Prerequisites for Group Delinquency

To setup the group delinquency feature, you need to do the following:

• Define the required business rules using the following business rule categories:

  • Delinquency Grace Period Business Rule

  • Delinquency Event Attributes Business Rule

  • Delinquency Termination Date Rule Business Rule

  • Delinquency Miscellaneous Options Business Rule

  Note: You can define the above business rules through the Business Rules screen.

• Define the required access permissions for the Account and Person entities in the delinquency process.

• Define a fully insured group customer with the following information:

  • A fully insured group policy using a policy type where the policy category is set to Fully Insured Group.

  • Different types of plans defined in a fully insured group policy.

  • Different types of memberships defined for a fully insured group policy plan.

• Define the Membership Terminate Request (C1-MemberTermRequest) business object which is used to setup the outbound message type for creating the membership termination request in the XML format.

  Note: The outbound message type is configured in the Membership Termination Outbound Message Trigger (C1-MTOMT) batch which creates an outbound message whenever the membership termination process request is initiated.

• Define an algorithm of the C1-EVALDPAPP algorithm type to evaluate the approval configuration on the delinquency process type when a manual intervention happens in the delinquency process.

• Define the algorithms of the C1-DETTERMDT and C1-DETTRTGDT algorithm type as the event activation algorithm if you want to calculate the termination date and termination trigger date in a single event.

  Note: To calculate the termination date and termination trigger date separately, you need to configure the above algorithms under respective events separately as the event activation algorithm.

• Define the appropriate collection method in the collection class of a person or an account whose overdue debt you want to monitor through the delinquency management. For more information, see Collection Class

• Define the required collection methods, such as, Self-Control Delinquency (SDEL) and Parental Delinquency (DELP) in the COLL_​METH_​FLG lookup field.

  Note: You must define a collection class for an account and a person with the respective collection method through the Collection Class screen.

  The following table describes how you can setup the system for an account or a person based on the respective collection method:

  Scenario	System Behavior
  A collection class is defined for an Account entity where the collection method is set to Self-Control Delinquency.	The account entity has its own distinct delinquency process. The debt of the account is monitored at predefined system events and the delinquency process is commenced whenever the account’s debt is overdue. Note: The system creates a delinquency process for an account only when at least one bill of the account is overdue.
  A collection class is defined for a Person entity where the collection method is set to Self-Control Delinquency.	The person entity has its own distinct delinquency process. The child person’s accounts and its grandchild’s accounts are not considered in the parent person’s delinquency. Note: The system creates a delinquency process for a person only when at least one bill of any account (considered) in its hierarchy is overdue.
  A collection class is defined for a Person entity where the collection method is set to Parental Delinquency.	The person entity has its own distinct delinquency process. The persons, child person, and grandchild accounts are considered in the parent person’s delinquency. Any such account in the person’s hierarchy where the collection is set to Self-Control Delinquency is not considered in the parent person’s delinquency.

• Define the following fields in the XML schema of the Health Care Inbound Message (C1-HCInboundMessage) business object:

  • Collection Class

  • Postpone Credit Review Until

  • Drag Days

  Note: You can specify the values for the above fields while creating the health care inbound message.

• Configure the delinquency control along with its respective algorithms in the system.

• Configure the delinquency event type along with its respective algorithms in the system.

• Configure the delinquency process type along with its respective algorithms in the system.

• Define the required field mapping preference categories in the system

  • Routing Method - Contact Method Mapping

  • Delinquency Process Type

  • Delinquency Process

• Create a delinquency event type for advance deposit, attach the C1-APPADVDEP algorithm to the Event Activation system event, and configure the delinquency event type while creating a delinquency process type for advance deposit purposes.

• Define values for the Delinquency Process Field Mapping, Policy Characteristic Type for Customer Contact, and Routing Method - Contact Method Mapping option types in the DELINPROC feature configuration.

• Define a delinquency process type preference for the fully insured group business and specify the preference code in the Delinquency Process Type Field Mapping – Group parameter of the C1-DLNQMNRL and C1-DLNQMNRAC algorithm.

• Attach the C1-DLNQMNRL algorithm to the Delinquency Monitor Rule system event in the Delinquency Control screen for creating a group delinquency process at Person level.

• Attach the C1-DLNQMNRAC algorithm to the Delinquency Monitor Rule system event in the Delinquency Control screen for creating a group delinquency process at Account level.

• Set the rule type category as Parameter Based if you have selected Delinquency Event Type Eligibility as the rule type usage while defining a rule type.

• Attach the C1-TRNTERTRG algorithm to the Delinquency Monitor Rule system event in the Delinquency Event Type screen for transitioning the delinquency process to pending termination.

• Assign the Delinquency Process Approval Notification (C1-DPAPR) To Do type to a To Do role which is also specified as the Submitter and Approval To Do role.

• Set the values for the following option types in the C1-ASOBLLNG feature configuration:

  • Membership Active Status

  • Membership Terminated Status

  • Policy Active Status

  • Policy Pending Termination Status

  • Policy Pending Reinstatement Status

• Define the required parameter configurations for the delinquency business rules.

• Define the required customer contact event to create a customer contact.

• To setup the advance deposit feature, define the following entities:

  • Define the required account relationship type and advance deposit contract type in the system.

  • Define the Advance Deposit Account Relationship Type and Advance Deposit Contract Type field mapping attributes in the Delinquency Process field mapping preference.

  • Define an algorithm of the C1-FIACCPP algorithm type and attach it to the Post-Processing system event of the C1-AccountBO business object.

  • Define an algorithm of the C1-ACTPOSP algorithm type and attach it to the Post-Processing system event of the C1-AccountBO business object.

  • Define an algorithm of the C1-FIPOLPP algorithm type and attach it to the Post-Processing system event of the C1-POLICY business object.

  • Define a new offset request type where the offset category is set to Advance Deposit.

  • Define an offset request type as a soft parameter in the C1-APPADVDEP algorithm.

  • Define the debit adjustment type and credit adjustment as soft parameters in the C1-APPADVDEP algorithm and attach both the adjustment types in the Adjustment Type Profile tab of the Contact Type screen.

• Define the following customer contacts in the system:

  • Configure the Customer Contact Type, Customer Contact Class, and Default Contact Method parameters in the Advance Deposit Monitor (C1-ADMON) batch to create a customer contact when the payment is not received.

  • Configure the Customer Contact Type, Customer Contact Class, and Default Contact Method parameters in the C1-NOTADREC algorithm to create a customer contact when the advance deposit payment is received.

  • Configure the Customer Contact Type, Customer Contact Class, and Default Contact Method parameters in the C1-NOTADCAN algorithm to create a customer contact when the advance deposit payment is canceled.

  • Configure the Customer Contact Type For Partial Usage Of Deposit, Customer Contact Class For Partial Usage Of Deposit and parameters in the C1-APPADVDEP algorithm to create a customer contact when the advance deposit is partially considered.

  • Configure the Customer Contact Type For Partial Usage Of Deposit, Customer Contact Class For Partial Usage Of Deposit, and Default Contact Method parameters in the C1-APPADVDEP algorithm to create a customer contact when the advance deposit amount is depleted.

• Define a match type for advance deposit and configure the payment distribution override algorithm (in the match type) using the C1-MATSATYP algorithm type.

• Define the required third party payor for payment agreement purposes.

• Attach the C1-CDPPAYCAN and C1-RODPDUEPX algorithms to the Algorithm Types for Payment Cancellation System Event system event of a customer class to resume the delinquency process for the respective accounts on the payment cancellation. For more information about the algorithms, see the Resuming a Delinquency Process on Payment Cancellation.

Related Topics

Parent topic: Individual Health Insurance Delinquency