Defining a Claim Pricing Rule for a Bill Group

Prerequisites

To define a claim pricing rule for a bill group, you should have:

  • Business Object C1-PricingRule defined for pricing rule.

  • Business Object C1-PricingRuleClaim defined for claim pricing rule.

  • Pricing rule type defined in the application.

  • Policy status defined in the application.

  • Price item defined in the application.

  • Rate options defined in the Rate Option (C1-ExtLookRateType) extendable lookup.

  • Claim template defined in the Claim Template (C1-ExtLookClaimTemplate) extendable lookup.

  • Line items defined in the Line Item (C1-ExtLookPricingRuleLineItem) extendable lookup.

Procedure

To define a claim pricing rule for a bill 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 Indicates the name of the parent customer. Not applicable
    Person Type Indicates the type of the parent customer. Not applicable
    Pricing Rule Type Used to indicate the pricing rule type using which you want to create a claim pricing rule for the bill group.
    Note: You can create a claim pricing rule using the Pricing Rule Type for claim.
    		 Yes
    Pricing Group Used to indicate the pricing group for the bill group.
    Note: Select the pricing group option when the claim pricing rule has to be defined for a bill group using the pricing group.
    		 No
    Policy Status Used to indicate the policy status for the bill group. The valid values are:

    • In Force/Active

    • Post Runout

    • Runout

    Note: Claim pricing rule cannot be created for Runout or Post Runout policy statuses, where the policy run out end date is missing.
    		 Yes
  4. Click OK.

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

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

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

    • Claim Handling Fees - Used to define the claim handling fees on the lines items for the claim pricing rule.

    • Markup or Markdown Values - Used to define the markup or markdown values for the line items in the claim pricing rule.

    • Line Items - Used to associate line items eligible for billing in the claim pricing rule.

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

    The Customer Information section contains the following fields:

    Field Name Field Description
    Bill Group Information Displays the bill group information.
    Policy Start Date Displays the date from when the policy is effective.
    Policy End Date Displays the date till when the policy is effective.
    Policy Status Indicates the policy status for the claim pricing rule. The valid values are:

    • In Force/Active

    • Post Runout

    • Runout
    Pricing Rule Type Indicates the pricing rule type.
    Status Indicates the bill group status for the claim pricing rule. The valid values are:

    • Active

    • Inactive

    • Pending

    The Main section contains the following fields:

    Field Name Field Description Mandatory (Yes or No)
    Price Item Used to indicate the price item for which you want to edit the pricing. Yes
    Pricing Start Date Used to specify the start date from when the pricing will be effective for the price item.
    Note: The pricing start date cannot be later than the pricing end date.
    		 Yes (Conditional)
    Note: Pricing Start Date should be entered if Pricing End Date has been mentioned.
    Pricing End Date Used to specify the end date till when the pricing will be effective for the price item.
    Note: The pricing end date cannot be earlier than the pricing start date.
    		 No
    Rate Option Used to indicate the rate option that you want to use while editing the pricing for the price item. Yes
    Claim Template Used to indicate the claim template of the claim pricing rule for a bill group. Yes (Conditional)
    Note: This field is required when you are reapplying for a claim template.
    Note: This section also consists of a button, Reapply, on clicking the button a message occurs indicating that updating the claim template will reset all the default fields on the pricing rule.
  5. Enter the required details in the Main section.
  6. Define the claim handling fees for the line items in a claim pricing rule, if required.
    Note: The Claim Handling Fees section appears when an option from Claim Template field is selected.
  7. Define the markup or markdown values for the line items in a claim pricing rule, if required.
    Note: The Markup or Markdown Values section appears when an option from Claim Template field is selected.
  8. Define line items in a claim pricing rule, if required.
    Note: The Line Items section appears when an option from Claim Template field is selected.
  9. Define characteristics for a claim pricing rule, if required.
  10. Click Save.
    The claim pricing rule for a bill group is defined.
    Note: A price list and price assignment is created, the created price list is assigned to the claim 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 claim handling fees for the line items in a claim pricing rule Defining the Claim Handling Fees For Line Items in a Claim Pricing Rule
How to define markup or markdown values for the line items in a claim pricing rule Defining the Markup or Markdown Values For Line Items in a Claim Pricing Rule
How to define a characteristic for a claim pricing rule Defining a Characteristic for a Claim Pricing Rule