C1-MembershipRepricing Business Service

Oracle Revenue Management and Billing enables you to do the following through the C1-MembershipRepricing business service:

• Define and edit the following types of membership:

  • Active Employee Coverage Membership

  • Employer Sponsored Group Medicare Membership (800 Series Plans)

  • COBRA Membership

• Add a member person to the membership

• Edit the existing member person details of the membership

• Create a person whom you want to add to the membership

• Edit the details of a person who is added to the membership

• Define and edit a benefit of a member person in a medicare membership

  Note: While editing a benefit of a member person, the system inactivates the old record and creates a new record in the system. The status of the old benefit record is set to Inactive and the status of the new benefit record is set to Active.

• Recalculate the membership premium (i.e. trigger repricing) in the following scenarios:

  • A membership is added or edited in the policy or health plan.

  • A member person is added to the membership.

  • The fields, characteristics, or statuses which are monitored for the auditing purposes are updated at the membership or member person level.

• Recalculate the membership premium in the simulation mode and not in real time

  Note: You can use the simulation mode as the What-If Analysis tool. In the simulation mode, you can evaluate the membership premium when a new membership will be added or the existing membership will be updated. However, in the simulation mode, the system neither adds or edits the membership in the system nor creates the billable charge for the membership premium. It only recalculates the membership premium and sends the premium calculation details in the response. Note that membership premium recalculation happens only in the above three listed scenarios.

• View the information of the memberships whose start and end dates fall within the specified date range. The information includes:

  • Details of the membership

  • Details of each member person in the membership

  • Benefit details of a member person in a medicare membership

  • Details of the billable charges created for the membership premium for different price items

  • Pricing rule and price assignment used during the membership premium billable charge creation

  • Account for which the membership premium billable charge is created

  • How premium is calculated for each timeline of the billable charge

  Note:

  If the age based pricing is used during the membership premium calculation, the premium is calculated for each eligible member of the membership. Here, the premium amount is the sum of the base fee and modifier fee (if any) for the eligible member.

  However, if the tier based pricing is used during the membership premium calculation, the premium is calculated at the membership level. Here, the premium amount is the base fee applicable for the membership.

  You can also filter the list of membership premium billable charges by specifying price items whose billable charges you want to view.

• View the last billed amount and current balance of the account on which the membership premium is billed.

You can define or edit only one membership at a time through the C1-MembershipRepricing business service. You can only create or edit a member person and not a bill group or parent customer through the C1-MembershipRepricing business service.

We have shipped a SOAP based inbound web service named C1-MembRepricing with the product. You can send the membership repricing request from the external system in the XML format through the C1-MembRepricing inbound web service. If you want to send the request in the XML and/or JSON format, you need to create a REST based inbound web service.