Defining an Ancillary Pricing Rule Type

Prerequisites

To define an ancillary pricing rule type, you should have:

  • Ancillary pricing rule type business object defined in the application.

  • Ancillary pricing rule business object defined in the application.

Procedure

To define an ancillary pricing rule type:

  1. Click the Admin link in the Application toolbar.
    A list appears.
  2. From the Admin menu, select P and then click Pricing Rule Type.
    A sub-menu appears.
  3. Click the Add option from the Pricing Rule Type sub-menu.

    The Select Business Object screen appears. It contains the following field:

    Field Name Field Description Mandatory (Yes or No)
    Pricing Rule Type Business Object Used to indicate the business object using which you want to create an ancillary pricing rule type. The valid values are:

    • Aggregate Stop-Loss (ASL) Pricing Rule Type

    • Ancillary Pricing Rule Type

    • Claim Pricing Rule Type

    • Discount Arrangement Pricing Rule Type

    • Flat Fee Pricing Rule Type

    • Level Funded (LF) Pricing Rule Type

    • Retention Type Claim Based Pricing Rule Type

    • Retention Type Enrollment Based Pricing Rule Type

    • Specific Stop-Loss (SSL) Pricing Rule Type

    Note: You must select the Ancillary Pricing Rule Type option from the Pricing Rule Type Business Object list while defining an ancillary pricing rule type.
    		 Yes
    Tip: Alternatively, you can access this screen by clicking the Add button in the Page Title area of the Pricing Rule Type screen.
  4. Select the Ancillary Pricing Rule Type option from the Pricing Rule Type Business Object list.
  5. Click OK.

    The Ancillary Pricing Rule Type screen appears. It contains the following sections:

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

    • Related Pricing Rule Types - Used to indicate the non-primary pricing rule types which should inherit the transaction field mapping details from the ancillary pricing rule type. You can add a pricing rule type which belongs to the following category:

      1. Specific Stop Loss

      2. Aggregate Stop Loss

      3. Level Funding

      Note: You can use any of the above specified pricing rule types as the related pricing rule type in an ancillary pricing rule type.
    • Transaction Field Mapping - Used to map the transaction fields in a ancillary transaction to the appropriate fields in the ancillary pricing rule type. This helps the system to determine the field where the data from the transaction field must be stored. This data is then used in the system for various reasons, such as for deriving a bill group and pricing, deriving an effective related pricing rule, and so on.
      Note: The Billing Eligibility Identifier field is required when you are defining the Transaction Field Mapping for an ancillary pricing rule type.

    • Algorithms - Used to associate the algorithms with an ancillary pricing rule type.

    • Additional Data - Used to specify additional information about the ancillary pricing rule type.

    • Price Items - Used to add the price items for which you can define the ancillary pricing rules using the ancillary pricing rule type.

    • Price Item Parameters - Used to add the price item parameters based on which you want to define the price item pricing.
      Note: There are two price item parameters that are mandatory in the ancillary pricing rule type:

      • A price item which stores the billable charge line type from the ancillary transaction.

      • A price item which stores the pricing arrangement from the ancillary transaction.

    • Characteristics - Used to define the characteristics for an ancillary pricing rule type.

    • Ancillary-Specific Additional Data - Used to define the ancillary-specific additional data in an ancillary pricing rule type.
      Note: Following fields are required when you are defining the Ancillary-Specific Additional Data for the ancillary pricing rule type.

      • Billing Eligibility Identifier Value

      • Billing Non-Eligibility Identifier Value

    • Pricing Arrangements - Used to define the following pricing arrangements that are used while defining an ancillary pricing rule type.

      • Pass Through (Markup or Markdown Optional)

      • Pass Through Without Markup or Markdown

      • Rate Based (Markup or Markdown Optional)

    The Main section contains the following fields:

    Field Name Field Description Mandatory (Yes or No)
    Pricing Rule Type Used to specify the ancillary pricing rule type. Yes
    Description Used to specify the description for the ancillary pricing rule type. Yes
    Detailed Description Used to specify additional information about the ancillary pricing rule type. No
    Pricing Rule Business Object Used to indicate the business object using which you want to create the ancillary pricing rule. The valid values are:

    • Aggregate Stop-Loss (ASL) Pricing Rule

    • Ancillary Pricing Rule

    • Claim Pricing Rule

    • Discount Arrangement Pricing Rule

    • Flat Fee Pricing Rule

    • Level Funded (LF) Pricing Rule

    • Retention Type Claim Based Pricing Rule

    • Retention Type Enrollment Based Pricing Rule

    • Specific Stop-Loss (SSL) Pricing Rule

    Note: You must select the Ancillary Pricing Rule option from the Pricing Rule Business Object list while defining an ancillary pricing rule type.
    		 Yes
    Business Object Indicates the business object using which you are defining the ancillary pricing rule type. Not applicable
    Status Used to indicate the status of the ancillary pricing rule type. The valid values are:

    • Active

    • Inactive

    		 Yes
    Primary Used to indicate whether the ancillary pricing rule type is a primary pricing rule type. No
    Pricing Rule Type Category Used to indicate the category to which the ancillary pricing rule type belongs. The valid value are:

    • Aggregate Stop-Loss

    • Ancillary

    • Claim

    • Discount Arrangement

    • Flat Fees

    • Level Funded

    • Retention Type Claim Based

    • Retention Type Enrollment Based

    • Specific Stop-Loss

    Note: You must select the Ancillary option from the Pricing Rule Type Category list while defining an ancillary pricing rule type.
    		 Yes
  6. Enter the required details in the Main section.
  7. Select the Ancillary Pricing Rule option from the Pricing Rule Business Object list.
  8. Select the Primary option in the Main section.
    The Related Pricing Rule Types and Transaction Field Mapping sections appear.
  9. Select the Ancillary option from the Pricing Rule Type Category list.
  10. Add the related pricing rule types in the ancillary pricing rule type, if required.
  11. Map the transaction fields of an ancillary transaction to the appropriate fields in the ancillary pricing rule type.
  12. Associate the following algorithms with the ancillary pricing rule type:
    System Event Algorithm Algorithm Type Description
    Bill Group Derivation C1_​TXNBGDRV C1_​TXNBGDRV Derive Bill Group
    Account and Price Item Derivation C1_​ACCPRIDRV C1_​ACCPRIDRV Account and Price Item Derivation
    Bill After Date Determination C1_​BAFTDRV C1_​BAFTDRV Bill After Date Determination
  13. Define additional data for an ancillary pricing rule type, if required.
  14. Add the required price items for which you can define ancillary pricing rules using the ancillary pricing rule type.
  15. Add the price item parameters based on which you want to define the ancillary pricing, if required.
  16. Define the characteristics for an ancillary pricing rule type, if required.
  17. Define the required ancillary-specific additional data in the ancillary pricing rule type.
  18. Define the pricing arrangements for an ancillary pricing rule type, if required.
  19. Click Save.
    The ancillary pricing rule type is defined.

Related Topics

For more information on... See...
How to add the related pricing rule types in the primary pricing rule type Adding Related Pricing Rule Types in a Primary Pricing Rule Type
How to define the transaction field mapping in the primary pricing rule type Defining Transaction Field Mapping in a Primary Pricing Rule Type
How to associate algorithms with the pricing rule type Associating Algorithms with a Pricing Rule Type
How to define additional data for the pricing rule type Defining Additional Data for a Pricing Rule Type
How to add pricing items in the pricing rule type Adding Price Items in a Pricing Rule Type
How to add price item parameters in the pricing rule type Adding a Price Item Parameter in a Pricing Rule Type
How to define a characteristic for the pricing rule type Defining a Characteristic for a Pricing Rule Type
How to define ancillary-specific data in the pricing rule type Defining the Ancillary-Specific Data in an Ancillary Pricing Rule Type
How to define pricing arrangements for the pricing rule type Defining Pricing Arrangements in an Ancillary Pricing Rule Type