Fully-Insured Billable Charge Creation

Oracle Revenue Management and Billing enables you to create billable charges for pre-calculated premium amount (which is received through a health care inbound message) and calculated premium amount (which is derived using a pricing rule defined at the policy plan level). Before creating an SQI based billable charge, the system derives the bill period for the account using the Invoice Day (C1OFFRST) characteristic defined on the account.

While creating a billable charge for the pre-calculated premium amount through a health care inbound message, the system creates an SQI based billable charge for the membership and price item combination. Note that if the bill period or frequency is given in the billable charge information in the health care inbound message, the system does not derive the bill period for the account.

However, for creating a billable charge for the calculated premium amount, you need to execute the Fully-Insured Group Billable Charge Creation (C1-FIBCR) batch. It creates an SQI based billable charge for calculated premium amount. It considers the timelines in the Pending (P) and Error (E) status from the CI_​PRCE_​CALC table. Note that it considers only those timelines where the entity type is set to Membership. For each timeline, membership and price item combination, the system does the following:

1. Derives the bill period for the account using the Invoice Day (C1OFFRST) characteristic defined on the account.

2. Creates an SQI based billable charge. Here, the start and end dates on the billable charge are set to the timeline start and end dates.

If the premium amount of the two consecutive timelines of a membership and price item combination is same, this algorithm does not create a new billable charge. Instead, it extends the end date of the previous timeline's billable charge. If the membership end date is set to a date which is earlier than the previous date (for example, Old Membership End Date: 31-12-2019 and New Membership End Date: 31-10-2019) and a billable charge exists for the membership and price item combination with the same start date and amount, then the system behaves in the following manner:

However, if the membership end date is set to a date which is earlier than the previous date (for example, Old Membership End Date: 31-12-2019 and New Membership End Date: 31-10-2019) and a billable charge exists for the membership and price item combination with the same start date, but different amount, then the system behaves in the following manner:

And, if the membership end date is set to a date which is earlier than the previous date (for example, Old Membership End Date: 31-12-2019 and New Membership End Date: 31-10-2019) and a billable charge does not exist for the membership and price item combination with the same start date, then a billable charge is created for the 01-01-2019 to 31-10-2019 period. Note that if there are billable charges for the membership and price item combination whose date range is within the timeline, such billable charges are canceled and their corresponding bill segments (if any) are either deleted or canceled in the system.

The pre-calculated or calculated premium amount is stored as a pass through line in the SQI based billable charge. Note that these pass through lines are memo only and no general ledger entries will be created for these pass through lines. This algorithm fetches SQI from the Proration SQI option type of the C1-ASOBLLNG feature configuration. The SQI value is set to the total amount of the pass through lines in the billable charge. The system prorates the amount when the SQ rule specified in the rate schedule attached to the active contract contains the SQI which is specified in the Proration SQI option type of the C1-ASOBLLNG feature configuration.

Once the billable charge is created, the membership ID is stamped as characteristic on the billable charge. This indicates that the billable charge is created for the respective membership. This algorithm fetches the characteristic type, which must be defined on the billable charge, from the Characteristic Type For Membership Id option type of the C1-ASOBLLNG feature configuration.

Finally, the status of the corresponding timeline is set to Complete (C) in the CI_​PRCE_​CALC table. If any error occurs while creating a billable charge, the status of the corresponding timeline is set to Error (E) in the CI_​PRCE_​CALC table. In addition, if an error occurs, a To Do is created using the C1-FIBCR To Do type and assigned to all users with a To Do role which is specified as characteristic on the parent customer. The system considers the characteristic on the parent customer which is specified in the To Do Role Characteristic Type option type of the C1-ASOBLLNG feature configuration. Note that the system does not create a To Do for each error record. Instead, the system creates distinct To Do for each membership and pricing rule combination.

This batch is a multi-threaded batch. For more information about the batch, refer to Oracle Revenue Management and Billing Batch Guide.

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