C1-HCINPROC

This algorithm is invoked once a health care inbound message is successfully validated. It processes the health care inbound message and creates or updates the parent customers, bill groups (including derivation and pricing parameters for the bill group), accounts, self-funded or fully-insured group policies, policy plans, memberships, member persons, pass-through billable charges, and pricing rules. In addition, it allows you to terminate, reinstate, and renew a fully-insured group policy.

If the person type specified in the health care inbound message matches the person type specified in the Bill Group Person Type or Parent Person Type option type of the C1-PERSTYPE feature configuration, the system creates or updates the person, account, policy, policy plan, and address through a customer registration object. The memberships, pass-through billable charges, and pricing rules are created directly and not via customer registration object. However, if the person type specified in the health care inbound message does not match the person type specified in the Bill Group Person Type or Parent Person Type option type of the C1-PERSTYPE feature configuration, the system creates or updates the person and its other entities directly and not through a customer registration object. In this case, the system only refers the customer registration type for the business objects using which the person, account, policy plan, membership, and address should be created or updated in the system.

If the processing fails due to any reason, the status of the health care inbound message is changed to Rejected. In addition, the appropriate log entry is added which you can view in the Inbound Message Log zone.

It contains the following parameters:

  • Next Status - Used when you want to override the default next status specified in the lifecycle.

  • Next Transition Condition - Used when you want to override the default next transition condition specified in the lifecycle.

Note: At a time, you can specify value for either the Next Status or Next Transition Condition parameter. If you don't specify any value for these parameters, the system will transition the business object to the default next status specified in its lifecycle.