Creating a Reseeding Request for a Parent Accumulation Group (Specific to Health Insurance Domain)

Procedure

To create a reseeding request for a parent accumulation group:

  1. Click the Menu link in the Application toolbar.
    A list appears.
  2. From the Main menu, select Transaction and Audit Event Management and then click Disaggregation Request.
    The Disaggregation Request screen appears.
  3. Click the Add button available in the upper right corner of the Disaggregation Request screen.

    The Add Disaggregation Request screen appears. It contains the following field:

    Field Name Field Description Mandatory (Yes or No)
    Disaggregation Request Type Used to indicate the entity for which you want to create a disaggregation request. The valid values are:
    • Account - Used to create a disaggregation request for an account.
      Note: In this case, the system will disaggregate all billable charges of the account.
    • Billable Charge - Used to create a disaggregation request for an account for which a particular billable charge is created.
      Note: In this case, the system will disaggregate a specific billable charge of the account.

    • Parent Accumulation Group - Used to create reseeding requests for the accounts using a parent accumulation group and by specifying the accumulation type (i.e. whether it is stop-loss or discount arrangement).

      Note: The Parent Accumulation Group option is used to create reseeding requests for accounts which belong to the healthcare domain.

    • Person - Used to create a disaggregation request for one or more accounts of a person and its child persons.

      Note: In this case, the system will disaggregate all billable charges of the account.

    • Price Assignment - Used to create a disaggregation request for an account with a particular price assignment.

      Note: In this case, the system will disaggregate only those billable charges of the account which are created using the respective price assignment.

    • Price Item - Used to create a disaggregation request for an account or for one or more accounts of a person and its child persons where a particular price item is assigned.

      Note: In this case, the system will disaggregate only those billable charges of the accounts which are created for the respective price item.
    		 Yes
  4. Select the Parent Accumulation Group option from the Disaggregation Request Type list.
  5. Click OK.

    The Add Disaggregation Request screen appears. It contains the following field:

    Field Name Field Description Mandatory (Yes or No)
    Accumulation Type Used to create reseeding request for a particular type of an accumulation group. The valid values are:

    • Discount Arrangement - Used to create reseeding request for accounts of all bill groups of a parent customer (for whom the parent accumulation group is created) where the claim settlement is based on a discount arrangement.

    • Stop Loss - Used to create reseeding request for accounts of all bill groups of a parent customer (for whom the parent accumulation group is created) where changes are made to the specific stop-loss (SSL), aggregate stop-loss (ASL), or level funded pricing rule.

    		 Yes
  6. Select the required option from the Accumulation Type field.

    The following fields appear in the Add Disaggregation Request screen:

    Field Name Field Description Mandatory (Yes or No)
    Parent Accumulation Group ID Used to create reseeding request for accounts of all bill groups of a parent customer which belongs to a particular parent accumulation group.
    Note:

    The Search (The Search Icon) icon appears corresponding to the Parent Accumulation Group ID field. On clicking the Search icon, the Parent Accumulation Group ID Search window appears where you can search for the respective parent accumulation group.

    		 Yes
    Disaggregate All Account Used to indicate whether you want to create reseeding requests for accounts of all bill groups of a parent customer where the accumulation type is Stop Loss. If you do not select this option, the system creates reseeding requests for accounts of only those bill groups where the parent accumulation group is used for creating the specific stop-loss and aggregate stop-loss pricing rules.
    Note: This field appears only when you select the Stop Loss option from the Accumulation Type field.
    		 No
  7. Enter the required details in the Add Disaggregation Request screen.
  8. Click Save.
    The Accumulation Based Disaggregation screen appears with a list of accounts belonging to the parent accumulation group for which the reseeding request is created.

Related Topics

For more information on... See...
Disaggregation Request screen Disaggregation Request
Search Disaggregation Request zone Search Disaggregation Request