Mapping the Transaction Field in an Ancillary Pricing Rule Type

Prerequisites

To map the transaction field mapping for an ancillary pricing rule type, you should have:

  • Transaction fields defined in the application

Procedure

To map the transaction field mapping for an ancillary pricing rule type:

  1. Ensure that the Transaction Field Mapping section is expanded when you are defining an ancillary pricing rule type.
    Note:

    This section appears when you have chosen the Primary option from the Main section.

    The Transaction Field Mapping section contains the following fields:

    Field Name Field Description Mandatory (Yes or No)
    Source System Used to map to a transaction field which indicates the external system from where the ancillary transaction is received. The information stored in this field is then used for deriving the bill group, parent customer, and policy for the ancillary transaction. Yes
    Parameter 1 Used to map to a transaction field which indicates the employee attribute based on which you want to derive the bill group. Yes
    Parameter 2 Used to map to a transaction field which indicates the employee attribute based on which you want to derive the bill group. Yes (Conditional)
    Note: This field is required when you want to derive the bill group using multiple employee attributes.
    Parameter 3 Used to map to a transaction field which indicates the employee attribute based on which you want to derive the bill group. Yes (Conditional)
    Note: This field is required when you want to derive the bill group using multiple employee attributes.
    Parameter 4 Used to map to a transaction field which indicates the employee attribute based on which you want to derive the bill group. Yes (Conditional)
    Note: This field is required when you want to derive the bill group using multiple employee attributes.
    Incurred Date Used to map to a transaction field which contains the date when the health insurance service was availed by the employee. Yes (Conditional)
    Note: This field is required when you want to fetch an effective specific stop-loss or aggregate stop-loss pricing rule for the claim transaction.
    Paid Date Used to map to a transaction field which contains the date when the claim amount was paid to the employee. Yes (Conditional)
    Note: This field is required when you want to fetch an effective specific stop-loss or aggregate stop-loss pricing rule for the ancillary transaction.
    Source of Funds Used to map to a transaction field which indicates the source of funding. At present, this field is not used in the system. No
    Composite Used to map to a transaction field which indicates whether the employee is covered under the composite insurance. No
    Claim Disposition Used to map to a transaction field which helps to determine how the claim based fees should be charged for the positive and negative claim transactions. Yes (Conditional)
    Note: This field is required while calculating the retention type claim based fees for the claim transaction.
    Provider's Tax Identification Number Used to map to a transaction field which states the health insurance provider's identification number. The information stored in this field is then used to determine whether the health insurance provider is excluded from the specific stop-loss coverage. Yes (Conditional)
    Note: This field is required while calculating specific stop-loss for the ancillary transaction.
    Member ID Used to map to a transaction field which states the member's identification number. The information stored in this field is then used to determine whether the member is excluded from the specific stop-loss coverage. Yes (Conditional)
    Note: This field is required while calculating specific stop-loss for the ancillary transaction.
    Main Subscriber ID Used to map to a transaction field which states the main subscriber's identification number. The information stored in this field is then used to determine whether the main subscriber is excluded from the specific stop-loss coverage. Yes (Conditional)
    Note: This field is required while calculating specific stop-loss for the ancillary transaction.
    Run-in Identifier Used to map to a transaction field which indicates whether the ancillary transaction is a run-in ancillary transaction. Yes (Conditional)
    Note: This field is required while defining a ancillary pricing rule type.
    Runout Identifier Used to map to a transaction field which indicates whether the ancillary transaction is a runout ancillary transaction. At present, this field is not used in the system. No
    Third Party Identifier Used to specify the third party identifier to determine that the ancillary transaction is received from an external source system while defining an ancillary pricing rule type. No
    Coverage Start Date Used to map to a transaction field which indicates the coverage start date. The information stored in this field is then used to fetch an effective retention type enrollment based pricing rule for a non-retroactive enrollment transaction. Yes (Conditional)
    Note: This field is required while defining a retention type enrollment based pricing rule type.
    Coverage End Date Used to map to a transaction field which indicates the coverage end date. The information stored in this field is then used to fetch an effective retention type enrollment based pricing rule for a retroactive enrollment transaction. Yes (Conditional)
    Note: This field is required while defining a retention type enrollment based pricing rule type.
    Retroactivity Indicator Used to map to a transaction field which indicates whether the enrollment transaction is a retroactive enrollment transaction. Yes (Conditional)
    Note: This field is required while defining a retention type enrollment based pricing rule type.
    Network Indicator Used to map to a transaction field which indicates whether the service provider is in network or out of network. Yes (Conditional)
    Note: This field is required while defining a discount arrangement pricing rule.
    Covered Charge Amount Used to map to a transaction field which indicates the amount which is covered for the employee in the policy. Yes (Conditional)
    Note: This field is required while calculating the discount using a discount guarantee pricing rule.
    Discount Savings Amount Used to map to a transaction field which indicates the amount which is offered as the discount to the service provider. Yes (Conditional)
    Note: This field is required while calculating the discount using a discount guarantee or discount share pricing rule.
    Accumulation Only Identifier Used to map to a transaction field which indicates that the ancillary transaction should only be used for calculating charges for the accumulated products, such as Specific Stop-Loss, Aggregate Stop-Loss, and so on. This means that the system should not derive the ancillary transaction leg. Instead, it should only derive the specific stop-loss or aggregate stop loss transaction legs for the ancillary transaction. No
    Billing Eligibility Identifier Used to map to a transaction field which indicates whether the ancillary transaction is eligible for billing. Yes (Conditional)
    Note: This field is required while defining an ancillary pricing rule type.
    Transaction Upload Date Used to map to a transaction field which indicates the date when the transaction was uploaded in the external system. The system does not derive the discount transaction leg when the transaction upload date is later than the settlement date. Yes (Conditional)
    Note: This field is required while calculating the discount using a discount guarantee or discount share pricing rule.
    Note:

    The Search (The Search Icon) icon appears corresponding to each field. On clicking the Search icon, the Transaction Field Search window appears.

    On specifying the transaction field, the description of the transaction field appears corresponding to the respective field.

  2. Enter the required details in the Transaction Field Mapping section.
  3. Click Save.
    The transaction fields are mapped to the appropriate fields in the claim pricing rule type.

Related Topics

For more information on... See...
How to define an ancillary pricing rule type Defining an Ancillary Pricing Rule Type
How to edit an ancillary pricing rule type Editing an Ancillary Pricing Rule Type