Fully-Insured Billing

This chapter explains how the billing is done for fully-insured business in Oracle Revenue Management and Billing. It contains the following topics:

  • Audit Framework for Fully-Insured Billing

  • Premium Proration Rules

  • Age Monitoring

  • State of Issue

  • Membership Premium Calculation

  • Bill Group Derivation for Membership

  • Account and Price Item Derivation for Membership

  • Bill Cycle and Bill Period Derivation

  • Bill Period Timeline

  • 9/10 Billing (Skip Months)

  • Repricing

  • Fully-Insured Billable Charge Creation

  • New Born Credit Waiver

  • Membership Benefit Billing

  • Additional Repricing Entity Detail Records

  • Rounding Premium at the Member Level

  • Support Open Ended Policies, Plans, Pricing Rules, and Memberships

  • Hold Repricing

  • Prorate Membership Benefit and Corresponding Sponsor Charges

  • Repricing Request

  • Membership Repricing through Inbound Web Service

  • Benefit Passthrough Charges vs. Calculated Charges

  • Billing Preference

Related Topics

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Audit Framework for Fully-Insured Billing Audit Framework for Fully-Insured Billing
Premium Proration Rules Premium Proration Rules
Age Monitoring Age Monitoring
State of Issue State of Issue
Membership Premium Calculation Membership Premium Calculation
Bill Group Derivation for Membership Bill Group Derivation for Membership
Account and Price Item Derivation for Membership Account and Price Item Derivation for Membership
Bill Cycle and Bill Period Derivation Tightly Coupled Bill Cycle and Bill Period through Billing Preference
Bill Period Timeline Bill Period Timeline
9/10 Billing (Skip Months) 9/10 Billing (Skip Months)
Repricing Repricing
Fully-Insured Billable Charge Creation Fully-Insured Billable Charge Creation
New Born Credit Waiver New Born Credit Waiver
Membership Benefit Billing Membership Benefit Billing
Additional Repricing Entity Detail Records Additional Repricing Entity Detail Records
Rounding Premium at the Member Level Rounding Premium at the Member Level
Support Open Ended Policies, Plans, Pricing Rules, and Memberships Support Open Ended Policies, Plans, Pricing Rules, and Memberships
Hold Repricing Hold Repricing
Prorate Membership Benefit and Corresponding Sponsor Charges Prorate Membership Benefit and Corresponding Sponsor Charges
Zero-Amount Membership Benefit Charges Zero-Amount Membership Benefit Charges
Benefit Passthrough Charges vs. Calculated Charges Benefit Passthrough Charges vs. Calculated Charges
Repricing Request Repricing Request
Membership Repricing through Inbound Web Service Membership Repricing Through Inbound Web Service
Pricing Vs Passthrough Charges Pricing Vs Passthrough Charges
Billing Preference Billing Preference

Parent topic: Oracle Revenue Management and Billing Insurance Business Processes