Level Funded

The Level Funded zone displays the details of the level funded pricing rule for the respective parent customer, bill group, or a bill group using a pricing group. It contains the following sections:

• Main - Displays basic details of the level funded pricing rule. It contains the following columns:

  Column Name	Column Description
  Parent Customer Information	Displays the parent customer information. In addition, a context menu appears corresponding to this field which helps in navigating to other screens in the application. Note: It has a link. On clicking the link, the Person, Account or Policy screen appears where you can view the details of the parent customer.
  Bill Group Information	Displays the bill group information. In addition, a context menu appears corresponding to this field which helps in navigating to other screens in the application. Note: It has a link. On clicking the link, the Person, Account or Policy screen appears where you can view the details of the bill group.
  Policy Information	Displays the policy information. Note: It has a link. On clicking the link, the Policy screen appears where you can view the details of the policy.
  Pricing Rule Type	Indicates the type of the pricing rule.
  Status	Indicates the status of the pricing rule.
  Price Item Information	Indicates the price item for which the pricing rule is created. Note: It has a link. On clicking the link, the Price Item screen appears where you can view the details of the price item.
  Parent Customer's Pricing Rule	Displays the pricing rule of the parent customer.
  Pricing Start Date	Displays the date from when the pricing rule is effective.
  Pricing End Date	Displays the date till when the pricing rule is effective.
  Rate Option	Indicates the rate option of the level funded pricing rule for the price item.
  Settlement Frequency	Indicates the settlement frequency which helps to determine the bill after date.
  Settlement Fund Price Item	Indicates the price item derived from the level funded pricing rule type, used to create the level funded pricing rule type. Note: The settlement fund price item appears when the level funded pricing rule is created for a bill group.
  Underwriter Review	Indicates whether the underwriter settlement review flag is on or off.

• Accumulation Parameters - Displays the accumulation parameters for a parent customer in the level funded pricing rule. It contains the following fields:

  Column Name	Column Description
  Accumulation Group ID	Displays an accumulation group ID which is generated when accumulation parameter values are defined for a level funded pricing rule.
  Settlement Account ID	Indicates the account ID to whom the settlement amount is credited.
  Incurred Start Date	Displays the incurred start date (inherited from parent customer's specific stop-loss pricing rule) based on which you want to accumulate the level funded pricing.
  Incurred End Date	Displays the incurred end date (inherited from parent customer's specific stop-loss pricing rule) based on which you want to accumulate the level funded pricing.
  Paid Start Date	Displays the paid start date (inherited from parent customer's specific stop-loss pricing rule) based on which you want to accumulate the level funded pricing.
  Paid End Date	Displays the paid end date (inherited from parent customer's specific stop-loss pricing rule) based on which you want to accumulate the level funded pricing.
  Settlement Days	Indicates the number of days as the settlement days which help in calculating the settlement date.

  Note:

  The above section appears when the level funded pricing rule is created for a parent customer.

• Accumulation Criteria - Displays the accumulation criteria for a bill group in the level funded pricing rule. It contains the following columns:

  Column Name	Column Description
  Accumulation Group ID	Displays the accumulation group ID generated when the accumulation criteria values were defined for a level funding pricing rule type.
  Price Item Information	Displays the price item information. Note: It has a link. On clicking the link, the Price Item screen appears where you can view the details of the price item.
  Price Item Parameters	This field contains the following columns: Column Name Column Description Price Item Parameter Displays the multiple parameters based on which you have determined the price item utilization. Note: It has a link. On clicking the link, the Parameter screen appears where you can view the details of the parameter. Parameter Value Displays the value of the parameter.

  Note:

  The above section appears when the level funded pricing rule is created for a bill group.

  The accumulation criteria for each rule appears when the level funded pricing rule is created for a bill group using a pricing group.

• The Pricing Information for rule type category : Claim zone contains the following sections:

  • The Claim Pricing Rule section contains the following columns:

    Column Name	Column Description
    Pricing Rule Type	Indicates the claim pricing rule type effective for the level funded pricing.
    Derive Using	Indicates the method through which the claim pricing rule information is derived.
    Effective Claim Pricing Rule	Displays the claim pricing rule effective for pricing.

  • The Domestic Provider Claims section contains the following columns:

    Column Name	Column Description
    Exclude LF (Percentage)	Displays the billable charge line excluding the level funding charge in the percentage to create the domestic provider claim calculation lines.

  • The Markup or Markdown Values section contains the following columns:

    Column Name	Column Description
    Pricing Strategy	Indicates the pricing strategy for the claim line items.
    Markup or Markdown Type	Indicates the markup or markdown value type for the claim line items.
    Markup or Markdown Amount	Displays the markup or markdown amount for the claim line items. Note: This field displays amount when Markup or Markdown Type field is set as Flat Amount.
    Markup / Markdown Included in Settlement?	Displays whether the markup or markdown amount should be included in the level funding settlement. The valid values are:

  • The Line Items section contains the following columns:

    Column Name	Column Description
    Sequence	Displays the sequence number for the line items.
    Line Item	Displays the billing line items.
    Include in Settlement	Indicates whether the line item should be included in the level funded claim pricing settlement.
    Markup or Markdown Included in Settlement	Indicates whether markup or markdown should be included in the level funded claim settlement.
    Markup or Markdown Percentage Eligibility	Indicates whether the line item is eligible or not eligible for markup or markdown percentage.
    Markup or Markdown Percentage	Indicates the percentage for markup or markdown value.

  Note:

  The above section appears when the level funded pricing rule is created for a bill group.

• The Pricing Information for rule type category : Ancillary zone contains the following sections:

  • The Ancillary Pricing Rule section contains the following columns:

    Column Name	Column Description
    Pricing Rule Type	Indicates the ancillary pricing rule type effective for level funded pricing.
    Derive Using	Indicates the method through which the ancillary pricing rule information is derived.
    Effective Ancillary Pricing Rule	Displays the ancillary pricing rule effective for pricing.

  • The Billable Charge Line Types section contains the following columns:

    Column Name	Column Description
    Sequence	Displays the sequence number for the line items.
    Billable Charge Line Type	Indicates the billable charge line type using which you want to create the calculation line for the charge (i.e. line item)
    Include in Settlement	Indicates whether the billable charge line item should be included in the level funded ancillary pricing settlement.
    Rate Based	Indicates that the billable charge line type is rate based.
    Rate	Displays the rate for the billable charge line type.
    Markup / Markdown Included in Settlement?	Indicates that markup or markdown amount must be included in the level funding settlement.
    Pricing Strategy	Displays the pricing strategy for the billable charge line items.
    Markup or Markdown Type	Indicates the markup or markdown type for the billable charge line items.
    Amount/Percentage	Displays the amount or percentage which is specified as the markup or markdown value.

  Note:

  The above section appears when the level funded pricing rule is created for a bill group.

• The Pricing Information for rule type category : Discount zone contains the following section:

  Column Name	Column Description
  Pricing Rule Type	Indicates the discount arrangement pricing rule type which is effective for level funding.
  Derive Using	Indicates the method through which the discount arrangement pricing rule information is derived.

  • Discount Pricing Rule - Indicates the discount arrangement pricing rule. It contains the following columns:

    Column Name	Column Description
    Discount Pricing Rule	Indicates the discount arrangement pricing rule which is effective for level funding.

  Note:

  The above section appears when the level funded pricing rule is created for a bill group.

• The Pricing Information for rule type category : Retention zone contains the following section:

  Column Name	Column Description
  Retention Rule Type	Indicates the retention type claim based and/or retention type enrollment based pricing rule type for the level funded pricing rule. Note: It has a link. On clicking the link, Pricing Rule Type screen appears where you can view the details of the rule type.
  Price Item	Indicates the price item for the level funded pricing rule. Note: It has a link. On clicking the link, Price Item screen appears where you can view the details of the price item.

  Note:

  The above section appears when the level funded pricing rule is created for a bill group.

• Final Settlement Rules - Displays the final settlement rules when the customer renews or cancels the contract. It contains the following columns:

  Column Name	Column Description
  Final Settlement Mode	Displays the final settlement mode when the customer renews the level funded agreement
  Final Settlement Option	Indicates the final settlement option when the customer renews the level funded agreement.
  Flat/Percentage	Indicates the final settlement payment type when the customer renews the level funded agreement.
  Percentage Retained	Displays the percentage retained by the ASO provider when the customer renews the level funded agreement.
  Flat Effective Payout	Displays the actual amount which should be retained by the ASO provider or offered as a discount, when the customer renews the level funded agreement.

  The Renewal Decision sub-section contains the following columns:

  Column Name	Column Description
  Renewal Decision	Indicates the upcoming status of the level funded contract.

• Characteristics - Displays the characteristics defined for the level funded pricing rule. It contains the following columns:

  Column Name	Column Description
  Effective Date	Displays the date from when the characteristic is effective for the level funded pricing rule.
  Characteristic Type	Indicates the characteristic type.
  Characteristic Value	Displays the value of the characteristic type.

Related Topics