Bill Group Derivation for Membership

While deriving a bill group for a membership, the system first checks whether the characteristics specified in the following option types of the C1-ASOBLLNG feature configuration are defined for the membership:

• Account Identifier Type Char Type - Used to specify the characteristic type which stores the identifier type of the account to which the membership should be billed. Here, you must specify a characteristic type where the characteristic entity is set to Membership.

• Account Identifier Value Char Type - Used to specify the characteristic type which stores the corresponding identifier of the account to which the membership should be billed. Here, you must specify a characteristic type where the characteristic entity is set to Membership.

If the above two characteristics are defined for the membership, the system derives the account and then the person (i.e. bill group or parent customer) to which the account belongs. However, if the above two characteristics are not defined for the membership, the system then checks whether the characteristics specified in the following option types of the C1-ASOBLLNG feature configuration are defined for the membership:

• Person Identifier Type Char Type - Used to specify the characteristic type which stores the identifier type of the person to which the membership should be billed. Here, you must specify a characteristic type where the characteristic entity is set to Membership.

• Person Identifier Value Char Type - Used to specify the characteristic type which stores the corresponding identifier of the person to which the membership should be billed. Here, you must specify a characteristic type where the characteristic entity is set to Membership.

If the above two characteristics are defined for the membership, the system derives the person (i.e. bill group or parent customer) to which the membership should be billed. However, if the above two characteristics are not defined for the membership, the system checks whether the characteristics specified in the following parameters of the C1_​MEMBGDRV algorithm are defined for the membership:

• Characteristic Type for Bill level 1 - Used to specify the characteristic type which stores the bill group derivation and pricing parameter 1 for the membership. Here, you must specify a characteristic type where the characteristic entity is set to Membership.

• Characteristic Type for Bill level 2 - Used to specify the characteristic type which stores the bill group derivation and pricing parameter 2 for the membership. Here, you must specify a characteristic type where the characteristic entity is set to Membership.

• Characteristic Type for Bill level 3 - Used to specify the characteristic type which stores the bill group derivation and pricing parameter 3 for the membership. Here, you must specify a characteristic type where the characteristic entity is set to Membership.

• Characteristic Type for Bill level 4 - Used to specify the characteristic type which stores the bill group derivation and pricing parameter 4 for the membership. Here, you must specify a characteristic type where the characteristic entity is set to Membership.

• Characteristic Type for Source system - Used to specify the characteristic type which stores the external system from where the fully-insured policy is received for billing. Here, you must specify a characteristic type where the characteristic entity is set to Membership, Policy Plan, or Policy. The system searches for the characteristic on the following entity in the specified order:

  1. Membership

  2. Policy Plan

  3. Policy

  If the characteristic is defined at first level (i.e. membership), the system will not search for the characteristic at the subsequent levels. However, if the characteristic is not defined at first level, the system will search for the characteristic at the second level (i.e. policy plan). If the characteristic is defined at second level, the system will not search for the characteristic at the subsequent level. However, if the characteristic is not defined at second level, the system will search for the characteristic at the third level (i.e. policy).

To derive the source system from the membership, policy plan, or policy, the system first derives the policy plan to which membership belongs and then the policy to which the policy plan belongs. The above characteristics indicate the Source System, Parameter 1, Parameter 2, Parameter 3, and Parameter 4. The system derives a bill group using the derivation and pricing parameters (i.e. Source System, Parameter 1, Parameter 2, Parameter 3, and Parameter 4) which are defined for the bill group. Note that the system considers the derivation and pricing parameters which are effective on the effective date (which is available corresponding to the record in the CI_​REPRC_​ENTITY_​DTL table). It first searches for the bill group using the exact match. Let us understand this with the help of an example.

And, the following characteristics are defined for the M1 membership which belongs to the PP1 policy plan:

Now, if the Location, Grade, and External System characteristic types are specified in Characteristic Type for Bill level 1, Characteristic Type for Bill level 2, and Characteristic Type for Source system parameters of the C1_​MEMBGDRV algorithm, the system searches for a bill group where the following derivation and

If the exact match is not available, the system finds the bill group using the best fit match.

Once the policy and policy plan is derived, the system

Based on the characteristic values on the membership for bill level 1 to bill level 4 and characteristic value of source system, the bill group and parent customer corresponding to the membership is derived. 2. Deriving policy : Policy is derived from the plan to which the membership is linked.

To derive the bill group for a membership to which its premium and other pass-through charges should be billed, you need to attach an algorithm created using the C1_​MEMBGDRV algorithm type to the Bill Group Derivation system event in a pricing rule type where the category is set to Age Based, Tier Based, or Pass-Through Billable Charge.

Note that while searching for a bill group, the source system and Parameter 1 (i.e. Bill Level 1) are mandatory.

This algorithm contains the following parameters:

• Characteristic Type for Bill Level 1 - Used to indicate the characteristic type. This characteristic type must be defined on the membership. It is used to store the derivation and pricing parameter 1 for the membership.

• Characteristic Type for Bill Level 2 - Used to indicate the characteristic type. This characteristic type must be defined on the membership. It is used to store the derivation and pricing parameter 2 for the membership.

• Characteristic Type for Bill Level 3 - Used to indicate the characteristic type. This characteristic type must be defined on the membership. It is used to store the derivation and pricing parameter 3 for the membership.

• Characteristic Type for Bill Level 4 - Used to indicate the characteristic type. This characteristic type must be defined on the membership. It is used to store the derivation and pricing parameter 4 for the membership.

Once the bill group is derived, the system derives the parent customer of the bill group. If the system could not derive the policy, bill group, or parent customer, the status of the record is changed to Error (E) in the CI_​REPRC_​ENTITY_​DTL table.

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