Pass-Through Billable Charge

At times, the system might receive pre-calculated premium for the membership through a health care inbound message. If the price item, account identifier type, and account identifier are given in the billable charge information of a health care inbound message, the system directly creates an SQI based billable charge when you process the health care inbound message. The pre-calculated premium amount is stored as a pass through line in the SQI based billable charge. But, if only the price item is given in the billable charge information, the system checks whether the price item is included in any pricing rule type where the pricing rule type category is set to Pass-Through Billable Charge. If so, the system checks whether the pass-through billable charge pricing rule type is associated with the policy plan to which the membership belongs (for which the billable charge information is received). It is the pass-through billable charge pricing rule type which helps the system to determine:

• Algorithm which should be triggered for deriving the bill group, parent customer, and policy for a membership.

  Note: You must create an algorithm using the C1_​MEMBGDRV algorithm type and attach it to the Bill Group Derivation system event.

• Algorithm which should be triggered for deriving the account and price item for a membership.

  Note: You must create an algorithm using the C1_​ACCPRIMEM algorithm type and attach it to the Account and Price Item Derivation system event.

• Algorithm which should be triggered for deriving the bill period for the account.

  Note:

  You must create an algorithm using the C1-FIBCBP algorithm type and attach it to the Pricing Rule BC Creation Pre Processing system event.

  If the bill period or frequency is given in the billable charge information of the health care inbound message, the system does not derive the bill period for the account.

• Algorithm which should be triggered for creating the SQI based billable charges for each membership and price item combination.

  Note: You must create an algorithm using the C1-FICRETBC algorithm type and attach it to the Pricing Rule Billable Charge Creation system event.

• Price items for which you can create the SQI based billable charges using the pass-through billable charge pricing rule type.

  Note: You can add multiple price items in a pass-through billable charge pricing rule type. But, you cannot add the same price item in multiple pass-through billable charge pricing rule types.

• Type of account to which the respective price item should be billed based on the specified priority.

Related Topics

Parent Topic: Fully-Insured Pricing