Defining Transaction Field Mapping in a Primary Pricing Rule Type
Prerequisites
To define the transaction field mapping for a primary pricing rule type, you should have:
-
Transaction fields defined in the application
Procedure
To define the transaction field mapping for a primary pricing rule type:
-
Ensure that the Transaction Field Mapping section is expanded when you are defining a primary pricing rule
type.
Note:
This section appears when you have chosen the Primary option from the Main section.
The Transaction Field Mapping section contains the following fields:
Field Name Field Description Source System Used to specify the external system from where the transaction data is mapped. Note:On clicking the Search (
) icon that appears corresponding
to the Source System field, the Transaction Field Search window appears.On specifying the source system, the description of the source system appears corresponding to the Source System field.
Parameter 1.....Parameter 4 Used to specify the parameters mapped for the transaction. Note:On clicking the Search (
) icon that appears corresponding to
the Parameter 1, Parameter 2, Parameter 3, Parameter 4 field, the Transaction Field Search window
appears.On specifying the parameter, the description of the parameter appears corresponding to the Parameter 1, Parameter 2, Parameter 3, Parameter 4 field respectively.
Incurred Date Used to specify the date incurred for transaction. Note:On clicking the Search (
) icon that appears corresponding to
the Incurred Date field, the Transaction
Field Search window appears.On specifying the incurred date, the description of the incurred date appears corresponding to the Incurred Date field.
Paid Date Used to specify the transaction paid date. Note:On clicking the Search (
) icon that appears corresponding to
the Paid Date field, the Transaction
Field Search window appears.On specifying the paid date, the description of the paid date appears corresponding to the Paid Date field.
Source of Funds Used to specify the source of funds used to make the payment. Note:On clicking the Search (
) icon that appears corresponding to
the Source of Funds field, the Transaction
Field Search window appears.On specifying the source of funds, the description of the source of funds appears corresponding to the Source of Funds field.
Composite Used to specify the composite transaction data. Note:On clicking the Search (
) icon that appears corresponding to
the Composite field, the Transaction
Field Search window appears.On specifying the composite, the description of the composite appears corresponding to the Composite field.
Claim Disposition Used to specify the disposition of the claims transaction. Note:On clicking the Search (
) icon that appears corresponding to
the Claim Disposition field, the Transaction Field Search window appears.On specifying the claim disposition, the description of the claim disposition appears corresponding to the Claim Disposition field.
Provider's Tax Identification Number Used to specify the tax identification number of the provider. Note:On clicking the Search (
) icon that appears corresponding to
the Provider's Tax Identification Number field,
the Transaction Field Search window appears.On specifying the provider's tax identification number, the description of the provider's tax identification number appears corresponding to the Provider's Tax Identification Number field.
Member ID Used to specify the member ID. Note:On clicking the Search (
) icon
that appears corresponding to the Member ID field, the Transaction Field Search window
appears.On specifying the member ID, the description of the member ID appears corresponding to the Member ID field.
Main Subscriber ID Used to specify the customer ID. Note:On clicking the Search (
) icon
that appears corresponding to the Main Subscriber ID field, the Transaction Field Search window
appears.On specifying the main subscriber ID, the description of the main subscriber ID appears corresponding to the Main Subscriber ID field.
Run-in Identifier Used to specify the run-in identifier. Note:On clicking the Search (
) icon that appears corresponding to
the Run-in Identifier field, the Transaction Field Search window appears.On specifying the run-in identifier, the description of the run-in identifier appears corresponding to the Run-in Identifier field.
Runout Identifier Used to specify the runout identifier. Note:On clicking the Search (
) icon that appears corresponding to
the Runout Identifier field, the Transaction Field Search window appears.On specifying the runout identifier, the description of the runout identifier appears corresponding to the Runout Identifier field.
Third Party Identifier Used to specify the third party identifier to determine that the claim transaction is received from an external source system while defining a claim pricing rule type. Note:On clicking the Search (
) icon
that appears corresponding to the Third Party Identifier field, the Transaction Field Search window
appears.On specifying the third party identifier, the description of the third party identifier appears corresponding to the Third Party Identifier field.
Coverage Start Date Used to specify the transaction coverage start date. Note:On clicking the Search (
) icon that appears corresponding to
the Coverage Start Date field, the Transaction Field Search window appears.On specifying the coverage start date, the description of the coverage start date appears corresponding to the Coverage Start Date field.
Coverage End Date Used to specify the transaction coverage end date. Note:On clicking the Search (
) icon that appears corresponding to
the Coverage End Date field, the Transaction Field Search window appears.On specifying the coverage end date, the description of the coverage end date appears corresponding to the Coverage End Date field.
Retroactivity Indicator Used to specify information of the retroactivity indicator. Note:On clicking the Search (
) icon that appears corresponding to
the Retroactivity Indicator field, the Transaction Field Search window appears.On specifying the retroactivity indicator, the description of the retroactivity indicator appears corresponding to the Retroactivity Indicator field.
Network Indicator Used to map to a transaction field which indicates whether the service provider is in network or out of network. Note:On clicking the Search (
) icon that appears corresponding to
the Network Indicator field, the Transaction Field Search window appears.On specifying the network indicator, the description of the network indicator appears corresponding to the Network Indicator field.
Covered Charged Amount Used to map to a transaction field which indicates the amount which is covered for the employee in the policy. Note:On clicking the Search (
) icon that appears corresponding to
the Covered Charged Amount field, the Transaction Field Search window appears.On specifying the covered charged amount, the description of the covered charged amount appears corresponding to the Covered Charged Amount field.
Discount Savings Amount Used to map to a transaction field which indicates the amount which is offered as the discount to the service provider. Note:On clicking the Search (
) icon that appears corresponding to
the Discount Savings Amount field, the Transaction Field Search window appears.On specifying the discount savings amount, the description of the discount savings amount appears corresponding to the Discount Savings Amount field.
Accumulation Only Identifier Used to map to a transaction field which indicates that the claim transaction should only be used for calculating charges for the accumulated products, such as Specific Stop-Loss, Aggregate Stop-Loss, and so on. This means that the system should not derive the claim transaction leg. Instead, it should only derive the specific stop-loss or aggregate stop loss transaction legs for the claim transaction. Note:On clicking the Search (
) icon that appears corresponding to
the Accumulation Only Identifier field, the Transaction Field Search window appears.On specifying the accumulation only identifier, the description of the accumulation only identifier appears corresponding to the Accumulation Only Identifier field.
Billing Eligibility Identifier Used to specify whether the transaction is eligible for billing or not. Note:On clicking the Search (
) icon that appears corresponding to
the Billing Eligibility Identifier field, the Transaction Field Search window appears.On specifying the billing eligibility identifier, the description of the billing eligibility identifier appears corresponding to the Billing Eligibility Identifier field.
Transaction Upload Date Used to map to a transaction field which indicates the date when the transaction was uploaded in the external system. The system does not derive the discount transaction leg when the transaction upload date is later than the settlement date. Note:On clicking the Search (
) icon that appears corresponding to
the Transaction Upload Date field, the Transaction Field Search window appears.On specifying the transaction upload date, the description of the transaction upload date appears corresponding to the Transaction Upload Date field.
Claim Handling Fees Indicator Used to specify the claim handling fees which are applicable to one or more line items in the claim pricing rule. Note:On clicking the Search (
) icon that appears corresponding to
the Claim Handling Fees Indicator field, the Transaction Field Search window appears.On specifying the claim handling fees indicator, the description of the claim handling fees indicator appears corresponding to the Claim Handling Fees Indicator field.
- Enter the required details in the Transaction Field Mapping section.
-
Click Save.
The transaction field mapping is defined for the primary pricing rule type.
Related Topics
| For more information on... | See... |
|---|---|
| How to define a claim pricing rule type | Defining a Claim Pricing Rule Type |
| How to define a specific stop-loss (SSL) pricing rule type | Defining a Specific Stop-Loss (SSL) Pricing Rule Type |
| How to define an aggregate stop-loss (ASL) pricing rule type | Defining a Aggregate Stop-Loss (ASL) Pricing Rule Type |
| How to define a retention type claim based pricing rule type | Defining a Retention Type Claim Based Pricing Rule Type |
| How to define a retention type enrollment based pricing rule type | Defining a Retention Type Enrollment Based Pricing Rule Type |
| How to define a one-time flat fee pricing rule type | Defining a One-Time Flat Fee Pricing Rule Type |
| How to define a bill period based recurring flat fee pricing rule type | Defining a Bill Period Based Recurring Flat Fee Pricing Rule Type |
| How to define a frequency based recurring flat fee pricing rule type | Defining a Frequency Based Recurring Flat Fee Pricing Rule Type |
| How to edit a claim pricing rule type | Editing a Claim Pricing Rule Type |
| How to edit a specific stop-loss (SSL) pricing rule type | Editing a Specific Stop-Loss (SSL) Pricing Rule Type |
| How to edit an aggregate stop-loss (ASL) pricing rule type | Editing an Aggregate Stop-Loss (ASL) Pricing Rule Type |
| How to edit a retention type claim based pricing rule type | Editing a Retention Type Claim Based Pricing Rule Type |
| How to edit a retention type enrollment based pricing rule type | Editing a Retention Type Enrollment Based Pricing Rule Type |
| How to edit a one-time flat fee pricing rule type | Editing a One-Time Flat Fee Pricing Rule Type |
| How to edit a bill period based recurring flat fee pricing rule type | Editing a Bill Period Based Recurring Flat Fee Pricing Rule Type |
| How to edit a frequency based recurring flat fee pricing rule type | Editing a Frequency Based Recurring Flat Fee Pricing Rule Type |