Zero-Amount Membership Benefit Charges

Oracle Revenue Management and Billing enables you to receive the full or partial snapshot of benefit charges for a group or individual membership through a health care inbound message or through a membership repricing request. A new option type named Benefit Full Snapshot Upload is introduced in the C1-ASOBLLNG feature configuration. It enables the system to determine whether the full or partial snapshot of benefit charges is received for a group or individual membership through a health care inbound message or through a membership repricing request. You can set the Benefit Full Snapshot Upload option type to Y or N. If you set the Benefit Full Snapshot Upload option type to Y, the system behaves in the following manner in the respective scenarios:

Scenario Existing Benefit Data New Snapshot (Received through an Inbound Message) Comments
Benefit Record Benefit Coverage Benefit Amount Benefit Record Benefit Coverage Benefit Amount
S1 B1 Jan – Mar 100 B1 Jan – Mar 90 The system will update the B1 (Jan-Mar), B2 (Apr-Jun), and B3 (Jul-Dec) benefit records of the membership.
B2 Apr – Jun 100 B2 Apr – Jun 110
B3 Jul – Dec 200 B3 Jul – Dec 120
S2 B1 Jan – Mar 50 B1 Jan – Mar 50 The system will update the B1 (Jan-Mar) and B3 (Jul-Dec) benefit records of the membership. In addition, it will change the status of the B2 (Apr-Jun) benefit record to Inactive.
B2 Apr – Jun 90 B3 Jul – Dec 120
B3 Jul – Dec 150
S3 B1 Jan – Mar 100 B1 Jan – Mar 100 The system will update the B1 (Jan-Mar), B2 (Apr-Jun), and B3 (Jul-Dec) benefit records of the membership.
B2 Apr – Jun 100 B2 Apr – Jun 0
B3 Jul – Dec 200 B3 Jul – Dec 200
S4 B1 Jan – Mar 100 B11 Jan – Feb 90

The system will update the B3 (Jul-Dec) benefit record of the membership.

However, the system will change the status of B1 (Jan-Mar) and B2 (Apr-Jun) benefit records to Inactive and will create two new benefit records – B11 (Jan-Feb) and B12 (Mar-Jun) with the Active status.
B2 Apr – Jun 100 B12 Mar – Jun 110
B3 Jul – Dec 200 B3 Jul – Dec 120
Note: If you set the Benefit Full Snapshot Upload option type to Y, the system will update the existing benefit records when the benefit coverage period matches.

However, if you set the Benefit Full Snapshot Upload option type to N, the system behaves in the following manner in the respective scenarios:

Scenario Existing Benefit Data New Snapshot (Received through an Inbound Message) Comments
Benefit Record Benefit Coverage Benefit Amount Benefit Record Benefit Coverage Benefit Amount
S1 B1 Jan – Mar 100 B1 Jan – Mar 90 The system will change the status of the B1 (Jan-Mar), B2 (Apr-Jun), and B3 (Jul-Dec) benefit records to Inactive. The system will then create three new benefit records - B1 (Jan-Mar), B2 (Apr-Jun), and B3 (Jul-Dec) with the Active status.
B2 Apr – Jun 100 B2 Apr – Jun 110
B3 Jul – Dec 200 B3 Jul – Dec 120
S2 B1 Jan – Mar 100 B1 Jan - Dec 300

The system will change the status of the B1 (Jan-Mar), B2 (Apr-Jun), and B3 (Jul-Dec) benefit records to Inactive.

The system will then create one new benefit record – B1 (Jan-Dec) with the Active status.
B2 Apr – Jun 100
B3 Jul – Dec 200
S2 B1 Jan – Mar 100 B1 Jan - Jun 300 The system will change the status of the B1 (Jan-Mar), B2 (Apr-Jun), and B3 (Jul-Dec) benefit records to Inactive. The system will then create two new benefit records – B1 (Jan-Jun) and B2 (Jul-Dec) with the Active status.
B2 Apr – Jun 100 B2 Jul-Dec 0
B3 Jul – Dec 200
Note: If you set the Benefit Full Snapshot Upload option type to N, the system will always inactivate all the existing benefit records of the membership and will create the new benefit records for the membership in the Active status.

A new option type named Zero Dollar Benefit Charge is introduced in the C1-ASOBLLNG feature configuration. It enables the system to determine whether the billable charge for zero benefit amount should be created or not. You can set the Zero Dollar Benefit Charge option type to Y or N. If you set the Zero Dollar Benefit Charge option type to Y, the system will create a zero-amount benefit charge for the membership. However, if you set the Zero Dollar Benefit Charge option type to N, the system will not create a zero-amount benefit charge for the membership.