Defining an Aggregate Stop-Loss Pricing Rule for a Bill Group Using a Pricing Group

Prerequisites

To define an aggregate stop-loss pricing rule for a bill group using a pricing group, you should have:

  • Business Object C1-PricingRule defined for pricing rule.

  • Business Object C1-PricingRuleASL defined for aggregate stop-loss pricing rule.

  • Pricing rule type defined in the application.

  • Pricing group defined in the application.

  • Policy status defined in the application.

  • Price item defined in the application.

  • Rate option defined in the application.

Procedure

To define an aggregate stop-loss pricing rule for a bill group using a pricing group:

  1. Search for the account, person, or policy whose pricing details you want to view in the Customer 360° View screen.
  2. In the Search Results section, click the View (The View Icon) icon corresponding to the account, person, or policy whose pricing details you want to view.
    The Account, Person, or Policy tab in the Customer 360° Information screen appears.
  3. Click the Pricing tab and then click the Add link in the upper right corner of the Bill Group ASO Policy Pricing Rules zone.

    The Pricing Rule screen appears. It contains the following fields:

    Field Name Field Description Mandatory (Yes or No)
    Person Name Displays the person name. Not applicable
    Person Type Displays the person type. Not applicable
    Pricing Rule Type Used to indicate the pricing rule type to create the pricing rule.
    Note: You can create an aggregate stop-loss pricing rule using the Pricing Rule Type for aggregate stop-loss.
    		 Yes
    Pricing Group Used to indicate the pricing group. Yes
    Policy Status Used to indicate the policy status for pricing rule. The valid values are:

    • In Force/Active

    • Post Runout

    • Runout

    Note: Aggregate stop-loss pricing rule cannot be created for Runout or Post Runout policy status where the policy run out End Date is missing.
    		 Yes
  4. Click OK.

    The Aggregate Stop-Loss (ASL) Pricing Rule screen appears. It contains the following sections:

    • Customer Information - Displays the customer information for bill group using pricing group.

    • Main - Used to specify basic details about the claim pricing rule.

    • Markup or Markdown Values - Used to define the markup or markdown values for billable charge line for each rule.

    • Line Items - Used to associate line items eligible for billing for each rule.

    • Characteristics - Used to define the characteristics for the claim pricing rule.

    The Customer Information section contains the following fields:

    Field Name Field Description Mandatory (Yes or No)
    Bill Group Information Displays the bill group information. Not applicable
    Policy Start Date Displays the policy start date. Not applicable
    Policy End Date Displays the policy end date. Not applicable
    Policy Status Indicates the policy status for pricing rule. The valid values are:

    • In Force/Active

    • Post Runout

    • Runout

    		 Not applicable
    Pricing Group Displays the pricing group. Not applicable
    Pricing Rule Type Indicates the pricing rule type. Not applicable

    The Main section contains the following fields:

    Field Name Field Description Mandatory (Yes or No)
    Price Item Used to indicate the price item.
    Note: Once an option is selected for this field, the field appears disabled.
    		 Yes
    Parent Customer's SSL or ASL Pricing Rules Used to indicate the pricing date range derived from the parent customer's specific stop-loss or aggregate stop-loss pricing rule.
    Note: This field is enabled for selection when an option from Price Item field is selected.
    		 Yes
    Pricing Start Date Displays the pricing rule start date. Yes
    Pricing End Date Displays the pricing rule end date. Yes
    Rate Option Used to indicate the rate option to define the aggregate stop-loss pricing rule for the price item.
    Note: Rate options in this field appears for selection, when you select an option from the Price Item field.
    		 Yes
  5. Enter the required details in the Main section.
  6. Define accumulation criteria for each rule in an aggregate stop-loss pricing rule pricing rule, if required.
    Note: The Accumulation Criteria section appears in the rule section and the rule section appears when an option from Parent Customer's SSL or ASL Pricing Rules field is selected.
  7. Define stop-loss eligibility for claim line items, if required.
    Note: The Pricing Information section appears in the rule section and the rule section appears when an option from Parent Customer's SSL or ASL Pricing Rules field is selected.
  8. Define characteristics for an aggregate stop-loss pricing rule, if required.
  9. Click Save.
    The aggregate stop-loss pricing rule for a bill group using a pricing group is defined.
    Note: A price list and price assignment is created, the price list created is assigned to the aggregate stop-loss pricing rule.

Related Topics

For more information on... See...
Customer 360° Information - Pricing tab Customer 360° Information - Pricing Information
Bill Group ASO Policy Pricing Rules zone Bill Group Self-Funded Policy Pricing Rules
How to define Accumulation Criteria in an aggregate stop-loss pricing rule Defining Accumulation Criteria in an Aggregate Stop-Loss Pricing Rule
How to define stop-loss eligibility for claim line items Defining Claim Pricing Rules in an Aggregate Stop-Loss Pricing Rule
How to define a characteristic for an aggregate stop-loss pricing rule Defining a Characteristic for an Aggregate Stop-Loss Pricing Rule