premium Program Pricing Rule
Note: It has a link. On clicking the link, the Business Object screen appears where you can view the details of the respective business object.Business Object Indicates the pricing rule type business object. In addition, a context menu appears corresponding to this field which helps in navigating to other screens in the application. The valid values are: -
Claim Pricing Rule Type
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Aggregate Stop-Loss (ASL) Pricing Rule Type
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Specific Stop-Loss (SSL) Pricing Rule Type
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Retention Type Claim Based Pricing Rule Type
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Retention Type Enrollment Based Pricing Rule Type
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Flat Fee Pricing Rule Type
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Ancillary Pricing Rule Type
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Discount Arrangement Pricing Rule Type
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Level Funded (LF) Pricing Rule Type
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Minimum Premium Program Pricing Rule Type
Note: It has a link. On clicking the link, the Business Object screen appears where you can view the details of the respective business object.Status Indicates the status of the pricing rule type. The valid values are: -
Active
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Inactive
Primary Displays whether the pricing rule type is primary or not. Pricing Rule Type Category Indicates 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
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Flat Fees
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Ancillary
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Discount Arrangement
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Level Funded
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Minimum Premium Program
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Related Pricing Rule Types – This section lists the pricing rule types which are related to the parent pricing rule type. It contains the following columns:
Column Name Column Description Sequence Displays the order in which pricing rule type is executed. Pricing Rule Type Displays the related pricing rule type for the parent rule type. Note: It has a link. On clicking the link, the Pricing Rule Type screen appears where you can view the details of the respective pricing rule type.Eligibility Rule Type Indicates the rule type eligibility for the related pricing rule type. Note: It has a link. On clicking the link, the Rule Type screen appears where you can view the eligibility details of the respective pricing rule type.Note: This section appears when the pricing rule type is a primary pricing rule type. -
Transaction Field Mapping – This section displays the transaction related data mapped to the pricing rule type. It contains the following fields:
Field Name Field Description Source System Displays the external system from where the transaction data is mapped. Parameter 1 ... Parameter 4 Displays the parameters mapped for the transactions. Incurred Date Displays the date incurred for transaction. Paid Date Displays the transaction paid date. Source of Funds Displays the source of funds used to make the payment. Composite Displays the composite transaction data. Claim Disposition Displays the disposition of the claims transaction. Provider's Tax Identification Number Displays the tax identification number of the provider. Member ID Displays the member ID. Main Subscriber ID Displays the customer ID. Run-in Identifier Displays the run-in identifier. Runout Identifier Displays the runout identifier. Coverage Start Date Displays the transaction coverage start date. Coverage End Date Displays the transaction coverage end date. Retroactivity Indicator Displays information of the retroactivity indicator. Note: This section appears when the pricing rule type is a primary pricing rule type. -
Algorithms – This section displays the algorithms used for the pricing rule type. It contains the following columns:
Column Name Column Description System Event Indicates the system event on which the algorithm must be executed. The valid values are: -
Account and Price Item Derivation
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Account and Price Item Derivation Post-Processing
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Accumulation Billable Charge Post-Processing
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Accumulation Billable Charge Pre-Processing
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Accumulation Post-Processing
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Accumulation Pre-Processing
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Bill After Date Determination
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Bill Group Derivation
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Billable Charge Creation Post-Processing
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Billable Charge Creation Pre-Processing
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Final Settlement Derivation
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New Born Waiver Calculation
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Premium Calculation
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Pricing Rule Derivation
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Pricing Rule Post-Processing
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Pricing Rule Pre-Processing
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Pricing Rule Proration Amount Calculation
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Skip Month Premium Calculation
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Transaction Validation
Sequence Displays the order in which the algorithms for each system event must be executed. Algorithm Displays the algorithm. Note: It has a link. On clicking the link, the Algorithm screen appears with the details of the respective algorithm. -
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Additional Data – This section displays the additional information about the pricing rule type. It contains the following fields:
Field Name Field Description Eligible for Level Funding Indicates whether the pricing rule type is eligible for level funding or not. The valid values are: -
Yes
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No
Eligible for Specific Stop-Loss Indicates whether the pricing rule type is eligible for specific stop-loss or not. The valid values are: -
Yes
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No
Note: This field appears when the option selected for the Pricing Rule Type Category is Claim, Retention Type Claim Based, or Retention Type Enrollment Based.Eligible for Minimum Premium Program Indicates whether the pricing rule type is eligible for minimum premium program or not. The valid values are: -
Yes
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No
Note: This field appears when the option selected for the Pricing Rule Type Category isRun-in Identifier Value Displays the value for run-in identifier. Runout Identifier Value Displays the value for runout identifier. Note: This section does not appear when the pricing rule type category is flat fees. -
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Price Items – This section displays the price items assigned to the pricing rule type. It contains the following columns:
Column Name Column Description Price Item Displays the price item information. Note: It has a link. On clicking the link, the Price Item screen appears where you can view the details of the respective price item.Rate Option On clicking the Add ( ) icon, the following column appears:
Column Name Column Description Rate Option Indicates the rate option for the price item. Note: This column does not appear when the pricing rule type category is flat fees.Bill To Account On clicking the Add ( ) icon, the following columns appear:
Column Name Column Description Priority Displays the order in which the invoice type was considered while defining a price item. Invoice Type Displays the invoice type for the price item. Eligibility Rule Type Indicates the rule type which indicates the rules that should be executed to determine whether the price item is eligible for billing. Note: It has a link. On clicking the link, the Rule Type screen appears where you can view the eligibility details of the respective pricing rule type. -
Price Item Parameters – This section displays the price item parameters in the pricing rule type. It contains the following columns:
Column Name Column Description Price Item Parameter Displays the parameter associated with the price item. Note: It has a link. On clicking the link, the Parameter screen appears where you can view the details of the respective parameter.Transaction Field Displays the additional transaction data. Note:It has a link. On clicking the link, the Field screen appears where you can view the details of the respective transaction field.
This column does not appear when the pricing rule type category is flat fees.
Eligible for Specific Stop-Loss Displays the parameter eligible for Specific Stop-Loss when the eligibility checkbox was checked. Note: This field appears only when the option selected for the Pricing Rule Type Category is Claim, Retention Type Claim Based, or Retention Type Enrollment Based.Eligible for Level Funding Displays the parameter eligible for level funding when the eligibility checkbox was checked. -
Characteristics – This section displays the pricing rule type characteristics. It contains the following columns:
Column Name Column Description Characteristic Type Indicates the characteristic type. Characteristic Value Displays the value for the characteristic type. -
Event Management – This section displays the audit event details. It contains the following columns:
Column Name Column Description Audit Event Type Displays the audit event type which you can use while adding elements for audit in a fully-insured benefit pricing rule type. Element Type Indicates the type of audit element for a fully-insured benefit pricing rule type. The valid values are: -
Business Object Status
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Characteristic
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Field
Element Name Displays the element name for a fully-insured benefit pricing rule type. Element Value Displays the value for an element name. -
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Claim Templates – This section list the pricing rule type for claim template. It contains the following field:
Field Name Field Description Claim Template Indicates the claim template. Note: This section appears when the Business Object is Claim Pricing Rule Type. -
Claim-Specific Additional Data – This section displays the claim specific additional data. It contains the following fields:
Field Name Field Description Rule Based Billing Eligibility Field Displays whether the rule based field is eligible for billing or not. Note: It has a link. On clicking the link, the Field screen appears where you can view the details of the respective field.Rule Based Markup or Markdown Eligibility Field Displays whether the rule based markup or markdown field is eligible for billing or not. Note: It has a link. On clicking the link, the Field screen appears where you can view the details of the respective field.Markup or Markdown Billable Charge Line Type Displays the markup or markdown billable charge line type. Note: This section appears when the Business Object is Claim Pricing Rule Type. -
ASL-Specific Additional Data – This section displays the Aggregated Stop-Loss specific additional data. It contains the following fields:
Field Name Field Description ASL Billable Charge Line Type Displays the Aggregated Stop-Loss billable charge line type. Domestic Provider Claim Billable Charge Line Type Displays the claim billable charge line type for domestic provider. Rule Based Domestic Provider Claim Eligibility Field Displays the rule based domestic provider for claim eligibility field. ASL Limit Price Item Displays the Aggregated Stop-Loss limit price item. Rule Based Billing Eligibility Field Displays whether the rule based field is eligible for billing or not. Note: It has a link. On clicking the link, the Field screen appears where you can view the details of the respective field.Rule Based Markup or Markdown Eligibility Field Displays whether the rule based markup or markdown field is eligible for billing or not. Note: It has a link. On clicking the link, the Field screen appears where you can view the details of the respective field.Markup or Markdown Billable Charge Line Type Displays the markup or markdown billable charge line type. Note: This section appears when the Business Object is Aggregate Stop-Loss (ASL) Pricing Rule Type. -
Enrollment-Specific Additional Data – This section displays the enrollment specific additional data. It contains the following fields:
Field Name Field Description Retroactivity Indicator Value Displays the value for the retroactivity indicator. Note: This section appears when the Business Object is Retention Type Enrollment Based Pricing Rule Type. -
Claim Disposition Details – This section displays the details of claim disposition. It contains the following columns:
Column Name Column Description Claim Disposition Indicates the claim disposition. Disposition Mode Indicates the claim disposition mode. The valid values are: -
Align Signage
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Zero Out
Note: This section appears when the Business Object is Retention Type Claim Based Pricing Rule Type. -
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SSL-Specific Additional Data – This section displays the Specific Stop-Loss additional data. It contains the following fields:
Field Name Field Description SSL Billable Charge Line Type Displays the Specific Stop-Loss billable charge line type. Domestic Provider Claim Billable Charge Line Type Displays the claim billable charge line type for domestic provider. Rule Based Domestic Provider Claim Eligibility Field Displays the rule based domestic provider for claim eligibility field. Rule Based Billing Eligibility Field Displays whether the rule based field is eligible for billing or not. Note: It has a link. On clicking the link, the Field screen appears where you can view the details of the respective field.Rule Based Markup or Markdown Eligibility Field Displays whether the rule based markup or markdown field is eligible for billing or not. Note: It has a link. On clicking the link, the Field screen appears where you can view the details of the respective field.Markup or Markdown Billable Charge Line Type Displays the markup or markdown billable charge line type. Note: This section appears when the Business Object is Specific Stop-Loss (SSL) Pricing Rule Type. -
Billable Charge Line Types – This section list the billable charge line type. It contains the following column:
Column Name Column Description Billable Charge Line Type Indicates the billable charge line type. Note: This section appears when the Business Object is Flat Fees Pricing Rule Type. -
Flat Fees - Specific Additional Data – This section displays the recurring flat fee that is specific and considered as additional data. It contains the following fields:
Field Name Field Description Bill Segment Cancel Reason Indicates the reason for cancelling the bill segment. Recurring Fee Displays whether the recurring flat fee is required or not. Recurring Method Indicates the recurring method if recurring fee is required. The valid values are: -
Bill Period
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Frequency
Note: This field appears when the checkbox for Recurring Fee field is selected.Note: This section appears when the Business Object is Flat Fees Pricing Rule Type.This section contains the following sub-section:
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Bill Periods – This section displays the bill period for the recurring flat fee. It contains the following column:
Column Name Column Description Bill Period Indicates the bill period. Note: This section appears when the Recurring Method is Bill Period.
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Additional Fee Indicator – This section displays the additional fees which are applicable to one or more line items in the claim pricing rule. It contains the following fields:
Column Name Column Description Fee Indicates the charge type category for the claim pricing rule. Claim Additional Fee Indicator Indicates the charge type sub category for the claim pricing rule. Note: This section appears when the Business Object is Claim Pricing Rule Type. -
Minimum Premium Program - Specific Additional Data –
Column Name Column Description -
Record Actions – This section contains the following buttons:
Button Name Button Description Edit Used to edit the details of the pricing rule type. Delete Used to delete the pricing rule type. -
Record Information – This section contains the following fields:
Field Name Field Description Business Object Indicates the business object using which the extendable lookup value for pricing rule type is created. In addition, a context menu appears corresponding to this field which helps in navigating to other screens in the application. Note: It has a link. On clicking the link, the Business Object screen appears with the details of the respective business object.By default, the Pricing Rule Type zone does not appear in the Pricing Rule Type screen. It appears when you click the Broadcast (
) icon corresponding to the pricing rule type in the Pricing Rule Type List zone.
Related Topics
For more information on... | See... |
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Pricing Rule Type screen | Pricing Rule Type |
Pricing Rule Type List zone | Pricing Rule Type List |
How to edit the claim pricing rule type | Editing a Claim Pricing Rule Type |
How to edit the specific stop-loss pricing rule type | Editing a Specific Stop-Loss (SSL) Pricing Rule Type |
How to edit the aggregate stop-loss pricing rule type | Editing an Aggregate Stop-Loss (ASL) Pricing Rule Type |
How to edit the retention type claim based pricing rule type | Editing a Retention Type Claim Based Pricing Rule Type |
How to edit the retention type enrollment based pricing rule type | Editing a Retention Type Enrollment Based Pricing Rule Type |
How to edit the one-time flat fee pricing rule type | Editing a One-Time Flat Fee Pricing Rule Type |
How to edit the bill period based recurring flat fee pricing rule type | Editing a Bill Period Based Recurring Flat Fee Pricing Rule Type |
How to edit the frequency based recurring flat fee pricing rule type | Editing a Frequency Based Recurring Flat Fee Pricing Rule Type |
How to delete a pricing rule type | Deleting a Pricing Rule Type |
How to edit a benefit pricing rule type | Editing a Benefit Pricing Rule Type |
How to delete a benefit pricing rule type | Deleting a Benefit Pricing Rule Type |