Automatic Offset of Debit and Credit Bill Line Items

The fully insured individual business do come across various scenarios wherein the customers would need a facility to automatically offset the debit and credit bill line items of an account. For example:

An individual enrolls for a health plan. But the individual fails to pay the binder payment before the membership start date. Such individual memberships are canceled once the appropriate inbound message is received to cancel the individual membership. On canceling the individual membership, an adhoc invoice is generated in the system and the premium billed for the individual membership is reversed. In this scenario, you may want to automatically offset the debit and credit bill line items of the individual member's account.
An individual enrolls for a health plan having subsidy. The subsidy fully covers the premium, and therefore a zero balance bill is generated. If you internally offset a zero balance bill, the system matches the debit and credit line items of a zero balance bill on the bill completion. But, in this case, the match events are not created at the bill line item level. In such scenario, you may want to automatically offset the debit and credit bill line items of the individual member's account such that match events are created at the bill line item level.

Oracle Revenue Management and Billing facilitates you with the auto maintenance process for accounts wherein the system will automatically offset the debit and credit bill line items of the accounts. The auto maintenance process is driven using the Offset Request feature ensuring that the match events are created at the bill line item level. Note that, at present, the auto maintenance process for accounts is only tested and certified for the different lines of business in the health insurance domain.

While running the auto maintenance process for an account, the system creates an auto maintenance offset request for the account when either of the following criteria is met:

Total amount of the open and unmatched items of the account is equal to zero. For example, an A1 account has two bills - B1 for Jan 2023 with the open balance 200 and B2 for Feb 2023 with the open balance -200 and thereby the A1 account balance is zero.
Total amount of the open and unmatched items of the account in a specific coverage period is equal to zero. For example, an A2 account has three bills - B1 for Jan 2023 with the open balance 300, B2 for Feb 2023 with the open balance 300, and B3 for Feb 2023 with the open balance -300. Here, the overall account balance of A2 is not zero, but the account balance of A2 for Feb 2023 is zero.

Note: While running the auto maintenance process for an account, the system does not consider the payments applied on the On Account, Excess Credit, and Suspense contracts of the account.

The system creates an auto maintenance offset request for an account using an offset request type where the offset category is set to Auto Maintenance. A new field named Offset Category is available while defining an offset request type. It helps to differentiate between the traditional (i.e. manual) offset requests and automatic offset requests. If you want to create a manual offset request using an offset request type, you must set the offset category in the offset request type to Regular. However, if you want to create an automatic offset request using an offset request type, you must set the offset category in the offset request type to Auto Maintenance. By default, the offset category is set to Regular. Note that you cannot edit the offset category in an offset request type when an offset request is already created using the offset request type.

The system enables you to skip a set of accounts for which auto maintenance is not required. A new field named SKIP_AUTOM_SW is added in the CI_ACCT table. It indicates whether you want to skip auto maintenance for the account. At present, you can provide the skip auto maintenance information for an account through a healthcare inbound message and not from the user interface. The system then displays the skip auto maintenance information of an account in the Main section of the Account Information zone on the Account tab of the Customer 360° Information screen. Note that the Skip Auto Maintenance field appears in the Main section for the account only when it is set to Y.

To use the auto maintenance feature for accounts, you need to do the following:

Create an offset request type where the offset category is set to Auto Maintenance

Note: While creating an offset request type for auto maintenance of accounts, you need to ensure that the Bill Line Items Level Offset option is selected and the Transfer Adjustment option is not selected.
Set the Avoid internal match event creation for zero dollar bill option type of the C1_FINTRANOP feature configuration to Y

A new batch named C1-AUTOM is introduced in this release. It considers those accounts for auto maintenance where the Skip Auto Maintenance field is set to N. It then checks whether either of the following criteria is met for the account:

Total amount of the open and unmatched items of the account is equal to zero
Total amount of the open and unmatched items of the account in a specific coverage period is equal to zero

Here, the system considers the eligible accounts with zero and non-zero balance. If the eligible account has zero balance, the system considers the bills with zero and non-zero balance where the open and unmatched debit and credit line items can be offset. If the eligible account has non-zero balance, the system considers the bills with zero and non-zero balance where the open and unmatched debit and credit line items of the same coverage period can be offset.

If either of the above two criteria is met, the system creates and processes an auto maintenance offset request. The auto maintenance offset request automatically closes the open and unmatched bill line items of the account that amounts to zero balance. To close an open and unmatched bill line item of the account, the system creates an offset request adjustment against each such debit or credit financial transaction. If the match event is present on any financial transaction, the same match event is stamped on the offset request adjustment. However, if the match event does not exist on any financial transaction, the system creates a new match event and stamps it against the financial transaction and its corresponding offset request adjustment.

This batch is a multi-threaded batch. The multi-threading is based on account ID and chunks for multi-threading are created based on numerical distribution of account ID. This batch contains the following parameters:

Parameter Name	Mandatory (Yes or No)	Description
Division	Yes (Conditional)	Used when you want to run the auto maintenance process for the accounts which belong to a particular division. Note: This parameter is required when you specify a customer class while executing this batch.
Customer Class	No	Used when you want to run the auto maintenance process for the accounts which belong to a particular customer class.
Offset Request Type	Yes	Used to indicate the offset request type using which you want to create auto maintenance offset requests for the accounts. Note: Here, you must specify an offset request type where the offset category is set to Auto Maintenance.
Freeze Number of Days	Yes	Used to specify the number of days. The system considers those accounts for auto maintenance whose financial transactions are frozen in the last specified number of days. Note: The parameter value must be greater than or equal to zero.
Skip Auto Maintenance for Accounts with Open Refund or Write Off Request (Y/N)	Yes	Used to indicate whether you want to skip auto maintenance for those accounts for which the refund or write off request is still in the non-final status. The valid values are: Y N Note: By default, the parameter value is set to Y.
Skip Auto Maintenance for Accounts with Open Payment, Payment Transfer Request (Y/N)	Yes	Used to indicate whether you want to skip auto maintenance for those accounts for which the payment creation or payment transfer request is still in the non-final status. The valid values are: Y N Note: By default, the parameter value is set to Y
Skip Auto Maintenance for Accounts with Open Offset Request (Y/N)	Yes	Used to indicate whether you want to skip auto maintenance for those accounts for which the manual offset request is still in the non-final status. The valid values are: Y N Note: By default, the parameter value is set to Y
Account ID	No	Used when you want to run the auto maintenance process for a particular account.
Fetch Only Open Overdue Bills	Yes	Used to indicate whether you want to consider the overdue bills or all the open bills of the account for auto maintenance. The valid values are: Y - Used when you want to consider only the overdue bills of the account for auto maintenance. N - Used when you want to consider all the open bills of the account for auto maintenance. Note: By default, the parameter value is set to Y.
Thread Pool Name	No	Used to specify the thread pool on which you want to execute the batch.

On successful completion of this batch, the system creates and processes an auto maintenance offset request for an account that meets the criteria. You can view the details of an auto maintenance offset request through the Offset Request screen.

While viewing the details of an auto maintenance offset request, the system displays the Auto Maintenance Financial Transactions zone instead of the Selected Bills and Offset Request Adjustments zones in the Main tab of the Offset Request screen. The system also displays the account information in the Main section of the Offset Request zone. The Auto Maintenance Financial Transactions zone lists the financial transactions of the account for which the corresponding offset request adjustments are created during the auto maintenance process.

To design the auto maintenance process for accounts, the following algorithms are enhanced:

C1-OFFSUBENT - Here, some of the existing validations are skipped for an auto maintenance offset request and few new validations are introduced for an auto maintenance offset request.
C1-OFST-DIST - Here, additional logic is added to handle the offset category and to create auto maintenance offset requests for accounts that meet the criteria. Note that the Match Type, Match Type Entity, and Credit Bill Distribution Algorithm parameters are not applicable while creating offset request adjustments for an auto maintenance offset request.

The system enables you to cancel an auto maintenance offset request, if required, through the Unapply button. While canceling an offset request, you need to specify a reason why you want to cancel an offset request. On canceling an auto maintenance offset request, the system cancels the offset request adjustments and opens the corresponding bill line items which were offset during auto maintenance of the account.