Health Care Inbound Message XML Format

Note: We recommend you to refer the Health Care Inbound Message schema in parallel while understanding the below mentioned tags. This will help you to understand how the tags are nested in the schema.

Before calling the C1-HCInboundMessage inbound web service, you need to ensure that the health care inbound message contains the following tags:

Tag Name Tag Description Mandatory (Yes or No)
schema Used to specify the tags of a health care inbound message. Yes
bo Used to indicate the business object using which the health care inbound message should be created in the system. The valid value is:

  • C1-HCInboundMessage

 Yes
messageType

You can use this tag within the following tags:

  • schema - Here, the messageType tag indicates the health care inbound message type using which the health care inbound message should be created in the system.
    Note: The system refers the value from within the headerData tag.

  • headerData - Here, the messageType tag is used to specify the health care inbound message type using which the health care inbound message should be created in the system.

    Note: You must specify a valid health care inbound message type which is in the Active status.
 Yes
sourceSystem

You can use this tag within the following tags:

  • schema - Here, the sourceSystem tag indicates the external system from where the health care inbound message is received.
    Note: The system refers the value from within the headerData tag.

  • headerData - Here, the sourceSystem tag is used to indicate the external system from where the health care inbound message is received.

  • billLevelParameters - Here, the sourceSystem tag is used to indicate the source system using which you want to define the derivation and pricing parameters for the bill group.

  • memberData - Here, the sourceSystem tag is used to indicate the source system using which you want to derive the policy where the policy plan is defined.

  • policyData - Here, the sourceSystem tag is used to indicate the source system from where the policy is originated.

Note:

You must specify a source system which is already defined in the C1-SourceSystemLookup extendable lookup. It must be in the Active status.

This tag is applicable only for the Self-Funded Group Health Insurance and Fully-Insured Group Health Insurance businesses.

 Yes
externalTransactionId

You can use this tag within the following tags:

  • schema - Here, the externalTransactionId tag indicates the transaction in the external source system which resulted in the health care inbound message.
    Note: The system refers the value from within the headerData tag.

  • headerData - Here, the externalTransactionId tag is used to indicate the transaction in the external source system which resulted in the health care inbound message.

 No
externalBatchId

You can use this tag within the following tags:

  • schema - Here, the externalBatchId tag indicates the external batch job or batch run number through which the health care inbound message is created.
    Note: The system refers the value from within the headerData tag.

  • headerData - Here, the externalBatchId tag is used to indicate the external batch job or batch run number through which the health care inbound message is created.

 Yes
externalSourceId

You can use this tag within the following tags:

  • schema - Here, the externalSourceId tag displays the external source system ID.
    Note: The system refers the value from within the headerData tag.

  • headerData - Here, the externalSourceId tag is used to specify the external source system ID.

 Yes
characteristics

You can use this tag within the following tags:

  • schema - Here, the characteristics tag is used to specify a list of characteristics for the health care inbound message.

  • personData - Here, the characteristics tag is used to specify a list of characteristics for the person.

  • relatedPersons - Here, the characteristics tag is used to specify a list of characteristics for the person to person relationship.

  • memberData - Here, the characteristics tag is used to specify a list of characteristics for the membership.

  • billableChargeData - Here, the characteristics tag is used to specify a list of characteristics for the billable charge.

  • accountData - Here, the characteristics tag is used to specify a list of characteristics for the account.

  • policyData - Here, the characteristics tag is used to specify a list of characteristics for the policy.

  • planData - Here, the characteristics tag is used to specify a list of characteristics for the policy plan.

  • pricingRuleData - Here, the characteristics tag is used to specify a list of characteristics for the pricing rule.

  • benefitData - Here, the characteristics tag is used to specify a list of characteristics for the membership benefit.

 No
inboundMessageCharacteristic Used to specify a characteristic for the health care inbound message. No
adhocCharacteristicValue Used to specify the value for the adhoc characteristic type. Yes (Conditional)
Note: This data is required while defining or editing an adhoc characteristic of the health care inbound message.
characteristicType

You can use this tag within the following tags:

  • inboundMessageCharacteristic - The characteristicType tag is used to specify the characteristic type. Here, you must specify a characteristic type where the characteristic entity is set to Inbound Message.

  • characteristicsList - The characteristicType tag is used to specify the characteristic type. If you are defining a characteristic for a:

    • Person - You must specify a characteristic type where the characteristic entity is set to Person.

    • Related Person - You must specify a characteristic type where the characteristic entity is set to Person to Person.

    • Membership - You must specify a characteristic type where the characteristic entity is set to Membership.

    • Membership Person - You must specify a characteristic type where the characteristic entity is set to Membership Person.

    • Membership Benefit - You must specify a characteristic type where the characteristic entity is set to Benefit.

    • Billable Charge - You must specify a characteristic type where the characteristic entity is set to Billable Charge.

    • Account - You must specify a characteristic type where the characteristic entity is set to Account.

    • Policy - You must specify a characteristic type where the characteristic entity is set to Policy.

    • Policy Plan - You must specify a characteristic type where the characteristic entity is set to Policy Plan.

    • Pricing Rule - You must specify a characteristic type where the characteristic entity is set to Pricing Rule.

    • Pricing Rule - You must specify a characteristic type where the characteristic entity is set to Pricing Rule.

 Yes (Conditional)
Note: This data is required while defining or editing a characteristic of the respective entity.
effectiveDate

You can use this tag within the following tags:

  • inboundMessageCharacteristic - Here, the effectiveDate tag is used to specify the date from when the characteristic is effective for the health care inbound message.

  • characteristicsList - Here, the effectiveDate tag is used to specify the date from when the characteristic is effective for the respective entity (i.e. person, person to person relationship, membership, member person, billable charge, account, policy, policy plan, pricing rule, or membership benefit).

  • billLevelParameters - Here, the effectiveDate tag is used to specify the date from when the derivation and pricing parameters are effective for the bill group.

  • policyPlanProrationRuleList - Here, the effectiveDate tag is used to specify the proration rules defined for the policy plan.

Note: You must specify the date in the YYYY-MM-DD format.
 Yes (Conditional)
Note: This data is required while defining or editing a characteristic of the respective entity or while defining the derivation and pricing parameters for the bill group.
characteristicValue

You can use this tag within the following tags:

  • inboundMessageCharacteristic - Here, the characteristicValue tag is used to specify the value for the predefined characteristic type.

  • characteristicsList - Here, the characteristicsList tag is used to specify the value for the characteristic type.

 Yes (Conditional)
Note: This data is required while defining or editing a characteristic of the respective entity.
customerStructureMessage Used to specify the details of the customer including the header information for the health care inbound message. Yes
characteristicValueForeignKey1 Used to specify the first value for the foreign key characteristic type. Yes (Conditional)
Note: This data is required while defining or editing a foreign key characteristic of the health care inbound message.
characteristicValueFK2 Used to specify the second value for the foreign key characteristic type. No
characteristicValueFK3 Used to specify the third value for the foreign key characteristic type. No
characteristicValueFK4 Used to specify the fourth value for the foreign key characteristic type. No
characteristicValueFK5 Used to specify the fifth value for the foreign key characteristic type. No
headerData Used to specify the header information for the health care inbound message. Yes
personData Used to specify the details of the parent customer, bill group, or member person. Yes (Conditional)
Note: This data is required while defining or editing a person.
accessGroup

You can use this tag within the following tags:

  • personData - Here, the accessGroup tag is used to indicate the user group that can access the person data.

  • accountData - Here, the accessGroup tag is used to indicate the user group that can access the account data.

  • customerStructureData - Here, the accessGroup tag is used to indicate the user group that can access the customer data.

Note: If you do not specify a value, by default it is set to system default.
 No
sequence

You can use this tag within the following tags:

  • personData - Here, the sequence tag is used to indicate the order in which the person should be created in the system.

  • personName - Here, the sequence tag is used to indicate the order in which the person name should be displayed in the user interface.

  • billLevelParameters - Here, the sequence tag is used to indicate the order in which the derivation and pricing parameters should be created for the bill group.

  • billableChargeData - Here, the sequence tag is used to indicate the order in which the billable charge should be created for the membership.

  • baseRate - Here, the sequence tag is used to indicate the order in which the billable charge should be created for the membership.

  • pricingParameter - Here, the sequence tag is used to indicate the order in which the pricing eligibility criteria should be created using the parameter information.

  • modifierInformation - Here, the sequence tag is used to indicate the order in which the pricing eligibility criteria should be created using the modifier information.

  • benefitDataList - Here, the sequence tag is used to indicate the order in which the benefit charge should be created for the membership.

  • accountData - Here, the sequence tag is used to indicate the order in which the account should be created in the system.

  • memberData - Here, the sequence tag is used to indicate the order in which the membership benefit should be created in the system.

 Yes (Conditional)
Note: This data is required while defining or editing the respective information.
personType Used to indicate the type of person. The valid values are:

  • B - Indicates that the person is a business owner.

  • BG - Indicates that the person is a bill group.

  • G - Indicates that the person is a group owner.

  • K - Indicates that the person is a broker.

  • P - Indicates that the person is an individual.

  • PG - Indicates that the person is a parent customer.

Note: You must specify a value which is already defined in the PER_​OR_​BUS_​FLG lookup field. It must be in the Active status.
 Yes (Conditional)
Note: This data is required while defining or editing a person.
personName Used to specify a list of names for the person. Yes (Conditional)
Note: This data is required while defining a person.
entityName Used to specify the name of the person. Yes (Conditional)
Note: This data is required while defining a person.
nameType Used to indicate the type of name.
Note: You must specify a value which is already defined in the NAME_​TYPE_​FLG lookup field. It must be in the Active status.
 Yes (Conditional)
Note: This data is required while defining a person.
identifiers

You can use this tag within the following tags:

  • personData - Here, the identifiers tag is used to specify the identification details for the person.

  • accountData - Here, the identifiers tag is used to specify the identification details for the account.

Note: You must specify one primary identifier for a person and account.
 Yes (Conditional)
Note: This data is required while defining or editing the respective information.
idType

You can use this tag within the following tags:

  • identifiers - Here, the idType tag is used to specify the person or account identifier type.

  • relatedPersons - Here, the idType tag is used to specify the person identifier type.

  • mainSubscriber - Here, the idType tag is used to specify the person identifier type.

  • accountPerson - Here, the idType tag is used to specify the person identifier type.

  • policyPersons - Here, the idType tag is used to specify the person identifier type.

Note: You must specify a person or account identifier type which is already defined in the system.
 Yes (Conditional)
Note: This data is required in the following scenarios:

  • While defining or editing the identification details of a person and account.

  • While defining or editing a person to person relationship.

  • While defining or editing the membership information of a person.

  • While linking an account to another person.

  • While associating a person with a policy.
idValue

You can use this tag within the following tags:

  • identifiers - Here, the idValue tag is used to specify the person or account identifier.

  • relatedPersons - Here, the idValue tag is used to indicate the person with whom you want to establish the person to person relationship.

  • mainSubscriber - Here, the idValue tag is used to indicate the person who is the main subscriber of the membership.

  • accountPerson - Here, the idValue tag is used to indicate the person to whom you want to link the account.

  • policyPersons - Here, the idValue tag is used to indicate the person to whom you want to associate the policy.

 Yes (Conditional)
Note: This data is required while defining or editing the respective information.
isPrimary Used to indicate whether the person or account identifier is a primary identifier. The valid values are:

  • Y

  • N

Note: If you do not specify the value, by default, it is set to N.
 No
division

You can use this tag within the following tags:

  • personData - Here, the division tag is used to indicate the division to which the person belongs.

  • accountData - Here, the division tag is used to indicate the division to which the account belongs.

  • statementConstructDetails - Here, the division tag is used indicate the division to which the statement construct belongs.

Note: You must specify a division which is already defined in the system.
 No
birthDate Used to specify the date when the person was born.
Note: You must specify the date in the YYYY-MM-DD format.
 No
sinceDate Used to specify the date when the person's record is created in the system. This is purely informational.
Note: You must specify the date in the YYYY-MM-DD format.
 No
address

You can use this tag within the following tags:

  • personData - Here, the address tag is used to specify the address of the person.

  • accountData - Here, the address tag is used to specify the address of the account.

 Yes (Conditional)
Note: This data is required while defining or editing the address of the respective entity.
addressEffDate Used to specify the date from when the address is effective.
Note:

You must specify the date in the YYYY-MM-DD format.

If you do not specify the date, by default, the system sets the effective date to the date when the address is created in the system through the health care inbound message.

 Yes (Conditional)
Note: This data is required while editing the address of a person or account.
addressType Used to indicate the type of address. The valid values are:

  • MAIN - Indicates that the address is the person's mailing address. You can use this address type while specifying the address for the person and account.

  • SEAS - Indicates that the address is the person's seasonal address. You can use this address type while specifying the address for the person.

  • OVRD - Indicates that the address is the account's override address. You can use this address type while specifying the address for the account.

Note:

If you do not specify the address type, by default, it is set to MAIN.

You must specify an address type which is already defined in the ADDRESS_​TYPE_​FLG lookup field. It must be in the Active status.

 Yes (Conditional)
Note: This data is required while editing the address of a person or account.
mailingName Used to specify the name using which the person should be addressed in the mail communication. The system also uses the mailing name in the bills, letters, quotes, and statements. No
address1

You can use this tag within the following tags:

  • address - Here, the address1 tag is used to specify the first line of the address. It may contain details, such as the house number.

  • personAddressOverride - Here, the address1 tag is used to specify the first line of the address. It may contain details, such as the house number.

 Yes (Conditional)
Note: This data is required while defining and editing the address of a person and account.
address2

You can use this tag within the following tags:

  • address - Here, the address2 tag is used to specify the second line of the address. It may contain details, such as the apartment name.

  • personAddressOverride - Here, the address2 tag is used to second line of the address. It may contain details, such as the apartment name.

 No
address3

You can use this tag within the following tags:

  • address - Here, the address3 tag is used to specify the third line of the address. It may contain details, such as the street name.

  • personAddressOverride - Here, the address3 tag is used to specify the third line of the address. It may contain details, such as the street name.

 No
address4

You can use this tag within the following tags:

  • address - Here, the address4 tag is used to specify the fourth line of the address. It may contain the landmark details.

  • personAddressOverride - Here, the address4 tag is used to specify the fourth line of the address. It may contain the landmark details.

 No
city

You can use this tag within the following tags:

  • address - Here, the city tag is used to specify the city name.

  • personAddressOverride - Here, the city tag is used to specify the city name.

 No
state

You can use this tag within the following tags:

  • address - Here, the state tag is used to indicate the state where the city is located.

  • personAddressOverride - Here, the state tag is used to indicate the state where the city is located.

 No
zip Used to specify the zip code of the address. No
addressStatus

You can use this tag within the following tags:

  • address - Here, the addressStatus tag is used to indicate whether you want to maintain both the active and inactive address.

  • personAddressOverride - Here, the addressStatus tag is used to indicate whether you want to maintain both the active and inactive address.

 No
country

You can use this tag within the following tags:

  • address - Here, the country tag is used to indicate the country where the person or account is located.

  • personAddressOverride - Here, the country tag is used to indicate the country where the person is located.

 Yes (Conditional)
Note: This data is required while defining or editing the address of a person or account.
houseType

You can use this tag within the following tags:

  • address - Here, the houseType tag is used to indicate the type of the house.

  • personAddressOverride - Here, the houseType tag is used to indicate the type of the house.

Note: You must specify a house type which is already defined in the HOUSE_​TYPE lookup field. It must be in the Active status.
 No
streetNumber1

You can use this tag within the following tags:

  • address - Here, the streetNumber1 tag is used to specify the numeric information, if any, related to the address.

  • personAddressOverride - Here, the streetNumber1 tag is used to specify the numeric information, if any, related to the address.

 No
streetNumber2

You can use this tag within the following tags:

  • address - Here, the streetNumber2 tag is used to specify the numeric information, if any, related to the address.

  • personAddressOverride - Here, the streetNumber2 tag is used to specify the numeric information, if any, related to the address.

 No
inCityLimit

You can use this tag within the following tags:

  • address - Here, the inCityLimit tag is used to indicate whether the address is within the city limit. The valid values are:

    • Y

    • N

  • personAddressOverride - Here, the inCityLimit tag is used to indicate whether the address is within the city limit. The valid values are:

    • Y

    • N

 No
taxVendorGeographicalCode

You can use this tag within the following tags:

  • address - Here, the taxVendorGeographicalCode tag is used to specify the geographic code of the address.

  • personAddressOverride - Here, the taxVendorGeographicalCode tag is used to specify the geographic code of the address.

 No
county

You can use this tag within the following tags:

  • address - Here, the county tag is used to specify the county name.

  • personAddressOverride - Here, the county tag is used to specify the county name.

 No
email Used to specify the e-mail ID of the person. No
overrideMailingName1 Used to specify the name using which you want to override the person's mailing name. No
overrideMailingName2 Used to specify the name using which you want to override the person's override mailing name 1. No
overrideMailingName3 Used to specify the name using which you want to override the person's override mailing name 2. No
phones Used to specify the phone details of the person. Yes (Conditional)
Note: This data is required while defining or editing the phone details of a person.
phoneType Used to indicate the type of phone.
Note: You must specify a phone type which is already defined in the system.
 Yes (Conditional)
Note: This data is required while defining or editing the phone details of a person.
phoneValue Used to specify the phone number of the person. Yes (Conditional)
Note: This data is required while defining or editing the phone details of a person.
extension Used to specify the extension value of the phone number. Yes (Conditional)
Note: This field is required when you are adding the phone details of a person.
relatedPersons Used to list other persons with whom you want to establish the person's relationship. Yes (Conditional)
Note: This data is required while defining or editing a person to person relationship.
personRelationshipType Used to indicate how the other person is related to the person.
Note:

You must specify a person relationship type which is already defined in the system.

If you have specified a parent customer as the related person for a bill group, the system, by default, uses the person relationship type which is specified in the Person Relationship Type option type of the C1-ASOBLLNG feature configuration. It does not considers the value specified in this tag.

 Yes (Conditional)
Note: This data is required while creating relationship between a bill group and person whose the person type is not Parent Customer.
startDate

You can use this tag within the following tags:

  • relatedPersons - Here, the startDate tag is used to specify the date from when the other person is related to the person.

  • memberData - Here, the startDate tag is used to specify the date from when the membership is effective.

  • billableChargeData - Here, the startDate tag is used to specify the start date of the billable charge.

  • autoPayDetails - Here, the startDate tag is used to specify the date from when the auto pay instruction is effective.

  • policyData - Here, the startDate tag is used to specify the date from when the policy is effective.

  • policyPersons - Here, the startDate tag is used to specify the date from when the person is associated with the policy.

  • planData - Here, the startDate tag is used to specify the date from when the policy plan is effective.

  • pricingRuleData - Here, the startDate tag is used to specify the date from when the pricing rule is effective.

  • benefitDataList - Here, the startDate tag is used to specify the date from when the benefit is availed for the membership.
    Note:

    The start date of the membership benefit cannot be earlier than the membership start date or later than the membership end date.

    The membership benefit start date cannot be later than the membership benefit end date.

  • statementConstructDetails - Here, the startDate tag is used to specify the date from when the statement construct is effective.

Note: You must specify the date in the YYYY-MM-DD format.
 Yes (Conditional)
Note: This data is required in the following scenarios:

  • While defining the respective information.

  • While editing the membership information of a person.

  • While editing an auto pay instruction of an account.

  • While editing a pricing rule.

endDate

You can use this tag within the following tags:

  • relatedPersons - Here, the endDate tag is used to specify the date till when the other person is related to the person.

  • memberData - Here, the endDate tag is used to specify the date till when the membership is effective.

  • billableChargeData - Here, the endDate tag is used to specify the end date of the billable charge.

  • autoPayDetails - Here, the endDate tag is used to specify the date till when the auto pay instruction is effective.

  • policyData - Here, the endDate tag is used to specify the date till when the policy is effective.

  • policyPersons - Here, the endDate tag is used to specify the date till when the person is associated with the policy.

  • planData - Here, the endDate tag is used to specify the date till when the policy plan is effective.

  • pricingRuleData - Here, the endDate tag is used to specify the date till when the pricing rule is effective.

  • benefitDataList - Here, the endDate tag is used to specify the date till when the benefit is availed for the membership.
    Note:

    The end date of the membership benefit cannot be earlier than the membership start date or later than the membership end date.

    The membership benefit end date cannot be earlier than the membership benefit start date.

  • statementConstructDetails - Here, the endDate tag is used to specify the date till when the statement construct is effective.

Note: You must specify the date in the YYYY-MM-DD format.
 Yes (Conditional)
Note: This data is required while editing the membership information of a person.
financialRelationshipSw Used to indicate whether the other person is financially responsible for the person. The valid values are:

  • True

  • False

Note: If you do not specify the value, by default, it is set to False.
 No
parentOrChild Used to indicate whether the other person is parent or child. The valid values are:

  • P

  • C

 Yes (Conditional)
Note: This data is required while creating a person to person relationship.
characteristicsList

You can use this tag within the following tags:

  • characteristics - Here, the characteristicsList tag is used to specify a characteristic for the respective entity (i.e. person, person to person relationship, membership, billable charge, account, policy, policy plan, pricing rule, or benefit).

  • membershipPersonCharacteristic - Here, the characteristicsList tag is used to specify a characteristic for the member person.

  • benefitData - Here, the characteristicsList tag is used to specify a characteristic for the membership benefit.

  • personStatementConstructs - Here, the characteristicsList tag is used to specify a characteristic for the person.

 Yes (Conditional)
Note: This data is required while defining or editing a characteristic of the respective entity.
billLevelParameters Used to specify the derivation and pricing parameters for the bill group. No
billLevelInfo1 Used to specify the employee attribute based on which you want to derive the bill group.
Note: You must not specify the ampersand (&) character in the value.
 Yes (Conditional)
Note: This data is required while defining the derivation and pricing parameters for a bill group.
billLevelInfo2 Used to specify the employee attribute based on which you want to derive the bill group.
Note: You must not specify the ampersand (&) character in the value.
 No
billLevelInfo3 Used to specify the employee attribute based on which you want to derive the bill group.
Note: You must not specify the ampersand (&) character in the value.
 No
billLevelInfo4 Used to specify the employee attribute based on which you want to derive the bill group.
Note: You must not specify the ampersand (&) character in the value.
 No
memberData Used to specify basic information about the membership.
Note: This tag is applicable only for the Self-Funded Group Health Insurance, Fully-Insured Group Health Insurance, and Individual Health Insurance businesses.
 Yes (Conditional)
Note: This data is required while defining or editing the membership details of a person.
memberId Used to specify the external membership ID.
Note: Here, you need to specify a membership ID which is maintained in the external source system.
 No
memberRelationship Used to indicate how the main subscriber is related to the membership. Yes (Conditional)
Note: This data is required while defining or editing the membership details of a person.
membershipPersonStatus Used to indicate the status of the person in the membership. The valid values are:

  • Active

  • Inactive

 Yes
membershipPersonstatusReason Used to indicate the reason why you want to change the status of the member person. Yes
autoRenew Used to indicate whether the individual membership should be automatically renewed.
Note: This tag is applicable only for the Individual Health Insurance business.
 No
associatedMemberIdentifierType Used to indicate the associated membership identifier type.
Note: This tag is applicable only for the Individual Health Insurance business.
 Yes (Conditional)
Note: This field is required when the associated membership identifier is specified.
associatedMemberIdentifier Used to specify the value for associated membership identifier type.
Note: This tag is applicable only for the Individual Health Insurance business.
 Yes (Conditional)
Note: This field is required when the associated membership identifier type is specified.
exchangeFlag Used to indicate whether the individual membership is purchased from the exchange.

  • Off

  • On

Note: This tag is applicable only for the Individual Health Insurance business.
 Yes (Conditional)
Note: This field is required when you have purchased the individual membership from an exchange.
exchangeId Used to specify the exchange from where the individual membership is purchased.
Note: This tag is applicable only for the Individual Health Insurance business.
 Yes (Conditional)
Note: This field is required when you have purchased the individual membership from an exchange.
binderLiabilityAmount Used to specify the binder liability amount.
Note: This tag is applicable only for the Individual Health Insurance business.
 Yes (Conditional)
Note: This field is required when the Consider Binder Liability Amount attribute is set to Y in the binder payment preference.
binderPayApplicability Used to indicate that the system should monitor whether the binder payment is received before activating the individual membership. The valid values are:

  • Y

  • N

Note: This tag is applicable only for the Individual Health Insurance business.
 Yes
binderPayGraceDays Used to specify the days which are used to calculate the grace date for the individual membership.
Note: This tag is applicable only for the Individual Health Insurance business.
 No
binderPayThreshold Used to specify the threshold percentage using which the threshold amount should be calculated.
Note: This tag is applicable only for the Individual Health Insurance business.
 No
holdBilling Used to indicate whether you want to hold the bill generation process for the individual membership until the binder payment is received. The valid values are:

  • Y

  • N

Note: This tag is applicable only for the Individual Health Insurance business.
 Yes
membershipRenewalDate Used to indicate the date when the individual membership should be renewed.
Note:

Renewal date is required for manual renewal of the individual membership. In case of automatic renewal, the membership renewal date is calculated by the system.

This tag is applicable only for the Individual Health Insurance business.

 Yes (Conditional)
Note: This field is required when you manually want to renew the individual membership.
contractPeriod Used to indicate the period (in months) for which the individual membership should be automatically renewed.
Note: This tag is applicable only for the Individual Health Insurance business.
 Yes (Conditional)
Note: This field is required if you have entered the membership renewal date.
membershipIdentifier Used to specify one or more identifiers for the individual membership.
Note: This tag and all the tags within this parent tag are applicable only for the Individual Health Insurance business.
 Yes (Conditional)
Note: This data is required while defining or editing the individual membership details of a person.
membershipIdentifierType Used to indicate the membership identifier type. Yes (Conditional)
Note: This field is required when the membership identifier is specified.
membershipIdentifierValue Used to specify the value for the membership identifier type. Yes (Conditional)
Note: This field is required when the membership identifier type is specified.
isMemberSw Used to indicate whether the person is a member or a non-member in the membership. The valid values are:

  • Yes

  • No

 No
isFinanciallyResponsibleSw Used to indicate whether the person is financially responsible for the membership. The valid values are:

  • Yes

  • No

 No
membershipType

You can use this tag within the following tags:

  • memberData - Here, the membershipType tag is used to indicate the type of membership. The valid values are:

    • COBRA

    • Medicare

    Note: If you want to define an active employee coverage membership, you must leave this field blank.

  • mainSubscriber - Here, the membershipType tag is used to specify the policy number.

  • policyPlanProrationRuleList - Here, the membershipType tag is used to specify the proration rules defined for the policy plan.

 No
externalMedicareBeneficiaryId Used to indicate the beneficiary (i.e. member person) who has received the Medicare membership benefits.
Note: This tag is applicable only for the Fully-Insured Group Health Insurance and Individual Health Insurance businesses.
 No
mainSubscriber Used to indicate whether the person is the main subscriber of the membership. The valid values are:

  • Yes

  • No

Note: This tag and all the tags within this parent tag are only applicable for the Fully-Insured Group Health Insurance and Individual Health Insurance businesses.
 Yes
policyNumber

You can use this tag within the following tags:

  • memberData - Here, the policyNumber tag is used to specify the policy number.

  • policyData - Here, the policyNumber tag is used to specify the policy number.

Note: This tag is applicable only for the Self-Funded Group Health Insurance and Fully-Insured Group Health Insurance businesses.
 Yes (Conditional)
Note: This data is required while defining or editing the respective information.
planNumber

You can use this tag within the following tags:

  • memberData - Here, the planNumber tag is used to indicate the fully-insured group policy plan for which the membership is created.

  • planData - Here, the planNumber tag is used to specify the plan number.

Note: This tag is applicable only for the Self-Funded Group Health Insurance and Fully-Insured Group Health Insurance businesses.
 Yes (Conditional)
Note: This data is required while defining or editing the respective information.
healthPlanCode Used to indicate the health plan for which the main subscriber has enrolled.
Note: This tag is applicable only for the Individual Health Insurance business.
 Yes
membershipRateGuarantee Used to specify information about the rate guarantee.
Note: This tag and all the tags within this parent tag are applicable only for the Individual Health Insurance business.
 No
membershipRateGuaranteeList Used to specify rate guarantee details for each individual membership. No
rateGuaranteeStartDate Used to specify the date from when the rate guarantee is available for the individual membership. Yes (Conditional)
Note: This data is required while defining or editing the respective information.
rateGuaranteeEndDate Used to specify the date till when the rate guarantee is available for the individual membership. Yes (Conditional)
Note: This data is required while defining or editing the respective information.
rateGuaranteeStatus Used to indicate the status of the rate guarantee period. The valid values are:

  • Active

  • Inactive

 Yes (Conditional)
Note: This data is required while defining or editing the respective information.
membershipPersonCharacteristic Used to specify a list of characteristics for the member person. No
benefitData Used to specify information about the membership benefit.
Note: This tag and all the tags within this parent tag are applicable only for the Fully-Insured Group Health Insurance and Individual Health Insurance businesses.
 Yes (Conditional)
Note: This data is required while defining or editing a membership benefit.
benefitDataList Used to specify the details of a membership benefit. Yes (Conditional)
Note: This data is required while defining or editing a membership benefit.
benefitStatus Used to indicate the status of the membership benefit. The valid values are:

  • ACTIVE

  • DISCARD

Note:

While defining a membership benefit, by default, the status is set to Active.

On editing a membership benefit, the system inactivates the old record and creates a new record in the system. The status of the old benefit record is set to Inactive and the status of the new benefit record is set to Active.

You can discard an active or inactive membership benefit whenever required.

 Yes (Conditional)
Note: This data is required while defining or editing a benefit.
benefitSourceFlag Used to indicate the source (i.e. health insurance exchange) from where the benefit is received for the membership. The valid values are:

  • CMS

  • ST

Note: You can only specify a value which is defined in the BENEFIT_​SRC_​FLG lookup field.
 No
benefitSubTypeFlag Used to indicate whether the membership benefit is a Medicare Part A, Part B, or Part D benefit, Medicare Part D LIS, Medicare Part D LEP, APTC benefit, or any other membership benefit.
Note: You can only specify a benefit sub type which is already defined in the system.
 No
planBenefitPackageId Used to indicate the Medicare plan benefit package (i.e. 800 series plan) which is applicable for the membership benefit.
Note: You can only specify a Medicare plan benefit package which is already defined in the system.
 Yes (Conditional)
Note: This data is required while creating the Medicare Part A, Part B, or Part D membership benefit.
benefitAmount Used to specify the pass-through amount for the availed membership benefit. Yes (Conditional)
Note: This data is required while creating the Medicare Part D LIS, Medicare Part D LEP, APTC, or other membership benefits.
billableChargeData Used to specify the details for a billable charge. Ideally, this piece of information should be specified in the main subscriber details and not in the member person details.
Note: This tag and all the tags within this parent tag are applicable only for the Fully-Insured Group Health Insurance and Individual Health Insurance businesses.
 Yes (Conditional)
Note: This data is required while defining or editing a billable charge of a membership.
accountIdType Used to specify the account identifier type.
Note: You must specify an account identifier type which is already defined in the system.
 Yes (Conditional)
Note: This data is required when the accountIdValue tag contains the account identifier.
accountIdValue Used to indicate the account for which you want to create the billable charge. Yes (Conditional)
Note: This data is required when the accountIdType tag contains the account identifier type.
chargeType Used to indicate the type of billable charge that you want to create.
Note: You must specify a charge type which is already defined in the system.
 No
priceItemCode

You can use this tag within the following tags:

  • billableChargeData - Here, the priceItemCode tag is used to indicate the price item for which you want to create the billable charge.

  • planData - Here, the priceItemCode tag is used to indicate the price item which you want to associate with the policy plan.

 Yes (Conditional)
Note: This data is required while defining or editing a billable charge of a membership.
description

You can use this tag within the following tags:

  • billableChargeData - Here, the description tag is used to specify the description for the billable charge.

  • policyData - Here, the description tag is used to specify the description for the policy.

 Yes (Conditional)
Note: This data is required while defining the respective information.
recurringMethod Used to indicate whether recurring bill segments must be created for the billable charge at the specified intervals. The valid values are:

  • BP - Used when you want to create recurring bill segments at the intervals defined in the bill period.

  • FR - Used when you want to create recurring bill segments at the set invoice frequency.

 No
billPeriod Used to indicate the bill period using which you want to determine the intervals at which the recurring bill segments must be created.
Note: You must specify a bill period which is already defined in the system.
 Yes (Conditional)
Note: This data is required when the recurringMethod tag contains BP.
frequency Used to indicate the invoice frequency at which the recurring bill segments must be created.
Note: You must specify an invoice frequency which is already defined in the system.
 Yes (Conditional)
Note: This data is required when the recurringMethod tag contains FR.
billAfterDt Used to specify the date after which the bill must be generated for the billable charge.
Note: You must specify the date in the YYYY-MM-DD format.
 No
billableChargeLines Used to specify the details for a pass through line in the billable charge. Yes
descriptionOnBill Used to specify the information about the pass through line that should appear on the bill. Yes
currencyCode Used to indicate the currency in which you want to charge the amount.
Note:

You must specify a currency which is already defined in the system.

If you specify a currency other than the account's invoice currency, the system will do the currency conversion if the appropriate exchange rate is available in the system.

 Yes
chargeAmount Used to specify the charge amount. Yes
showOnBillSw Used to indicate whether the charge should appear on the person's printed bill. The valid values are:

  • True

  • False

Note: If you do not specify the value, by default, it is set to True.
 No
appearInSummarySw Used to indicate whether the charge should be included in the summary line. The valid values are:

  • true

  • false

Note: If you do not specify the value, by default, it is set to false.
 No
distributionCode Used to specify the distribution code which indicates the GL account associated with the charge.
Note: You must specify a distribution code which is already defined in the system.
 No
accountData Used to specify the account details of a person. Yes (Conditional)
Note: This data is required while defining or editing an account.
accountType Used to indicate the type of account. This information is stored as a characteristic for the account.
Note:

The value is stored in the characteristic type which is specified in the Invoice Type Characteristic Type option type of the C1-ASOBLLNG feature configuration.

You must specify a value which is already defined in the predefined characteristic type.

 Yes (Conditional)
Note: This data is required while defining or editing an account.
customerClass Used to indicate the customer class to which the account belongs.
Note: You must specify a customer class which is already defined in the system.
 Yes (Conditional)
Note: This data is required while defining an account.
billCycle Used to indicate the bill cycle for the account.
Note: You must specify a bill cycle which is already defined in the system.
 No
billLeadDays Used to indicate whether you want to bill the account in advance. Here, you need to specify the number of days which is used to derive the cut-off date for advance billing. If you do not want to bill the account in advance, you must specify the value as zero(0).
Note: If you do not specify the value, by default, it is set to zero(0).
 No
currency Used to indicate the currency in which you want to bill the account.
Note: You must specify a currency which is already defined in the system.
 Yes (Conditional)
Note: This data is required while defining an account.
dragDays

You can use this tag within the following tags:

  • personData - Here, the dragDays tag is used to specify additional grace days (if any) offered at the person level. These drag days are considered while calculating the grace end date when the trigger date calculation mode (in the respective delinquency process type) is set to Latest Bill Due Date with Grace Period.
    Note: For example, if the latest bill due date is 05-Jan-2024, grace period is set to 5 days (in the respective delinquency process type), and drag days is to 10 days (for the respective person), then the grace end date for the person is set to 20-Jan-2024.
  • accountData - Here, the dragDays tag is used to specify additional grace days (if any) offered at the account level. These drag days are considered while calculating the grace end date when the trigger date calculation mode (in the respective delinquency process type) is set to Latest Bill Due Date with Grace Period.
    Note: For example, if the latest bill due date is 05-Jan-2024, grace period is set to 5 days (in the respective delinquency process type), and drag days is to 10 days (for the respective account), then the grace end date for the account is set to 20-Jan-2024.
 Yes (Conditional)
Note: This data is required while defining an account.
setUpDate Used to specify the date when the account was first created. This is purely informational.
Note:

You must specify the date in the YYYY-MM-DD format.

If you do not specify the value, by default, it is set to the current date.

 No
acctUsageFlg Used to indicate the category to which the account belongs. The valid values are:

  • INVC - Indicates that the account will be used to bill charges of the usage accounts.

  • SETL - Indicates that the account will be used only for settlement purposes.

  • USAG - Indicates that the account will have its own charges. If the usage account is linked to any construct, the usage account's charges are billed through an invoice account. Otherwise, the usage account is billed individually.

Note: If you do not specify the value, by default, it is set to USAG.
 No
comments

You can use this tag within the following tags:

  • accountData - Here, the comments tag is used to specify additional information about the account.

  • autoPayDetails - Here, the comments tag is used to specify additional information about the auto pay instruction.

 No
deferAutoPayDt Used to specify the date till when you want to hold the automatic payment process for the account. No
collectionClass

You can use this tag within the following tags:

  • personData - Here, the collectionClass tag is used to control how the person's debt is compared against collection criteria (i.e. tolerance limit) to determine whether a collection process (such as delinquency process) should be initiated for the person. A new collection method named Self-Control Delinquency is available while defining a collection class. It is used to create a distinct or separate delinquency process for the persons who belong to the collection class. If you want to evaluate the debt of the person's accounts, its child persons, and the child persons’ accounts while monitoring the person's delinquency, you must set the collection method of their respective collection class to Parental Delinquency. If you set the collection method of the collection class for any of the person's account, any of its child person, or child persons' accounts to Self-Control Delinquency, the system does not consider the debt of the respective entity while monitoring the delinquency of the parent person.
    Note:

    If you do not want to initiate delinquency process for a child person or an account, ensure that the person or account belongs to a collection class where the collection method is set to Not Eligible for Collection.

    If the collection class is not defined for a person, the system skips the person while monitoring the delinquency.

  • accountData - Here, the collectionClass tag is used to control how the account's debt is compared against collection criteria (i.e. tolerance limit) to determine whether a collection process (such as delinquency process) should be initiated for the account. A new collection method named Self-Control Delinquency is available while defining a collection class. It is used to create a distinct or separate delinquency process for the accounts which belong to the collection class.
    Note:

    If you do not want to initiate delinquency process for an account, ensure that the account belongs to a collection class where the collection method is set to Not Eligible for Collection.

    If the collection class is not specified for an account, the system, by default, sets it to the one specified in the respective customer class when you create the account through a health care inbound message.

Note:

You must specify a collection class which is already defined in the system.

This tag is applicable only for the Fully-Insured Group Health Insurance and Individual Health Insurance businesses.

 No
postponeCreditReviewUntil Used when you want to review the account's debt after a particular date. The system will consider the account for monitoring the delinquency only after the specified date. You can specify the postpone credit review until date for an account from the user interface or through a health care inbound message.
Note: This tag is applicable only for the Fully-Insured Group Health Insurance and Individual Health Insurance businesses.
 Yes (Conditional)
Note: This data is required while defining or editing the respective information.
lastCreditReviewDate Used to indicate the date when the account's debt was last reviewed. The system stamps the last credit review date against an account when a delinquency process is initiated for the account through the C1-ACDLQ batch.
Note: This tag is applicable only for the Fully-Insured Group Health Insurance and Individual Health Insurance businesses.
 Yes (Conditional)
Note: This data is required while defining or editing the respective information.
billRouteType

You can use this tag within the following tags:

  • accountData - Here, the billRouteType tag is used to indicate how the account's bill must be sent to the main customer.

  • accountPersonRouting - Here, the billRouteType tag is used to indicate how the account's bill must be sent to the linked person.

Note: You must specify a bill route type which is already defined in the system.
 Yes (Conditional)
Note: This data is required while defining or editing the respective information.
billAddressSource

You can use this tag within the following tags:

  • accountData - Here, the billRouteType tag is used to indicate whether the account's bill must be sent to the main customer's mailing address or to the main customer's account override address. The valid values are:

    • PER

    • ACOV

  • accountPersonRouting - Here, the billRouteType tag is used to indicate whether the account's bill must be sent to the linked person's mailing address or to the linked person's account override address. The valid values are:

    • PER

    • ACOV

Note: You must specify a value which is already defined in the BILL_​ADDR_​SRCE_​FLG lookup field. It must be in the Active status.
 Yes (Conditional)
Note: This data is required while defining the respective information.
skipAutoMaintenanceSw Used to specify whether auto maintenance should be skipped for an account.
Note: This tag is applicable only for the Individual Health Insurance business.
 Yes (Conditional)
Note: This data is required while defining the respective information.
autoPayDetails Used to specify the auto pay instruction for the account. Yes (Conditional)
Note: This data is required while defining or editing an auto pay instruction of an account.
priority Used to indicate the priority in which the auto pay instruction should be considered when multiple auto pay instructions are effective on the bill's due date.
Note: The priority cannot be less than or equal to zero.
 Yes (Conditional)
Note: This data is required while defining or editing an auto pay instruction of an account.
percentage Used to indicate the percentage in which the payment must be split between two or more auto pay sources having the same priority. Yes (Conditional)
Note: This data is required while defining or editing the split auto pay instruction for an account.
autoPayMethod Used to indicate how you want to process the automatic payment request. The valid values are:

  • C1DD - Indicates that you want to directly debit the main customer's bank account.

  • C1PA - Indicates that you want to send a payment advice to the main customer.

 No
autoPayRouteType Used to indicate when and how automatic payment request of the account is routed to a financial institution.
Note: You must specify an auto pay route type which is already defined in the system.
 Yes (Conditional)
Note: This data is required while defining or editing an auto pay instruction of an account.
autoPaySourceCode Used to indicate the financial institution that receives the automatic payment request.
Note: You must specify an auto pay source which is already defined in the system.
 Yes (Conditional)
Note: This data is required while defining or editing an auto pay instruction of an account.
accountNumber Used to indicate the bank account number through which the automatic payment must be done. Yes (Conditional)
Note: This data is required while defining or editing an auto pay instruction of an account.
expiryMonth Used to specify the month when the tender type of the auto pay source will expire.
Note: You must specify the month in the MM format.
 Yes (Conditional)
Note: This data is required when the Expiration Date Required option is selected for the tender type which is specified in the auto pay source.
expiryYear Used to specify the year when the tender type of the auto pay source will expire.
Note: You must specify the year in the YYYY format.
 Yes (Conditional)
Note: This data is required when the Expiration Date Required option is selected for the tender type which is specified in the auto pay source.
name Used to specify the name of the person as it appears in the financial institution's system. No
maxWithdrawalAmount Used to specify the maximum amount that can be automatically debited from the bank account. It is used to set the limit on the withdrawal amount.
Note: The maximum withdrawal amount cannot be less than zero.
 No
accountPerson Used to specify information about the person (other than main customer) to whom you want to link the account.
Note:

The system, by default, adds the person (for whom the account information is given in the health care inbound message) as the main customer of the account. While linking the person as main customer of the account, the system sets the following attributes:

Attribute Name Attribute Value
Financially Responsible Y
Account Relationship Type Main Customer
Receive Copy of Bill Y
Bill Format Detailed
Receives Notification Y
Number of Bill Copies 1
Yes (Conditional)
Note: This data is required while linking a person to an account.
accountRelationshipType Used to indicate how the person is related to the account.
Note: You must specify an account relationship type which is already defined in the system.
 Yes (Conditional)
Note: This data is required while linking a person to an account.
isFinanciallyResponsible Used to indicate whether the person is financially responsible for the account. The valid values are:

  • True

  • False

Note: If you do not specify the value, by default, it is set to False.
 No
personAddressOverride Used to specify the account override address for the linked person. No
postal Used to specify the postal code of the address. No
accountPersonRouting Used to specify the bill routing information for the linked person. Yes (Conditional)
Note: This data is required while defining or editing the bill routing information of a linked person.
shouldReceiveCopyOfBill Used to indicate whether the linked person should receive a copy of the account's bill. The valid values are:

  • Y

  • N

Note: If you do not specify the value, by default, it is set to N.
 No
billFormat Used to indicate whether the linked person should receive the detailed or summary bill. The valid values are:

  • D

  • S

Note:

You must specify a value which is already defined in the BILL_​FORMAT_​FLG lookup field. It must be in the Active status.

If you do not specify the value, by default, it is set to D when the linked person should receive a copy of the account's bill.

This information is ignored when the shouldReceiveCopyOfBill tag contains N.

 No
numberOfBillCopies Used to indicate the number of copies of the bill which the linked person must receive.
Note:

If you do not specify the value, by default, it is set to 1 when the linked person should receive a copy of the account's bill.

This information is ignored when the shouldReceiveCopyOfBill tag contains N.

 No
receivesNotification Used to indicate whether the linked person should receive letters (i.e. notifications) initiated by collection, write-off, and overdue events. The valid values are:

  • Y

  • N

Note:

If you do not specify the value, by default, it is set to N.

This information is ignored when the shouldReceiveCopyOfBill tag contains N.

 No
policyData Used to specify the details of the policy.
Note: This tag and all the tags within this parent tag are only applicable for the Self-Funded Group Health Insurance and Fully-Insured Group Health Insurance businesses.
 Yes (Conditional)
Note: This data is required while defining or editing a policy.
policyType Used to indicate the policy type using which you are defining the policy.
Note: You must specify a policy type which is already defined in the system. If you want to create a fully-insured group policy, you must specify a policy type where the policy category is set to Fully-Insured Group. However, if you want to create a self-funded policy, you must specify a policy type where the policy category is set to Self-Funded.
 Yes (Conditional)
Note: This data is required while defining or editing a policy.
advancedLevelFundingEligibility Used to indicate whether the self-funded policy provides advanced level funding eligibility. The valid values are:

  • Yes

  • No

Note:

At present, if you are defining a self-funded policy the advanced level funded eligibility is set to No.

This tag and all the tags within this parent tag are only applicable for the Self-Funded Group Health Insurance and Fully-Insured Group Health Insurance businesses.

 Yes (Conditional)
Note: This data is required while defining or editing a policy.
runOutEndDate Used to specify the date when the runout period of the self-funded policy ends.
Note:

The runout end date cannot be earlier than or equal to the policy end date.

This data is required when you are defining a policy using a policy type where the policy category is set to Self-Funded.

This tag is applicable only for the Self-Funded Group Health Insurance business.

 No
runOutAdminOption Used to indicate whether the administration fees must be charged when the claim transaction for the self-funded policy is processed in the runout period. The valid values are:

  • None

  • Percentage of Claim

Note:

At present, this data is used only for the informational purposes and is not considered during the billable charge creation for the claim transactions which are received in the runout period of the policy.

This data is required when you are defining a policy using a policy type where the policy category is set to Self-Funded.

This tag is applicable only for the Self-Funded Group Health Insurance business.

 No
renewalDate Used to specify the date when you want to renew the fully-insured group policy.
Note:

You can renew a self-funded policy only from the user interface.

You must specify the date in the YYYY-MM-DD format.

This tag is applicable only for the Self-Funded Group Health Insurance and Fully-Insured Group Health Insurance businesses.

 Yes (Conditional)
Note: This data is required while renewing a fully-insured group policy.
advanceDepositApplSW Used to indicate whether the advance deposit is applicable for the policy. The valid values are:

  • Y

  • N

Note:

If you do not specify the value, the system, by default, sets it to N.

This tag is applicable only for the Fully-Insured Group Health Insurance business.

 Yes (Conditional)
Note: This data is required while renewing a fully-insured group policy.
advanceDepositAmount

You can use this tag within the following tags:

  • personData - Here, the advanceDepositAmount tag is used to specify the advance deposit amount. It is required when the advance deposit level is set to PG

    .

  • policyData - Here, the advanceDepositAmount tag is used to specify the advance deposit amount. It is required when the advance deposit applicability is set to Y

Note: This tag is applicable only for the Fully-Insured Group Health Insurance business.
 Yes (Conditional)
Note: This data is required while renewing a fully-insured group policy.
advanceDepositGraceDays

You can use this tag within the following tags:

  • personData - Here, the advanceDepositAmount tag is used to specify the grace days. The system then uses the grace days to derive the grace period within which the advance deposit should be received from the group customer. While calculating the grace period, the system derives the earliest start date among all the polices where the parent customer is the policy holder and considers it as the grace start date. Once the grace start date is derived, the system calculates the grace end date (i.e. grace start date + grace days).
    Note: For example, if a parent customer is the policy holder of two policies - P1 (01-Jan-2022 to 31-Dec-2022) and P2 (01-Jun-2022 to 31-Dec-2022) and advance deposit grace days is set to 6 days, then the system considers 01-Jan-2022 as the grace start date (as it is the earliest start date) and sets the grace end date to 07-Jan-2022. The advance deposit grace days is required when the advance deposit level is set to PG.
    .
  • policyData - Here, the advanceDepositAmount tag is used to specify the grace days. The system then uses the grace days to derive the grace period within which the advance deposit should be received from the group customer for the policy. While calculating the grace period, the system considers the policy start date as the grace start date. Once the grace start date is derived, the system calculates the grace end date (i.e. grace start date + grace days).
    Note: For example, if a parent customer is the policy holder of the P1 policy (01-Jan-2022 to 31-Dec-2022) and advance deposit grace days is set to 6 days, then the system considers 01-Jan-2022 as the grace start date and sets the grace end date to 07-Jan-2022. The advance deposit grace days is required when the advance deposit applicability is set to Y.
Note: This tag is applicable only for the Fully-Insured Group Health Insurance business.
 Yes (Conditional)
Note: This data is required while renewing a fully-insured group policy.
advanceDepositLevel Used to indicate whether you want to park the advance deposit received from the group customer at the parent customer or policy level. The valid values are:

  • PG

    - Used when you want to park the advance deposit at the parent customer level.

  • POLI

    - Used when you want to park the advance deposit at the policy level.
Note:

The advance deposit level is only applicable for the person whose person type is set to Parent Customer. If you do not specify the advance deposit level, then the parent customer is not eligible for the advance deposit either at the parent customer or policy level.

This tag is applicable only for the Fully-Insured Group Health Insurance business.

 Yes (Conditional)
Note: This data is required while renewing a fully-insured group policy.
advanceDepositAccountIdentifierType Used to specify the account identifier type.
Note:

It is required when the advance deposit applicability is set to Y.

This tag is only applicable for the Fully-Insured Group Health Insurance business.

 Yes (Conditional)
Note: This data is required while renewing a fully-insured group policy.
advanceDepositAccountIdentifierValue Used to specify the account identifier. Here, you must specify an account of the policy holder where the account relationship type is set to the value that is specified in the Advance Deposit Account Relationship Type attribute of the delinquency process preference.
Note:

It is required when the advance deposit applicability is set to Y.

This tag is applicable only for the Fully-Insured Group Health Insurance business.

 Yes (Conditional)
Note: This data is required while renewing a fully-insured group policy.
policyPersons Used to indicate the person that you want to associate with the policy. Yes
policyPerRole Used to indicate the role of the person in the policy.
Note: You must specify a policy person role which is already defined in the system.
 Yes (Conditional)
Note: This data is required while associating a person with the policy.
terminationInformation Used to specify the termination details of the fully-insured group policy.
Note:

At present, you cannot terminate a self-funded policy either from the user interface or through a health care inbound message.

This tag and all the tags within this parent tag are applicable only for Fully-Insured Group Health Insurance business.

 No
terminateDate Used to specify the date when you want to terminate the fully-insured group policy.
Note:

You must specify the date in the YYYY-MM-DD format.

The termination date cannot be earlier than the policy start date.

On terminating a policy, the status of the policy is changed to the status which is specified in the Policy Termination Status option type of the C1-ASOBLLNG feature configuration.

 Yes (Conditional)
Note: This data is required while terminating a fully-insured group policy.
terminationReason Used to indicate the reason why you want to terminate the fully-insured group policy.
Note: You must specify the status reason which is already defined for the status specified in the Policy Termination Status option type of the C1-ASOBLLNG feature configuration.
 Yes (Conditional)
Note: This data is required while terminating a fully-insured group policy.
reinstateInformation Used to specify the reinstatement details of the fully-insured group policy.
Note:

At present, you cannot reinstate a self-funded policy either from the user interface or through a health care inbound message.

This tag and all the tags within this parent tag are applicable only for Fully-Insured Group Health Insurance business.

 No
reinstatementDate Used to specify the date when you want to reinstate the fully-insured group policy.
Note:

You must specify the date in the YYYY-MM-DD format.

The reinstatement date cannot be earlier than the policy start date.

On reinstating a policy, the status of the policy is changed to the status which is specified in the Policy Reinstatement Status option type of the C1-ASOBLLNG feature configuration.

 Yes (Conditional)
Note: This data is required while reinstating a fully-insured group policy.
reinstateReason Used to indicate the reason why you want to reinstate the fully-insured group policy.
Note: You must specify the status reason which is already defined for the status specified in the Policy Reinstatement Status option type of the C1-ASOBLLNG feature configuration.
 Yes (Conditional)
Note: This data is required while reinstating a fully-insured group policy.
planData Used to specify the details of the policy plan.
Note:

At present, you can only define a policy plan in a fully-insured group policy. Therefore, the system will ignore this information when given for a self-funded policy.

This tag and all the tags within this parent tag are applicable only for the Self-Funded Group Health Insurance and Fully-Insured Group Health Insurance businesses.

 Yes (Conditional)
Note: This data is required while defining or editing a policy plan.
planName Used to specify the description of the policy plan. No
pricingRuleTypeList Used to associate a pricing rule type with the policy plan. Yes (Conditional)
Note: This data is required while associating a pricing rule type with the policy plan.
pricingRuleType Used to specify the pricing rule type.
Note: At present, you can only associate those pricing rule types where the category is set to Age Based, Tier Based, or Pass-Through Billable Charge. Therefore, the system will ignore the pricing rule types where the category is set to Claim, Specific Stop-Loss, Aggregate Stop-Loss, Retention Type Claim Based, Retention Type Enrollment Based, Flat Fees, Ancillary, Discount Arrangement, or Level Funded.
 Yes (Conditional)
Note: This data is required when a price item is not associated with the policy plan.
primaryPlanSw Used to indicate whether the plan is a primary plan in the policy. The valid values are:

  • Y

  • N

Note: If you do not specify the value, by default, it is set to N.
 No
benefitTypeFlag Used to indicate the type of benefit availed for the membership. The valid values are:

  • COMM

  • MA

Note: The list includes only those benefit types which are defined in the BENEFIT_​TYPE_​FLG lookup field.
 Yes
policyPlanProrationRuleList Used to specify the proration rules defined for the policy plan.
Note: This tag and all the tags within this parent tag are applicable only for Fully-Insured Group Health Insurance business.
 Yes (Conditional)
Note: This data is required while defining or editing the proration rules for the policy plan.
prorationEventType Used to indicate the event when you want to prorate the membership premium. The valid values are:

  • Enrollment - Used when you want to prorate the membership premium on enrolling a member person.

  • Termination - Used when you want to prorate the membership premium on terminating a member person.

  • New Born - Used when you want to prorate the membership premium on enrolling a new born.

  • Same Month Enrollment and Termination - Used when you want to prorate the membership premium on enrolling and terminating a member person in the same month.

 Yes (Conditional)
Note: This data is required while defining or editing the proration rules for the policy plan.
prorationType Used to indicate how you want to prorate the membership premium. The valid values are:

  • Daily - Used when you want to prorate the membership premium from the day the proration event has occurred.

  • Mid-Month - Used when you want to prorate the membership premium based on the proration date. The system calculates the proration date using the following formula: 

    Bill Period Start Date + Specified Number of Days

    For example, if the bill period start date is 1st of every month and number of days is 15, then the proration date would be 15th of every month. If a member person is enrolled to the membership on or before the proration date, the system will charge the premium for the member person. However, if a member person is enrolled to the membership after the proration date, the system will not charge the premium for the member person. And, if a member person is terminated from the membership on or after the proration date, the system will charge the premium for the member person. However, if a member person is terminated from the membership before the proration date, the system will not charge the premium for the member person.

  • Full Month - Used when the premium for a member person should be charged when the member person is enrolled or terminated on the coverage start date or coverage end date, respectively. If a member person is enrolled or terminated within the coverage period, the system will not charge the premium for the member person.

  • Waiver - Used when the premium for a member person should be waived off completely for the month when the member person is enrolled or terminated from the membership.

  • Coverage Days - Used when you want to prorate the premium for a member person based on the coverage days. If a member person is covered in the membership for a period less than the specified number of days, the system will not charge the premium for the member person. However, if a member person is covered in the membership for a period equal to or more than the specified number of days, the system will charge the premium for the member person.

    Note: You can use this proration type when the proration event is set to Same Month Enrollment and Termination.

  • Enrollment - Used when you want to prorate the premium for a member person using the proration type of the enrollment event.

    Note: You can use this proration type when the proration event is set to Same Month Enrollment and Termination.

  • Termination - Used when you want to prorate the premium for a member person using the proration type of the termination event.

    Note: You can use this proration type only when the proration event is set to Same Month Enrollment and Termination.
 Yes (Conditional)
Note: This data is required while defining or editing the proration rules for the policy plan.
numberOfDays Used to specify the number of days to determine the cutoff date. Yes (Conditional)
Note: This data is required when the proration type is set to Mid-Month or Coverage Days.
pricingRuleData Used to specify the details of the pricing rule.
Note: This tag and all the tags within this parent tag are applicable only for the Fully-Insured Group Health Insurance business.
 Yes (Conditional)
Note: This data is required while defining or editing a pricing rule.
entityIdentifiers Used to specify a list of entities (i.e. policy, source system, and plan) using which you can derive the plan to which you want to associate the pricing rule. Yes
entityIdentifiersList Used to specify the details of the entity. Yes
entityIdentifierType Used to specify the entity type. The valid values are:

  • PLAN - Used when you want to specify the plan number.

  • PLCY - Used when you want to specify the policy number.

  • SSYS - Used when you want to specify the source system

 Yes (Conditional)
Note: This data is required while defining or editing a pricing rule.
entityIdentifierValue Used to specify the entity identifier (i.e. plan number, policy number, or source system). Yes (Conditional)
Note: This data is required while defining or editing a pricing rule.
status Used to indicate the status of the pricing rule. The valid values are:

  • ACTV

  • INAC

Note: If you do not specify the value, by default, it is set to Active.
 No
pricingRuleType Used to indicate the pricing rule type using which you want to define the pricing rule.
Note: You must specify a pricing rule type where the category is set to Age Based or Tier Based.
 Yes (Conditional)
Note: This data is required while defining or editing a pricing rule.
priceItemCd Used to indicate the price item for which you want to define the pricing rule.
Note: You must specify a price item which is already associated with the respective pricing rule type.
 Yes (Conditional)
Note: This data is required while defining or editing a pricing rule.
rateOption Used to indicate the rate option using which you want to create price assignment for the pricing rule.
Note:

You must specify a rate option which is already defined in the C1-ExtLookRetTypeRateOpt extendable lookup. It must be in the Active status.

If the rate option is not given for an age-based pricing rule, by default, it is set to:

  • The value specified in the Default Rate Option - Flat option type of the C1-ASOBLLNG feature configuration when the modifier method is set to FLAT

  • The value specified in the Default Rate Option - Percentage option type of the C1-ASOBLLNG feature configuration when the modifier method is set to EXPT or INPT

However, if the rate option is not given for a tier-based pricing rule, by default, it is set to a value specified in the Default Rate Option - Flat option type of the C1-ASOBLLNG feature configuration when the modifier method is set to FLAT or NULL.

 No
modifierApplicability Used to indicate whether you want to increase or decrease the premium of an eligible member based on certain modifiers (i.e. parameters, such as tobacco usage, alcohol usage, and so on). The valid values are:

  • Y

  • N

Note: If you do not specify the value, by default, it is set to N.
 No
modifierMethod Used to indicate whether the system should consider the modifier rate as a flat amount or percentage. The valid values are:

  • FLAT - Indicates that the system should consider the modifier rate as a flat amount.

  • INPT - Indicates that the system should consider the modifier rate as inclusive percentage.

  • EXPT - Indicates that the system should consider the modifier rate as exclusive percentage.

 Yes (Conditional)
Note: This data is required when the modifierApplicability tag contains Y.
baseRate Used to specify the base fees for employees with a particular set of attributes. You can define different base fees for employees with different set of attributes.
Note: While creating a price assignment for the pricing rule, the system creates one price component for each given set of base rate information.
 Yes (Conditional)
Note: This data is required while defining a pricing rule.
baseFee Used to specify the base fees for the eligible members. Yes (Conditional)
Note: This data is required while defining a pricing rule.
lowerAgeLimit Used to specify the lower age limit. It is used to define lower age limit pricing eligibility criteria in the price component.
Note:

The system defines the lower age limit pricing eligibility criteria using the parameter which is specified in the Age Based Parameter option type of the C1-ASOBLLNG feature configuration.

This data is ignored when given in a tier-based pricing rule information.

 Yes (Conditional)
Note: This data is required while defining an age-based pricing rule.
upperAgeLimit Used to specify the upper age limit. It is used to define upper age limit pricing eligibility criteria in the price component.
Note:

The system defines the upper age limit pricing eligibility criteria using the parameter which is specified in the Age Based Parameter option type of the C1-ASOBLLNG feature configuration.

This data is ignored when given in a tier-based pricing rule information.

 Yes (Conditional)
Note: This data is required while defining an age-based pricing rule.
pricingParameter Used to specify a set of employee attributes based on which the base fees may vary. Yes (Conditional)
Note: This data is required while defining a tier-based pricing rule.
parameterCode

You can use this tag within the following tags:

  • pricingParameter - Here, the parameterCode tag is used to specify the employee attribute (i.e. parameter, such as employee status, employee location, and so on) using which you want to define the pricing eligibility criteria.

  • modifierInformation - Here, the parameterCode tag is used to specify the modifier (i.e. parameter, such as tobacco usage, alcohol usage, and so on) using which you want to define the pricing eligibility criteria.

Note:

You must define the employee attributes and modifiers as parameters in the system. Note that you must set the parameter usage for these parameters to Pricing Eligibility Criteria. The system creates an pricing eligibility criteria for each parameter and/or modifier specified in the pricing rule information.

You cannot specify any special character except underscore (_​) in the parameter name.

 Yes (Conditional)
Note: This data is required while specifying the respective information.
parameterValue

You can use this tag within the following tags:

  • pricingParameter - Here, the parameterValue tag is used to specify the value for the parameter (i.e. employee attribute).

  • modifierInformation - Here, the parameterValue tag is used to specify the value for the parameter (i.e. modifier).

Note: You can specify any special characters except ampersand (&), comma (,), underscore (_​), equal to (=), tilde (~), and semi-colon(;) in the parameter value.
 Yes (Conditional)
Note: This data is required while specifying the respective information.
modifierInformation Used to specify the modifier based on which you want to increase or decrease the base fees.
Note: While creating a price assignment for the pricing rule, the system creates one price component for each given set of modifier information and then links these modifier price components with the respective base rate price component.
 Yes (Conditional)
Note: This data is required while specifying the modifier information.
rate Used to specify the flat amount or percentage by which you want to increase or decrease the premium of an eligible member. Yes (Conditional)
Note: This data is required while specifying the modifier information.
statementConstructsData Used to specify the details of the statement construct.
Note: This tag and all the tags within this parent tag are applicable only for the Fully-Insured Group Health Insurance and Individual Health Insurance businesses.
 Yes (Conditional)
Note: This data is required while defining or editing a statement construct.
personStatementConstructs Used to specify the details of a person for whom the statement construct is created. Yes (Conditional)
Note: This data is required while defining or editing a statement construct.
personIdentifier Used to specify the person with the statement construct. Yes (Conditional)
Note: This data is required while defining or editing a statement construct.
personIdentifierType Used to specify the person identifier type associated with the statement construct. Yes (Conditional)
Note: This data is required while defining or editing a statement construct.
statementConstructIdentifier Used to specify the statement construct identifier defined for the statement construct. Yes (Conditional)
Note: This data is required while defining or editing a statement construct.
statementAddressSource Used to indicate the source whose address should be used for sending the statements to the person. The valid value is:

  • Person

 Yes (Conditional)
Note: This data is required while defining or editing a statement construct.
statementCycle Used to indicate the statement construct cycle for a person. Yes (Conditional)
Note: This data is required while defining or editing a statement construct.
statementRouteType Used to indicate how to route the statements to the person. Yes (Conditional)
Note: This data is required while defining or editing a statement construct.
effectiveStatus Used to indicate the status of the statement construct. The valid values are:

  • Active

  • Inactive

 Yes (Conditional)
Note: This data is required while defining or editing a statement construct.
addressId Used to specify the address to which the statement should be sent. Yes (Conditional)
Note: This data is required while defining or editing a statement construct.
numberOfCopies Used to specify the number of copies of the statement construct you want the person to receive. Yes (Conditional)
Note: This data is required while defining or editing a statement construct.
statementFormat Used to indicate the format of the statement construct. The valid values are:

  • Detail

  • Summary

 Yes (Conditional)
Note: This data is required while defining or editing a statement construct.
description Used to specify the description of the statement construct. Yes (Conditional)
Note: This data is required while defining or editing a statement construct.
statementConstructDetails Used to specify the statement construct details. Yes (Conditional)
Note: This data is required while specifying the statement construct information.
serviceAgreement Used to specify the statement construct contract. Yes
accountNumber Used to specify the value for the account identifier type of the payee.
Note: You must specify the account number which is already defined in the system.
 Yes (Conditional)
Note: This data is required while specifying the statement construct information.
accountNumberTypeCd Used to specify the account identifier type of the payee. Yes (Conditional)
Note: This data is required while specifying the statement construct information.
statementPrintDescription Used to specify the description of the construct detail associated with the contract. Yes (Conditional)
Note: This data is required while specifying the statement construct information.
printOrder Used to specify the financial transactions associated with the account / contract to appear on the printed statement. Yes (Conditional)
Note: This data is required while specifying the statement construct information.
repriceAfterDate Used to specify whether you want to hold the repricing for the membership until the specified date.
Note: This tag is applicable only for the Individual Health Insurance business.
 No
paidThroughDate Used to specify the term end date of the last fully or partially paid term. For more information about the paid through date, refer to Policy.
Note: This tag is applicable only for the Fully-Insured Group Health Insurance and Individual Health Insurance businesses.
 No

The following table lists and describes the tags which are available in the health care inbound message schema, but should not be included in the XML file:

Tag Name Tag Description
c1InboundMessage Displays the inbound message ID.
boStatus Displays the status of the health care inbound message.
statusReason Indicates the reason why the status of the health care inbound message is changed.
person At present, this tag is not supported in a health care inbound message.
statusDateTime Displays the date and time when the status of the health care inbound message is changed in the system.
creationDateTime Displays the date and time when the health care inbound message is created in the system.
searchCharacteristicValue At present, this tag is not supported in a health care inbound message.
version

This tag appears within the following parent tags:

Parent Tag Then the purpose of the version tag is...
schema Displays the version of the health care inbound message.
inboundMessageCharacteristic Displays the version of the characteristic defined for the health care inbound message.
toDoRetry Displays the information about the retry option used for the health care inbound message.
Note: This information appears at the bottom of the inbound message in the Inbound Message Content zone once the health care inbound message is validated and processed either through the user interface or batch process.
retryDateTime Displays the date and time when the retry option is used to change the status of the health care inbound message from Rejected to Pending.
numberOfRetries Indicates the number of times the retry option is used for the health care inbound message.
currentErrorState Indicates the status to which the health care inbound message is transitioned when its validation or processing fails. The valid value is:

  • REJECTED
isRetried Indicates whether the retry option is used to change the status of the health care inbound message. The valid values are:

  • true

  • false

Related Topics

For more information on... See...
Health Care Inbound Message Schema Health Care Inbound Message Schema
Sample Health Care Inbound Message for Fully-Insured Group Customer Setup Sample Health Care Inbound Message for Fully-Insured Group Customer Setup
Sample Health Care Inbound Message for Membership Sample Health Care Inbound Message for Group Membership (Without Benefit)
Sample Health Care Inbound Message for Pricing Rules Sample Health Care Inbound Message for Pricing Rules
Sample Health Care Inbound Message for Self-Funded Customer Setup Sample Health Care Inbound Message for Self-Funded Customer Setup
How to setup the C1-ASOBLLNG feature configuration Setting the C1-ASOBLLNG Feature Configuration