Automatic Contract Creation for Individual Membership

Oracle Revenue Management and Billing automatically creates contracts for each account of the financially responsible member person when:

• Person is added to an individual membership

• Account is added for a financially responsible member person

• Health plan is added or edited in the system

In the former two scenarios, the system derives the individual membership where the person is financially responsible for the membership. Once the individual membership is derived, the system derives the health plan for which the individual membership is enrolled.

Once the health plan is derived, the system checks whether the pricing rule types are associated with the health plan. If a pricing rule type is associated with the health plan and the pricing rule type contains one or more price items, it creates a contract using a distinct contract type which is associated with each price item. Let us assume that PRT1 is associated with the health plan and it contains three price items - PI1, PI2, and PI3. Now, if the PI1 is associated with the CT1 contract type, PI2 is associated with the CT2 contract type, and PI3 is associated with the CT3 contract type, the system will create three contracts - C1 using CT1, C2 using CT2, and C3 using CT3. However, if the PI1 and PI3 are associated with the CT1 contract type and PI2 is associated with the CT2 contract type, the system will create two distinct contracts - C1 using CT1 and C2 using CT2.

If multiple pricing rule types are associated with the health plan and each pricing rule type contains multiple price items, it creates a contract using a distinct contract type which is associated with each price item of each pricing rule type.

The status of each contract is set to Active. The contract start date is set to the start date of the respective individual membership. If the same contract type is associated with the same or different price items on the same or different pricing rule types of different health plans, the contract start date is set to the start date of the earliest health plan. The default rate schedule specified on the respective contract type is added to the contract in the rate information and its effective date is set to the contract start date.