Processing an Inbound Message

The system uses the C1-PERSTYPE feature configuration to decide whether the person type specified in the health care inbound message represents Parent Customer or Bill Group. If the person type specified in the health care inbound message matches the person type specified in the Bill Group Person Type or Parent Person Type option type of the C1-PERSTYPE feature configuration, the system creates or updates the person, account, policy, policy plan, and address through a customer registration object. Note that the memberships, pass-through billable charges, and pricing rules are created directly and not via customer registration object. However, if the person type specified in the health care inbound message does not match the person type specified in the Bill Group Person Type or Parent Person Type option type, the system creates or updates the person and its other entities directly and not through a customer registration object. In this case, the system only refers the customer registration type for the business objects using which the person, account, policy plan, membership, and address should be created or updated in the system.

If the derivation and pricing parameters are specified for a bill group, the system automatically creates one sort record for the bill group. Here, the sort ID is set to the bill group ID. The start and end dates of the sort record are set to the bill group and parent customer's relationship start and end dates. Once the sort record is created, the system creates the derivation and pricing parameters for the bill group and sort ID combination.

Creates or updates a health product, health plan, and pricing rules for individual memberships. In addition, it also maintains a log of the entities that are either added or updated through the health product and plan inbound message. Note that the system allows to upload the health product, health plan, and pricing rules together in a single inbound message or by creating three separate inbound messages. Finally, the status of the inbound message is changed to Processed.

The system uses the C1-HLTPRDVAL algorithm to validate the uploaded data through the health product and plan inbound message. Once the data is successfully validated, entities like health product, health plan, and pricing rules are created in the system.