Bill Group Derivation and Pricing Parameters

An employer may have different bill groups. Each bill group will handle the claim, enrollment, and ancillary transactions of employees based on the employee attributes, such as location, employment status, employment department, and so on.

Oracle Revenue Management and Billing allows you to define the derivation and pricing parameters, such as source system, parameter 1, parameter 2, parameter 3, and parameter 4 for the bill group. These parameters are used to derive the bill group against which the billable charges created for the claim, enrollment, and ancillary transactions should be billed in the system. The derived bill group is also used for billing the claim based fees, one-time or recurring fees, specific stop-loss credits, and aggregate stop-loss credits. You can define multiple derivation and pricing parameters for a bill group, but the derivation and pricing parameter combination must be unique for a particular duration.

For example, if you want bill group 1 to handle the claim, enrollment, and ancillary transactions of employees:

• Who reside in the Western location of the city

• Who belong to Grade A

• Whose transactions are received from the X system

Then, you need to define the following derivation and pricing parameters for bill group 1:

Example 1: Derivation and Pricing Parameters for Bill Group 1

Similarly, if you want bill group 2 to handle the claim, enrollment, and ancillary transactions of employees:

• Who reside in the Eastern location of Mumbai

• Who are the person of Indian origin

• Who belong to Grade A

• Whose transactions are received from the X system

Then, you need to define the following derivation and pricing parameters for bill group 2:

Example 2: Derivation and Pricing Parameters for Bill Group 2

In the example 1 and 2, the bill group is derived based on the specified employee attributes when the source system, parameter 1, parameter 2, parameter 3, and parameter 4 are mapped to the appropriate transaction fields in the primary pricing rule type using which the pricing rules are defined for the bill group. For example,

Example 3: Transaction Field Mapping in Primary Pricing Rule Type

You can also define criteria for a rule in a pricing group using the parameters, such as source system, parameter 1, parameter 2, parameter 3, and parameter 4.

Example 4: Rules Defined in a Pricing Group

If a pricing rule is defined for a bill group using a pricing group, you can define more than one price in the pricing rule which is offered based on the attributes of the employees.

Example 5: Defining a Pricing Rule Using a Pricing Group

In the example 5, the system will use the markup strategy on the claim line items for the employees who satisfy the criteria specified in R1. On the other hand, the system will use the markdown strategy on the claim line items for the employees who satisfy the criteria specified in R2.

The derivation and pricing parameters for the bill group and sort ID combination are effective from a particular date. However, the effective date must fall within the date range defined for the sort ID of the bill group. The source system and parameter 1 are mandatory while defining the derivation and pricing parameters for a bill group.

You can define and edit the derivation and pricing parameters for the bill group and sort ID combination from the Customer 360° Information screen. You can also upload the derivation and pricing parameters for one or more bill group and sort ID combinations at the same time using the Upload Request feature. You can upload the derivation and pricing parameters for the bill group and sort ID combinations from the Customer 360° Information or Upload Request screen. Note that you can upload the derivation and pricing parameters for the bill group and sort ID only using the CSV file format.

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