9/10 Billing (Skip Months)

In the health insurance domain, for a yearly coverage, the membership premium is calculated and billed every month. The fully-insured large groups such as school districts have two-three months of holiday every year. Usually, they prefer to distribute the off months’ premium in the remaining months of the coverage period. Oracle Revenue Management and Billing enables you to handle this requirement through the 9/10 Billing (Skip Months) feature. Note that, in this feature, only the recurring charges for membership premium and administration fees will be considered for distribution in the non-skip months of the coverage period.

You can set the skip months in a billing preference through the Field Mapping screen. You can specify one or more skip months in a billing preference which may be continuous or non-continuous. However, you cannot skip all 12 months in a billing preference. The system derives the skip months for an account using the billing preference. You can set the billing preference for an account through a characteristic type which is specified in the Bill Cycle Rule Code option type of the C1-ASOBLLNG feature configuration. Note that you must specify a characteristic type where the characteristic entity is set to Account in the Bill Cycle Rule Code option type. You can define this characteristic for an account from the user interface or through a health care inbound message. You can view a list of accounts for which skip months are defined in the billing preference using the Skip Months field in the 360° Search zone.

A new column named DIS_​AMT is added to the CI_​PRCE_​CALC and CI_​PRCE_​CALC_​LN tables. While calculating the membership premium using the age based or tier based pricing rule, the system checks whether the skip months are defined for the account. If the skip months are not defined for the account, the system stores the calculated premium in the DIS_​AMT column.

A new algorithm type named C1-SKPMNTHPC is introduced in this release. To setup the 9/10 billing feature, you need to create an algorithm using the C1-SKPMNTHPC algorithm type and attach it to the Skip Month Premium Calculation system event of the required age based and tier based pricing rule types. The system invokes this algorithm in the C1-REPC3 batch. This algorithm distributes the total premium in the non-skip months of the coverage period. In case of an age based pricing, the system calculates the distributed amount for each eligible member in the membership. And, in case of a tier based pricing, the system calculates the distributed amount for the membership. When a billable charge is created for a non-skip month through the C1-FIBCR batch, the distributed amount is stored through an SQI on the billable charge.