Defining a Retention Type Claim Based Pricing Rule for a Bill Group Using a Pricing Group

Procedure

To define a retention type claim based pricing rule for a bill group using pricing group:

  1. Search for the Administrative Services Only (ASO) person, whose person type is set to Bill Group, in the Customer 360° View screen.
  2. In the Search Results section, click the View (The View Icon) icon corresponding to the bill group whose pricing details you want to view.
    The Person tab appears in the Customer 360° Information screen.
  3. Click the Pricing tab.
    The Pricing tab appears.
  4. Click the Broadcast (The Broadcast Icon) icon in the Bill Group ASO Policy Information zone, corresponding to the Bill Group Information column, whose bill group details you want to view.
    The Bill Group ASO Policy Pricing Rules zone is displayed.
  5. 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 sections:

    • Main - This section 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. The valid values are:

      • Aggregate Stop-Loss (ASL) Pricing Rule

      • Claim Pricing Rule

      • Discount Arrangement Pricing Rule

      • Retention Type Claim Based Pricing Rule

      • Retention Type Enrollment Based Pricing Rule

      • Specific Stop-Loss (SSL) Pricing Rule

      Note: Select the Retention Type Claim Based Pricing Rule option, as the pricing rule type.
      		 Yes
      Note: If the pricing rule type is not selected then the application displays an error message.
      Pricing Group Used to indicate the pricing group for the bill group.
      Note: You must select a pricing group for the bill group on which the retention type claim based pricing rule is to be defined.
      		 Yes
      Policy Status Used to indicate the policy status for the bill group. The valid values are:

      • In Force/Active

      • Post Runout

      • Runout

      		 Yes (Conditional)
      Note: Policy Status is required once the Pricing Rule Type is selected.
  6. Select the appropriate fields in the Main section.
  7. Click OK.
    The Retention Type Claim Based Pricing Rule screen appears. It contains the following sections:

    • Main - This 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 define the pricing. The valid value are:

      • Admin Fee

      		 Yes
      Pricing Start Date Used to specify the start date from when the pricing will be effective for the price item. 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. No
      Rate Option Used to specify the rate option for the price item. The valid value are:

      • Flat Dollar Per Claim - Agg Daily

      		 Yes
      Pricing Group Rule Code Displays the code of the pricing group rule. Not applicable
      Description Displays the description of the pricing group rule. Not applicable
      Price Item Parameter Used to specify multiple price item parameters based on which you want to determine the price item utilization.
      Note: The Search (The Search Icon) icon does appear corresponding to this field. On clicking the Search icon, the Price Item Parameters screen appears.
      		 No
      Parameter Value Used to specify multiple price item parameter values based on which you want to determine the price item utilization.
      Note: The Search (The Search Icon) icon does appear corresponding to this field. On clicking the Search icon, the Parameter Value Search screen appears.
      		 No
      Fee Used to specify the fee for the price item parameter. No

    • Characteristics - Used to define the characteristics for the Retention Type Claim Based Pricing Rule for a Bill Group Using a Pricing Group.

  8. Add the required details in the main and characteristics section.
  9. Click Save.
    The retention type claim based pricing rule for a bill group using a pricing group is defined.
    Note:

    If the approval workflow group setting is set as Active for the bill group, for which the retention type claim based pricing rule is defined then an approval transaction is created for that particular bill group. The retention type claim based pricing rule for a bill group using a pricing group is defined, once the approval transaction is approved.

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How to define a characteristic for a retention type claim based pricing rule for a bill group using pricing group. Defining a Characteristic for a Retention Type Claim Based Pricing Rule for a Bill Group Using a Pricing Group