Defining the Level Funded Specific Additional Data in a Level Funded Pricing Rule Type

Prerequisites

To define level funded specific additional data in a level funded pricing rule type, you should have:

  • A rule type defined for Markup or Markdown Eligibility Rule Type and Domestic Provider Eligibility Rule Type field.

Procedure

To add the level-funded data in a level funded pricing rule type:

  1. Ensure that the Level Funded - Specific Additional Data section is expanded when you are defining or editing a level funded pricing rule type.

    The Level Funded - Specific Additional Data section contains the following fields:

    Field Name Field Description Mandatory (Yes or No)
    Funding Arrangement Used to indicate whether the level-funded premium (i.e. funds) should be calculated using the bill period based recurring flat fee pricing rule or using the retention type enrollment based pricing rule. The valid values are:

    • Enrollment Based Premium

    • Flat Rate Based Premium

    		 Yes
    Settlement Fund Pricing Rule Type Used to indicate the bill period based recurring flat fee pricing rule type or the retention type enrollment based pricing rule type which you want to use for calculating the level-funded premium.
    Note:

    The Search (The Search Icon) icon appears corresponding to the Settlement Fund Pricing Rule Type field. On clicking the Search (The Search Icon) icon corresponding to the Settlement Fund Pricing Rule Type field, the Contract Type Search window appears.

    On specifying the contract type, the description of the contact type appears corresponding to the Settlement Fund Pricing Rule Type field.

    		 Yes
    Settlement Fund Price Item Used to indicate the price item that you want to use for calculating the level-funded premium.
    Note:

    The Search (The Search Icon) icon appears corresponding to the Settlement Fund Price Item field. On clicking the Search (The Search Icon) icon corresponding to the Settlement Fund Price Item field, the Price Item Details window appears.

    On specifying the price item details, the description of the price item details appears corresponding to the Settlement Fund Price Item field.

    		 Yes
    LF Billable Charge Line Type Used to indicate the level funded billable charge line type using which you want to create the billable charges for level-funded settlement purposes.
    Note:

    The Search (The Search Icon) icon appears corresponding to the LF Billable Charge Line Type field. On clicking the Search (The Search Icon) icon corresponding to the LF Billable Charge Line Type field, the Billable Charge Line Type Search window appears.

    On specifying the billable charge line type, the description of the billable charge line type appears corresponding to the Billable Charge Line Type Search field.

    		 Yes
    GL Only Contract Type Used to indicate the contract against which the level-funded billable charges for claim, ancillary, claim based fees, enrollment based fees, discount, specific stop-loss, and aggregate stop-loss must be debited.
    Note:

    The Search (The Search Icon) icon appears corresponding to the GL Only Contract Type field. On clicking the Search (The Search Icon) icon corresponding to the GL Only Contract Type field, the Contract Type Search window appears.

    		 Yes
    Liability Distribution Code Used to indicate the GL account against which the level-funded billable charges (that are settled against the level-funded premium billable charge) must be credited.
    Note:

    The Search (The Search Icon) icon appears corresponding to the Liability Distribution Code field. On clicking the Search (The Search Icon) icon corresponding to the Liability Distribution Code field, the Distribution Code Search window appears.

    On specifying the distribution code, the description of the distribution code appears corresponding to the Liability Distribution Code field.

    		 Yes
    Renewal Decision Lead Time Used to specify the number of days before which you want to create a To Do for reminding the self-funded employer to renew the level-funded agreement. Yes
    Surplus Billable Charge Line Type Used to indicate the surplus billable charge line type using which you want to create the billable charge when the surplus funds are left with the ASO provider at the time of settlement.
    Note:

    The Search (The Search Icon) icon appears corresponding to the Surplus Billable Charge Line Type field. On clicking the Search (The Search Icon) icon corresponding to the Surplus Billable Charge Line Type field, the Billable Charge Line Type Search window appears.

    On specifying the billable charge line type, the description of the billable charge line type appears corresponding to the Surplus Billable Charge Line Type field.

    		 Yes
    Deficit Billable Charge Line Type Used to indicate the deficit billable charge line type using which you want to create the billable charge when the funds are in deficit at the time of settlement.
    Note:

    The Search (The Search Icon) icon appears corresponding to the Deficit Billable Charge Line Type field. On clicking the Search (The Search Icon) icon corresponding to the Deficit Billable Charge Line Type field, the Billable Charge Line Type Search window appears.

    On specifying the billable charge line type, the description of the billable charge line type appears corresponding to the Deficit Billable Charge Line Type field.

    		 Yes
    Domestic Provider Billable Charge Line Type Used to indicate the domestic provider billable charge line type using which you want to create level-funded settlement billable charge for a domestic provider.
    Note:

    The Search (The Search Icon) icon appears corresponding to the Domestic Provider Billable Charge Line Type field. On clicking the Search (The Search Icon) icon corresponding to the Domestic Provider Billable Charge Line Type field, the Billable Charge Line Type Search window appears.

    On specifying the billable charge line type, the description of the billable charge line type appears corresponding to the Domestic Provider Billable Charge Line Type field.

    		 No
    Markup or Markdown Billable Charge Line Type Used to indicate the markup or markdown billable charge line type using which you want to create the billable charges for markup or markdown which are settled against the level-funded premium.
    Note:

    The Search (The Search Icon) icon appears corresponding to the Markup or Markdown Billable Charge Line Type field. On clicking the Search (The Search Icon) icon corresponding to the Markup or Markdown Billable Charge Line Type field, the Billable Charge Line Type Search window appears.

    On specifying the billable charge line type, the description of the billable charge line type appears corresponding to the Markup or Markdown Billable Charge Line Type field.

    		 No
    Markup or Markdown Eligibility Rule Type Used to indicate the rules that should be executed to determine whether the markup or markdown calculation line is eligible for billing. No
    Rule Based Markup or Markdown Eligibility Field Used to indicate the transaction field which you want to use in the rules as the output parameter to determine whether the markup or markdown calculation line is eligible for billing.
    Note:

    The Search (The Search Icon) icon appears corresponding to the Rule Based Markup or Markdown Eligibility Field field. On clicking the Search (The Search Icon) icon corresponding to the Rule Based Markup or Markdown Eligibility Field Type field, the Field Search window appears.

    On specifying the eligibility field, the description of the field appears corresponding to the Rule Based Markup or Markdown Eligibility Field field.

    		 Yes (Conditional)
    Note: This field is required when you are specifying a markup or markdown eligibility rule type in a level funded pricing rule type.
    Domestic Provider Eligibility Rule Type Used to indicate the rules that should be executed to determine whether the level-funded premium is for a domestic provider. No
    Rule Based Domestic Provider Claim Eligibility Field Used to indicate the transaction field which you want to use in the rules as the output parameter to determine whether the level-funded premium is for a domestic provider.
    Note:

    The Search (The Search Icon) icon appears corresponding to the Rule Based Domestic Provider Claim Eligibility Field field. On clicking the Search (The Search Icon) icon corresponding to the Rule Based Domestic Provider Claim Eligibility Field field, the Field Search window appears.

    On specifying the eligibility field, the description of the field appears corresponding to the Rule Based Domestic Provider Claim Eligibility Field field.

    		 Yes (Conditional)
    Note: This field is required when you are specifying a domestic provider eligibility rule type in a level funded pricing rule type.
  2. Enter the required details in the Level Funded - Specific Additional Data section.
  3. Click Save.
    The level funded-specific data is added in the level funded pricing rule type.

Related Topics

For more information on... See...
How to define a level funded pricing rule type Defining a Level Funded Pricing Rule Type
How to edit a level funded pricing rule type Editing a Level Funded Pricing Rule Type