Prerequisites

To use the health care inbound message feature, you need to do the following:

• Define the required customer registration types in the system.

  Note: The health care inbound message creates the person, account, policy, and policy plan through a customer registration object. The system creates the customer registration object using the customer registration type specified in the health care inbound message type. While creating a health care inbound message type for the fully-insured group health insurance business, you must use a customer registration type where the Approval Required, Final Approval Required, and Manual Billing Hierarchy and Pricing options are not selected. However, while creating a health care inbound message type for the self-funded health insurance business, you must use a customer registration type where the Final Approval Required and Manual Billing Hierarchy and Pricing options are selected, but the Approval Required option is not selected.

• Define the required health care inbound message types in the system.

• Define the required characteristic types where the characteristic entity is set to Inbound Message Type.

• Define the required characteristic types where the characteristic entity is set to Inbound Message.

• Define the values for the required parameters in the C1-HCINVAL, C1-HCINPROC, C1-TODORETRY, and C1-TDCRINMSG algorithms.

• Define the values for the C1-SourceSystemLookup and C1-ExtLookRetTypeRateOpt extendable lookups.

• Define the values for the HOUSE_​TYPE, PER_​OR_​BUS_​FLG, NAME_​TYPE_​FLG, ADDRESS_​TYPE_​FLG, BILL_​ADDR_​SRCE_​FLG, BILL_​FORMAT_​FLG, and RUNOUT_​ADM_​OPT_​FLG lookup fields.

• Set the values for the following option types in the C1-ASOBLLNG feature configuration:

  • Person Relationship Type

  • Bill Group Policy Person Role

  • Parent Customer Policy Person Role

  • Invoice Type Characteristic Type

  • Policy Termination Status

  • Policy Reinstatement Status

  • Default Rate Option - Flat

  • Default Rate Option - Percentage

  • Age Based Parameter

  • Membership Inactive Status

  • Member Person Inactive Status

• Set the values for the following option types in the C1-PERSTYPE feature configuration:

  • Bill Group Person Type

  • Parent Person Type

• Define the required person identifier types, account identifier types, person relationship types, characteristic types, phone types, customer classes, bill cycles, collection classes, divisions, bill route types, charge types, currencies, bill periods, invoice frequencies, distribution codes, auto pay route types, auto pay sources, account relationship types, policy types, policy person roles and contract relationship types in the application.

• Define the values for the C1_​INVOICE_​DAY_​BILL_​PERIOD_​FLG lookup field.

  Note: Each lookup field value should be mapped to a valid bill period which exists in the system. You must then define this lookup field value as a predefined value for the C1OFFRST characteristic type. The system will then use the bill period configured for the respective invoice day when the C1OFFRST characteristic is defined for the account.

• Define the required predefined values for the C1OFFRST characteristic type.

• Set the batch control type of the Health Care Inbound Message Periodic Monitor (C1-HCINB) batch to Timed and define the following attributes:

  • Time Interval

  • Timer Active

  • User ID

  • Batch Language

  • Email Address

• Define the required status reasons for the status to which a policy must be transitioned on policy termination.

• Define the required status reasons for the status to which a policy must be transitioned on policy reinstatement.

• Define the bill cancel reasons which you want to use when the premium bill segment is canceled during the policy or membership termination.

• Define the required exchange rates in the system.

• Define the required access groups in the system.

• Attach a currency conversion algorithm to the Currency Conversion For Bill Segments algorithm spot of the required divisions.

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