Sample Health Care Inbound Message for Group Membership (With Benefit)
Using the below example, you can do the following:
-
Create group membership where the person is the main subscriber and contains dependent persons.
| Person Name | Member Relationship Type | Main Subscriber | Policy | Policy Plan | Benefit Type |
|---|---|---|---|---|---|
| TREVOR, WALSH | SELF | Yes | AP234389 |
HMO_MED_ SILVER_RETIRED |
MA |
| LETECIA, WALSH | SPOUSE | No | AP234389 |
HMO_MED_ SILVER_RETIRED |
MA |
| MIKE, WALSH | SON | No | AP234389 |
HMO_MED_ SILVER_RETIRED |
MA |
<schema>
<c1InboundMessage></c1InboundMessage>
<bo>C1-HCInboundMessage</bo>
<boStatus></boStatus>
<statusReason></statusReason>
<messageType>C1-HEALTHCARE_INB_MSG_TYPE</messageType>
<sourceSystem>ZZUHG</sourceSystem>
<externalTransactionId>123445</externalTransactionId>
<externalBatchId>433443</externalBatchId>
<externalSourceId>656565</externalSourceId>
<person></person>
<statusDateTime></statusDateTime>
<creationDateTime></creationDateTime>
<version></version>
<characteristics>
<inboundMessageCharacteristic>
<adhocCharacteristicValue></adhocCharacteristicValue>
<characteristicType>C1-EXTBTCT</characteristicType>
<effectiveDate>2021-01-01</effectiveDate>
<characteristicValue>DATAEXT2</characteristicValue>
<characteristicValueForeignKey1>
</characteristicValueForeignKey1>
<characteristicValueFK2></characteristicValueFK2>
<characteristicValueFK3></characteristicValueFK3>
<characteristicValueFk4></characteristicValueFk4>
<characteristicValueFK5></characteristicValueFK5>
<searchCharacteristicValue></searchCharacteristicValue>
<version></version>
</inboundMessageCharacteristic>
</characteristics>
<customerStructureMessage>
<headerData>
<messageType></messageType>
<sourceSystem></sourceSystem>
<externalTransactionId></externalTransactionId>
<externalBatchId></externalBatchId>
<externalSourceId></externalSourceId>
</headerData>
<customerStructureData>
<personData>
<sequence>1</sequence>
<personType>P</personType>
<personName>
<sequence>1</sequence>
<entityName>TREVOR,WALSH</entityName>
<nameType>PRIM</nameType>
</personName>
<identifiers>
<idType>SSN</idType>
<idValue>910-70-5110</idValue>
<isPrimary>Y</isPrimary>
</identifiers>
<division>HC</division>
<birthDate>1963-03-03</birthDate>
<sinceDate>2021-01-01</sinceDate>
<accessGroup></accessGroup>
<collectionClass></collectionClass>
<postponeCreditReviewUntil></postponeCreditReviewUntil>
<lastCreditReviewDate></lastCreditReviewDate>
<dragDays></dragDays>
<advanceDepositAmount></advanceDepositAmount>
<advanceDepositGraceDays></advanceDepositGraceDays>
<advanceDepositLevel></advanceDepositLevel>
<address>
<addressEffDate>2021-01-01</addressEffDate>
<addressType>MAIN</addressType>
<mailingName>TREVOR</mailingName>
<address1>TREVOR MANSION</address1>
<address2>CULLINAN STREET</address2>
<address3>RIVERDALE ROAD</address3>
<address4></address4>
<city>CINCINNATI</city>
<state>OH</state>
<zip>5825</zip>
<country>USA</country>
<houseType>RANCH</houseType>
<streetNumber1></streetNumber1>
<streetNumber2></streetNumber2>
<inCityLimit></inCityLimit>
<taxVendorGeographicalCode>
</taxVendorGeographicalCode>
<county></county>
<addressStatus></addressStatus>
</address>
<email>trevor.walsh@example.com</email>
<overrideMailingName1></overrideMailingName1>
<overrideMailingName2></overrideMailingName2>
<overrideMailingName3></overrideMailingName3>
<phones>
<phoneType>BUSN</phoneType>
<phoneValue>+1.222.414.6125</phoneValue>
<extension>7894</extension>
</phones>
<relatedPersons>
<idType></idType>
<idValue></idValue>
<personRelationshipType></personRelationshipType>
<startDate></startDate>
<endDate></endDate>
<financialRelationshipSw></financialRelationshipSw>
<parentOrChild></parentOrChild>
<characteristics>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
<characteristics>
</relatedPersons>
<characteristics>
<characteristicsList>
<characteristicType>PER_CAT</characteristicType>
<characteristicValue>EMPLOYEE</characteristicValue>
<effectiveDate>2021-01-01</effectiveDate>
</characteristicsList>
</characteristics>
<billLevelParameters>
<sequence></sequence>
<sourceSystem></sourceSystem>
<billLevelInfo1></billLevelInfo1>
<billLevelInfo2></billLevelInfo2>
<billLevelInfo3></billLevelInfo3>
<billLevelInfo4></billLevelInfo4>
<effectiveDate></effectiveDate>
</billLevelParameters>
<memberData>
<sequence>1</sequence>
<startDate>2021-01-01</startDate>
<endDate>2021-12-31</endDate>
<repriceAfterDate></repriceAfterDate>
<paidThroughDate></paidThroughDate>
<memberId>130010003</memberId>
<memberRelationship>SELF</memberRelationship>
<membershipPersonStatus>ACTIVE</membershipPersonStatus>
<membershipPersonstatusReason>
NEW ENROLLMENT
</membershipPersonstatusReason>
<autoRenew></autoRenew>
<associatedMemberIdentifierType>
</associatedMemberIdentifierType>
<associatedMemberIdentifier>
</associatedMemberIdentifier>
<exchangeFlag></exchangeFlag>
<exchangeId></exchangeId>
<binderLiabilityAmount></binderLiabilityAmount>
<binderPayApplicability></binderPayApplicability>
<binderPayGraceDays></binderPayGraceDays>
<binderPayThreshold></binderPayThreshold>
<holdBilling></holdBilling>
<membershipRenewalDate></membershipRenewalDate>
<contractPeriod></contractPeriod>
<membershipIdentifier>
<membershipIdentifierType>
SSN
</membershipIdentifierType>
<membershipIdentifierValue>
910-70-5110
</membershipIdentifierValue>
</membershipIdentifier>
<isMemberSw>Y</isMemberSw>
<isFinanciallyResponsibleSw>
Y
</isFinanciallyResponsibleSw>
<membershipType>COBR</membershipType>
<externalMedicareBeneficiaryId>
</externalMedicareBeneficiaryId>
<mainSubscriber>
<idType>SSN</idType>
<idValue>910-70-5110</idValue>
<membershipType>COBR</membershipType>
</mainSubscriber>
<policyNumber>AP234389</policyNumber>
<sourceSystem>ZZPRIME</sourceSystem>
<planNumber>HMO_MED_SILVER_RETIRED</planNumber>
<healthPlanCode></healthPlanCode>
<characteristics>
<characteristicsList>
<characteristicType>SMOKUSE</characteristicType>
<characteristicValue>Y</characteristicValue>
<effectiveDate>2021-01-01</effectiveDate>
</characteristicsList>
</characteristics>
<membershipRateGuarantee>
<membershipRateGuaranteeList>
<rateGuaranteeStartDate></rateGuaranteeStartDate>
<rateGuaranteeEndDate></rateGuaranteeEndDate>
<rateGuaranteeStatus></rateGuaranteeStatus>
</membershipRateGuaranteeList>
</membershipRateGuarantee>
<membershipPersonCharacteristic>
<characteristicsList>
<characteristicType>TOBUSAGE</characteristicType>
<characteristicValue>Y</characteristicValue>
<effectiveDate>2021-01-01</effectiveDate>
</characteristicsList>
<characteristicsList>
<characteristicType>C1_GENDER</characteristicType>
<characteristicValue>M</characteristicValue>
<effectiveDate>2021-01-01</effectiveDate>
</characteristicsList>
</membershipPersonCharacteristic>
<benefitData>
<benefitDataList>
<sequence>1</sequence>
<startDate>2023-01-15</startDate>
<endDate>2023-12-31</endDate>
<benefitStatus></benefitStatus>
<benefitSourceFlag>CMS</benefitSourceFlag>
<benefitTypeFlag>MA</benefitTypeFlag>
<benefitSubTypeFlag>BNFT_Y</benefitSubTypeFlag>
<planBenefitPackageId></planBenefitPackageId>
<benefitAmount>800</benefitAmount>
<characteristics>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue>
</characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</characteristics>
</benefitDataList>
</benefitData>
<billableChargeData>
<sequence>1</sequence>
<accountIdType>ACC_001</accountIdType>
<accountIdValue>MEDICAL_ACCOUNT</accountIdValue>
<chargeType></chargeType>
<startDate>2021-02-01</startDate>
<endDate>2021-04-31</endDate>
<priceItemCode>MED_PREM_FEE</priceItemCode>
<description>RECURRING PREMIUM FEES</description>
<recurringMethod>BP</recurringMethod>
<billPeriod>HC</billPeriod>
<frequency></frequency>
<billAfterDt></billAfterDt>
<billableChargeLines>
<descriptionOnBill>
RECURRING PREMIUM FEES
</descriptionOnBill>
<currencyCode>USD</currencyCode>
<chargeAmount>100</chargeAmount>
<showOnBillSw>TRUE</showOnBillSw>
<appearInSummarySw>FALSE</appearInSummarySw>
<distributionCode>HC</distributionCode>
</billableChargeLines>
<characteristics>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</characteristics>
</billableChargeData>
</memberData>
<accountData>
<accountType></accountType>
<customerClass></customerClass>
<billCycle></billCycle>
<billLeadDays></billLeadDays>
<division></division>
<dragDays></dragDays>
<currency></currency>
<setUpDate></setUpDate>
<acctUsageFlg></acctUsageFlg>
<comments></comments>
<deferAutoPayDt></deferAutoPayDt>
<collectionClass></collectionClass>
<billRouteType></billRouteType>
<billAddressSource></billAddressSource>
<accessGroup></accessGroup>
<skipAutoMaintenanceSw></skipAutoMaintenanceSw>
<identifiers>
<idType></idType>
<idValue></idValue>
<isPrimary></isPrimary>
</identifiers>
<address>
<addressEffDate></addressEffDate>
<addressType></addressType>
<address1></address1>
<address2></address2>
<address3></address3>
<address4></address4>
<city></city>
<state></state>
<zip></zip>
<country></country>
<houseType></houseType>
<streetNumber1></streetNumber1>
<streetNumber2></streetNumber2>
<inCityLimit></inCityLimit>
<taxVendorGeographicalCode>
</taxVendorGeographicalCode>
<county></county>
<addressStatus></addressStatus>
</address>
<autoPayDetails>
<priority>100</priority>
<startDate>2021-01-01</startDate>
<endDate>2021-12-31</endDate>
<percentage>100</percentage>
<autoPayMethod>C1DD</autoPayMethod>
<autoPayRouteType>NEFT</autoPayRouteType>
<autoPaySourceCode>CITIBANKCHK</autoPaySourceCode>
<accountNumber>442252</accountNumber>
<expiryMonth>11</expiryMonth>
<expiryYear>2022</expiryYear>
<name>GE</name>
<maxWithdrawalAmount></maxWithdrawalAmount>
<comments></comments>
</autoPayDetails>
<accountPerson>
<idType></idType>
<idValue></idValue>
<accountRelationshipType></accountRelationshipType>
<isFinanciallyResponsible></isFinanciallyResponsible>
<personAddressOverride>
<address1></address1>
<address2></address2>
<address3></address3>
<address4></address4>
<city></city>
<postal></postal>
<state></state>
<country></country>
<houseType></houseType>
<streetNumber1></streetNumber1>
<streetNumber2></streetNumber2>
<inCityLimit></inCityLimit>
<taxVendorGeographicalCode>
</taxVendorGeographicalCode>
<county></county>
<zip></zip>
<addressStatus></addressStatus>
</personAddressOverride>
<accountPersonRouting>
<billRouteType></billRouteType>
<shouldReceiveCopyOfBill>
</shouldReceiveCopyOfBill>
<billFormat></billFormat>
<numberOfBillCopies></numberOfBillCopies>
<receivesNotification></receivesNotification>
<billAddressSource></billAddressSource>
</accountPersonRouting>
</accountPerson>
<characteristics>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</characteristics>
</accountData>
<policyData>
<policyType>FIG</policyType>
<sourceSystem>ZZ_UHG</sourceSystem>
<policyNumber>AP234389</policyNumber>
<description></description>
<advancedLevelFundingEligibility>
</advancedLevelFundingEligibility>
<startDate>2021-01-01</startDate>
<endDate>2021-12-31</endDate>
<runOutEndDate></runOutEndDate>
<runOutAdminOption></runOutAdminOption>
<renewalDate></renewalDate>
<advanceDepositApplSW></advanceDepositApplSW>
<advanceDepositAmount></advanceDepositAmount>
<advanceDepositGraceDays></advanceDepositGraceDays>
<advanceDepositAccountIdentifierType>
</advanceDepositAccountIdentifierType>
<advanceDepositAccountIdentifierValue>
</advanceDepositAccountIdentifierValue>
<policyPersons>
<idType></idType>
<idValue></idValue>
<policyPerRole></policyPerRole>
<startDate></startDate>
<endDate></endDate>
</policyPersons>
<terminationInformation>
<terminateDate></terminateDate>
<terminationReason></terminationReason>
</terminationInformation>
<reinstateInformation>
<reinstatementDate></reinstatementDate>
<reinstateReason></reinstateReason>
</reinstateInformation>
<characteristics>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</characteristics>
<planData>
<planNumber>HMO_MED_SL_R022</planNumber>
<priceItemCode></priceItemCode>
<planName>HMO_MED_SILVER_RETIRED</planName>
<pricingRuleTypeList>
<pricingRuleType></pricingRuleType>
</pricingRuleTypeList>
<startDate>2021-01-01</startDate>
<endDate>2021-12-31</endDate>
<primaryPlanSw></primaryPlanSw>
<benefitTypeFlag>MA</benefitTypeFlag>
<characteristics>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</characteristics>
<policyPlanProrationRuleList>
<effectiveDate></effectiveDate>
<prorationEventType></prorationEventType>
<prorationType></prorationType>
<numberOfDays></numberOfDays>
<membershipType></membershipType>
</policyPlanProrationRuleList>
</planData>
</policyData>
</personData>
<personData>
<sequence>2</sequence>
<personType>P</personType>
<personName>
<sequence>1</sequence>
<entityName>LETICIA,WALSH</entityName>
<nameType>PRIM</nameType>
</personName>
<identifiers>
<idType>SSN</idType>
<idValue>955-77-3100</idValue>
<isPrimary>Y</isPrimary>
</identifiers>
<division>HC</division>
<birthDate>1968-05-10</birthDate>
<sinceDate>2021-01-01</sinceDate>
<accessGroup></accessGroup>
<collectionClass></collectionClass>
<postponeCreditReviewUntil></postponeCreditReviewUntil>
<lastCreditReviewDate></lastCreditReviewDate>
<dragDays></dragDays>
<advanceDepositAmount></advanceDepositAmount>
<advanceDepositGraceDays></advanceDepositGraceDays>
<advanceDepositLevel></advanceDepositLevel>
<address>
<addressEffDate>2021-01-01</addressEffDate>
<addressType>MAIN</addressType>
<mailingName>LETICIA</mailingName>
<address1>TREVOR MANSION</address1>
<address2>CULLINAN STREET</address2>
<address3>RIVERDALE ROAD</address3>
<address4></address4>
<city>CINCINNATI</city>
<state>OH</state>
<zip>5825</zip>
<country>USA</country>
<houseType>RANCH</houseType>
<streetNumber1></streetNumber1>
<streetNumber2></streetNumber2>
<inCityLimit></inCityLimit>
<taxVendorGeographicalCode>
</taxVendorGeographicalCode>
<county></county>
</address>
<email>leticia.walsh@example.com</email>
<overrideMailingName1></overrideMailingName1>
<overrideMailingName2></overrideMailingName2>
<overrideMailingName3></overrideMailingName3>
<phones>
<phoneType>BUSN</phoneType>
<phoneValue>+1.818.258.1214</phoneValue>
<extension>1254</extension>
</phones>
<relatedPersons>
<idType></idType>
<idValue></idValue>
<personRelationshipType></personRelationshipType>
<startDate></startDate>
<endDate></endDate>
<financialRelationshipSw></financialRelationshipSw>
<parentOrChild></parentOrChild>
<characteristics>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
<characteristics>
</relatedPersons>
<characteristics>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</characteristics>
<billLevelParameters>
<sequence></sequence>
<sourceSystem></sourceSystem>
<billLevelInfo1></billLevelInfo1>
<billLevelInfo2></billLevelInfo2>
<billLevelInfo3></billLevelInfo3>
<billLevelInfo4></billLevelInfo4>
<effectiveDate></effectiveDate>
</billLevelParameters>
<memberData>
<sequence>2</sequence>
<startDate>2021-01-01</startDate>
<endDate>2021-12-31</endDate>
<repriceAfterDate></repriceAfterDate>
<paidThroughDate></paidThroughDate>
<memberId>130010003</memberId>
<memberRelationship>SPOUSE</memberRelationship>
<membershipPersonStatus>ACTIVE</membershipPersonStatus>
<membershipPersonstatusReason>
NEW ENROLLMENT
</membershipPersonstatusReason>
<autoRenew></autoRenew>
<associatedMemberIdentifierType>
</associatedMemberIdentifierType>
<associatedMemberIdentifier>
</associatedMemberIdentifier>
<exchangeFlag></exchangeFlag>
<exchangeId></exchangeId>
<binderLiabilityAmount></binderLiabilityAmount>
<binderPayApplicability></binderPayApplicability>
<binderPayGraceDays></binderPayGraceDays>
<binderPayThreshold></binderPayThreshold>
<holdBilling></holdBilling>
<membershipRenewalDate></membershipRenewalDate>
<contractPeriod></contractPeriod>
<membershipIdentifier>
<membershipIdentifierType>
SSN
</membershipIdentifierType>
<membershipIdentifierValue>
955-77-3100
</membershipIdentifierValue>
</membershipIdentifier>
<isMemberSw>N</isMemberSw>
<isFinanciallyResponsibleSw>
N
</isFinanciallyResponsibleSw>
<membershipType>COBR</membershipType>
<externalMedicareBeneficiaryId>
</externalMedicareBeneficiaryId>
<mainSubscriber>
<idType>SSN</idType>
<idValue>955-77-3100</idValue>
<membershipType>COBR</membershipType>
</mainSubscriber>
<policyNumber>AP234389</policyNumber>
<sourceSystem>ZZPRIME</sourceSystem>
<planNumber>HMO_MED_SILVER_RETIRED</planNumber>
<healthPlanCode></healthPlanCode>
<characteristics>
<characteristicsList>
<characteristicType>SMOKUSE</characteristicType>
<characteristicValue>N</characteristicValue>
<effectiveDate>2021-01-01</effectiveDate>
</characteristicsList>
</characteristics>
<membershipRateGuarantee>
<membershipRateGuaranteeList>
<rateGuaranteeStartDate></rateGuaranteeStartDate>
<rateGuaranteeEndDate></rateGuaranteeEndDate>
<rateGuaranteeStatus></rateGuaranteeStatus>
</membershipRateGuaranteeList>
</membershipRateGuarantee>
<membershipPersonCharacteristic>
<characteristicsList>
<characteristicType>TOBUSAGE</characteristicType>
<characteristicValue>N</characteristicValue>
<effectiveDate>2021-01-01</effectiveDate>
</characteristicsList>
<characteristicsList>
<characteristicType>C1_GENDER</characteristicType>
<characteristicValue>F</characteristicValue>
<effectiveDate>2021-01-01</effectiveDate>
</characteristicsList>
</membershipPersonCharacteristic>
<benefitData>
<benefitDataList>
<sequence>2</sequence>
<startDate>2023-01-15</startDate>
<endDate>2023-12-31</endDate>
<benefitStatus></benefitStatus>
<benefitSourceFlag>CMS</benefitSourceFlag>
<benefitTypeFlag>MA</benefitTypeFlag>
<benefitSubTypeFlag>BNFT_N</benefitSubTypeFlag>
<planBenefitPackageId></planBenefitPackageId>
<benefitAmount>200</benefitAmount>
<characteristics>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</characteristics>
</benefitDataList>
</benefitData>
<billableChargeData>
<sequence>2</sequence>
<accountIdType>ACC_001</accountIdType>
<accountIdValue>MEDICAL_ACCOUNT</accountIdValue>
<chargeType></chargeType>
<startDate>2021-02-01</startDate>
<endDate>2021-04-31</endDate>
<priceItemCode>MED_PREM_FEE</priceItemCode>
<description>Recurring Premium Fees</description>
<recurringMethod>BP</recurringMethod>
<billPeriod>HC</billPeriod>
<frequency></frequency>
<billAfterDt></billAfterDt>
<billableChargeLines>
<descriptionOnBill>Premium Fees</descriptionOnBill>
<currencyCode>USD</currencyCode>
<chargeAmount>100</chargeAmount>
<showOnBillSw>TRUE</showOnBillSw>
<appearInSummarySw>FALSE</appearInSummarySw>
<distributionCode>HC</distributionCode>
</billableChargeLines>
<characteristics>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</characteristics>
</billableChargeData>
</memberData>
<accountData>
<accountType></accountType>
<customerClass></customerClass>
<billCycle></billCycle>
<billLeadDays></billLeadDays>
<division></division>
<dragDays></dragDays>
<currency></currency>
<setUpDate></setUpDate>
<acctUsageFlg></acctUsageFlg>
<comments></comments>
<deferAutoPayDt></deferAutoPayDt>
<collectionClass></collectionClass>
<billRouteType></billRouteType>
<billAddressSource></billAddressSource>
<accessGroup></accessGroup>
<skipAutoMaintenanceSw></skipAutoMaintenanceSw>
<identifiers>
<idType></idType>
<idValue></idValue>
<isPrimary></isPrimary>
</identifiers>
<address>
<addressEffDate></addressEffDate>
<addressType></addressType>
<address1></address1>
<address2></address2>
<address3></address3>
<address4></address4>
<city></city>
<state></state>
<zip></zip>
<country></country>
<houseType></houseType>
<streetNumber1></streetNumber1>
<streetNumber2></streetNumber2>
<inCityLimit></inCityLimit>
<taxVendorGeographicalCode>
</taxVendorGeographicalCode>
<county></county>
<addressStatus></addressStatus>
</address>
<autoPayDetails>
<priority>101</priority>
<startDate>2021-01-01</startDate>
<endDate>2021-12-31</endDate>
<percentage>100</percentage>
<autoPayMethod>C1DD</autoPayMethod>
<autoPayRouteType>NEFT</autoPayRouteType>
<autoPaySourceCode>CHFDBANKCHK</autoPaySourceCode>
<accountNumber>583432</accountNumber>
<expiryMonth>11</expiryMonth>
<expiryYear>2022</expiryYear>
<name>GW</name>
<maxWithdrawalAmount></maxWithdrawalAmount>
<comments></comments>
</autoPayDetails>
<accountPerson>
<idType></idType>
<idValue></idValue>
<accountRelationshipType></accountRelationshipType>
<isFinanciallyResponsible>
</isFinanciallyResponsible>
<personAddressOverride>
<address1></address1>
<address2></address2>
<address3></address3>
<address4></address4>
<city></city>
<state></state>
<country></country>
<houseType></houseType>
<streetNumber1></streetNumber1>
<streetNumber2></streetNumber2>
<inCityLimit></inCityLimit>
<taxVendorGeographicalCode>
</taxVendorGeographicalCode>
<county></county>
<zip></zip>
<addressStatus></addressStatus>
</personAddressOverride>
<accountPersonRouting>
<billRouteType></billRouteType>
<shouldReceiveCopyOfBill>
</shouldReceiveCopyOfBill>
<billFormat></billFormat>
<numberOfBillCopies></numberOfBillCopies>
<receivesNotification></receivesNotification>
<billAddressSource></billAddressSource>
</accountPersonRouting>
</accountPerson>
<characteristics>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</characteristics>
</accountData>
<policyData>
<policyType>FIG</policyType>
<sourceSystem>ZZ_UHG</sourceSystem>
<policyNumber>AP234389</policyNumber>
<description></description>
<advancedLevelFundingEligibility>
</advancedLevelFundingEligibility>
<startDate>2021-01-01</startDate>
<endDate>2021-12-31</endDate>
<runOutEndDate></runOutEndDate>
<runOutAdminOption></runOutAdminOption>
<renewalDate></renewalDate>
<advanceDepositApplSW></advanceDepositApplSW>
<advanceDepositAmount></advanceDepositAmount>
<advanceDepositGraceDays></advanceDepositGraceDays>
<advanceDepositAccountIdentifierType>
</advanceDepositAccountIdentifierType>
<advanceDepositAccountIdentifierValue>
</advanceDepositAccountIdentifierValue>
<policyPersons>
<idType></idType>
<idValue></idValue>
<policyPerRole></policyPerRole>
<startDate></startDate>
<endDate></endDate>
</policyPersons>
<terminationInformation>
<terminateDate></terminateDate>
<terminationReason></terminationReason>
</terminationInformation>
<reinstateInformation>
<reinstatementDate></reinstatementDate>
<reinstateReason></reinstateReason>
</reinstateInformation>
<characteristics>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</characteristics>
<planData>
<planNumber>HMO_MED_SL_R022</planNumber>
<priceItemCode></priceItemCode>
<planName>HMO_MED_SILVER_RETIRED</planName>
<pricingRuleTypeList>
<pricingRuleType></pricingRuleType>
</pricingRuleTypeList>
<startDate>2021-01-01</startDate>
<endDate>2021-12-31</endDate>
<primaryPlanSw></primaryPlanSw>
<benefitTypeFlag>MA</benefitTypeFlag>
<characteristics>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</characteristics>
<policyPlanProrationRuleList>
<effectiveDate></effectiveDate>
<prorationEventType></prorationEventType>
<prorationType></prorationType>
<numberOfDays></numberOfDays>
<membershipType></membershipType>
</policyPlanProrationRuleList>
</planData>
</policyData>
</personData>
<personData>
<sequence>3</sequence>
<personType>P</personType>
<personName>
<sequence>1</sequence>
<entityName>MIKE,WALSH</entityName>
<nameType>PRIM</nameType>
</personName>
<identifiers>
<idType>SSN</idType>
<idValue>940-55-2200</idValue>
<isPrimary>Y</isPrimary>
</identifiers>
<division>HC</division>
<birthDate>1975-01-20</birthDate>
<sinceDate>2021-01-01</sinceDate>
<accessGroup></accessGroup>
<collectionClass></collectionClass>
<postponeCreditReviewUntil></postponeCreditReviewUntil>
<lastCreditReviewDate></lastCreditReviewDate>
<dragDays></dragDays>
<advanceDepositAmount></advanceDepositAmount>
<advanceDepositGraceDays></advanceDepositGraceDays>
<advanceDepositLevel></advanceDepositLevel>
<address>
<addressEffDate>2021-01-01</addressEffDate>
<addressType>MAIN</addressType>
<mailingName>MIKE</mailingName>
<address1>TREVOR MANSION</address1>
<address2>CULLINAN STREET</address2>
<address3>RIVERDALE ROAD</address3>
<address4></address4>
<city>CINCINNATI</city>
<state>OH</state>
<zip>5825</zip>
<country>USA</country>
<houseType>RANCH</houseType>
<streetNumber1></streetNumber1>
<streetNumber2></streetNumber2>
<inCityLimit></inCityLimit>
<taxVendorGeographicalCode>
</taxVendorGeographicalCode>
<county></county>
<addressStatus></addressStatus>
</address>
<email>mike.walsh@example.com</email>
<overrideMailingName1></overrideMailingName1>
<overrideMailingName2></overrideMailingName2>
<overrideMailingName3></overrideMailingName3>
<phones>
<phoneType></phoneType>
<phoneValue></phoneValue>
<extension></extension>
</phones>
<relatedPersons>
<idType></idType>
<idValue></idValue>
<personRelationshipType>SON</personRelationshipType>
<startDate>2021-01-01</startDate>
<endDate>2021-12-31</endDate>
<financialRelationshipSw>N</financialRelationshipSw>
<parentOrChild>CHILD</parentOrChild>
<characteristics>
<characteristicsList>
<characteristicType>TOBUSAGE</characteristicType>
<characteristicValue>N</characteristicValue>
<effectiveDate>2021-01-01</effectiveDate>
</characteristicsList>
<characteristics>
</relatedPersons>
<characteristics>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</characteristics>
<billLevelParameters>
<sequence></sequence>
<sourceSystem></sourceSystem>
<billLevelInfo1></billLevelInfo1>
<billLevelInfo2></billLevelInfo2>
<billLevelInfo3></billLevelInfo3>
<billLevelInfo4></billLevelInfo4>
<effectiveDate></effectiveDate>
</billLevelParameters>
<memberData>
<startDate>2021-01-01</startDate>
<endDate>2021-12-31</endDate>
<repriceAfterDate></repriceAfterDate>
<paidThroughDate></paidThroughDate>
<memberId>130010003</memberId>
<memberRelationship>CHILD</memberRelationship>
<membershipPersonStatus>ACTIVE</membershipPersonStatus>
<membershipPersonstatusReason>
NEW ENROLLMENT
</membershipPersonstatusReason>
<autoRenew></autoRenew>
<associatedMemberIdentifierType>
</associatedMemberIdentifierType>
<associatedMemberIdentifier>
</associatedMemberIdentifier>
<exchangeFlag></exchangeFlag>
<exchangeId></exchangeId>
<binderLiabilityAmount></binderLiabilityAmount>
<binderPayApplicability></binderPayApplicability>
<binderPayGraceDays></binderPayGraceDays>
<binderPayThreshold></binderPayThreshold>
<holdBilling></holdBilling>
<membershipRenewalDate></membershipRenewalDate>
<contractPeriod></contractPeriod>
<membershipIdentifier>
<membershipIdentifierType>
SSN
</membershipIdentifierType>
<membershipIdentifierValue>
940-55-2200
</membershipIdentifierValue>
</membershipIdentifier>
<isMemberSw>N</isMemberSw>
<isFinanciallyResponsibleSw>
N
</isFinanciallyResponsibleSw>
<membershipType>COBR</membershipType>
<externalMedicareBeneficiaryId>
</externalMedicareBeneficiaryId>
<mainSubscriber>
<idType>SSN</idType>
<idValue>940-55-2200</idValue>
<membershipType>COBR</membershipType>
</mainSubscriber>
<policyNumber>AP234389</policyNumber>
<sourceSystem>ZZPRIME</sourceSystem>
<planNumber>HMO_MED_SILVER_RETIRED</planNumber>
<healthPlanCode></healthPlanCode>
<characteristics>
<characteristicsList>
<characteristicType>TOBUSAGE</characteristicType>
<characteristicValue>N</characteristicValue>
<effectiveDate>2021-01-01</effectiveDate>
</characteristicsList>
</characteristics>
<membershipRateGuarantee>
<membershipRateGuaranteeList>
<rateGuaranteeStartDate></rateGuaranteeStartDate>
<rateGuaranteeEndDate></rateGuaranteeEndDate>
<rateGuaranteeStatus></rateGuaranteeStatus>
</membershipRateGuaranteeList>
</membershipRateGuarantee>
<membershipPersonCharacteristic>
<characteristicsList>
<characteristicType>C1_GENDER</characteristicType>
<characteristicValue>M</characteristicValue>
<effectiveDate>2021-01-01</effectiveDate>
</characteristicsList>
</membershipPersonCharacteristic>
<benefitData>
<benefitDataList>
<sequence>3</sequence>
<startDate>2023-01-15</startDate>
<endDate>2023-12-31</endDate>
<benefitStatus></benefitStatus>
<benefitSourceFlag>CMS</benefitSourceFlag>
<benefitTypeFlag>MA</benefitTypeFlag>
<benefitSubTypeFlag>BNFT_PREM</benefitSubTypeFlag>
<planBenefitPackageId></planBenefitPackageId>
<benefitAmount>500</benefitAmount>
<characteristics>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</characteristics>
</benefitDataList>
</benefitData>
<billableChargeData>
<sequence>3</sequence>
<accountIdType>ACC_001</accountIdType>
<accountIdValue>MEDICAL_ACCOUNT</accountIdValue>
<chargeType></chargeType>
<startDate>2021-03-01</startDate>
<endDate>2021-07-31</endDate>
<priceItemCode>MED_PREM_FEE</priceItemCode>
<description>Recurring Premium Fees</description>
<recurringMethod>BP</recurringMethod>
<billPeriod>HC</billPeriod>
<frequency></frequency>
<billAfterDt></billAfterDt>
<billableChargeLines>
<descriptionOnBill>Premium Fees</descriptionOnBill>
<currencyCode>USD</currencyCode>
<chargeAmount>100</chargeAmount>
<showOnBillSw>TRUE</showOnBillSw>
<appearInSummarySw>FALSE</appearInSummarySw>
<distributionCode>HC</distributionCode>
</billableChargeLines>
<characteristics>
<characteristicsList>
<characteristicType>
C1_GENDER
</characteristicType>
<characteristicValue>M</characteristicValue>
<effectiveDate>2021-01-01</effectiveDate>
</characteristicsList>
</characteristics>
</billableChargeData>
</memberData>
<accountData>
<accountType></accountType>
<customerClass></customerClass>
<billCycle></billCycle>
<billLeadDays></billLeadDays>
<division></division>
<dragDays></dragDays>
<currency></currency>
<setUpDate></setUpDate>
<acctUsageFlg></acctUsageFlg>
<comments></comments>
<deferAutoPayDt></deferAutoPayDt>
<collectionClass></collectionClass>
<billRouteType></billRouteType>
<billAddressSource></billAddressSource>
<accessGroup></accessGroup>
<skipAutoMaintenanceSw></skipAutoMaintenanceSw>
<identifiers>
<idType></idType>
<idValue></idValue>
<isPrimary></isPrimary>
</identifiers>
<address>
<addressEffDate></addressEffDate>
<addressType></addressType>
<address1></address1>
<address2></address2>
<address3></address3>
<address4></address4>
<city></city>
<state></state>
<zip></zip>
<country></country>
<houseType></houseType>
<streetNumber1></streetNumber1>
<streetNumber2></streetNumber2>
<inCityLimit></inCityLimit>
<taxVendorGeographicalCode>
</taxVendorGeographicalCode>
<county></county>
<addressStatus></addressStatus>
</address>
<autoPayDetails>
<priority></priority>
<startDate></startDate>
<endDate></endDate>
<percentage></percentage>
<autoPayMethod></autoPayMethod>
<autoPayRouteType></autoPayRouteType>
<autoPaySourceCode></autoPaySourceCode>
<accountNumber></accountNumber>
<expiryMonth></expiryMonth>
<expiryYear></expiryYear>
<name></name>
<maxWithdrawalAmount></maxWithdrawalAmount>
<comments></comments>
</autoPayDetails>
<accountPerson>
<idType></idType>
<idValue></idValue>
<accountRelationshipType></accountRelationshipType>
<isFinanciallyResponsible></isFinanciallyResponsible>
<personAddressOverride>
<address1></address1>
<address2></address2>
<address3></address3>
<address4></address4>
<city></city>
<state></state>
<country></country>
<houseType></houseType>
<streetNumber1></streetNumber1>
<streetNumber2></streetNumber2>
<inCityLimit></inCityLimit>
<taxVendorGeographicalCode>
</taxVendorGeographicalCode>
<county></county>
<zip></zip>
<addressStatus></addressStatus>
</personAddressOverride>
<accountPersonRouting>
<billRouteType></billRouteType>
<shouldReceiveCopyOfBill>
</shouldReceiveCopyOfBill>
<billFormat></billFormat>
<numberOfBillCopies></numberOfBillCopies>
<receivesNotification></receivesNotification>
<billAddressSource></billAddressSource>
</accountPersonRouting>
</accountPerson>
<characteristics>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</characteristics>
</accountData>
<policyData>
<policyType>FIG</policyType>
<sourceSystem>ZZ_UHG</sourceSystem>
<policyNumber>AP234389</policyNumber>
<description></description>
<advancedLevelFundingEligibility>
</advancedLevelFundingEligibility>
<startDate>2021-01-01</startDate>
<endDate>2021-12-31</endDate>
<runOutEndDate></runOutEndDate>
<runOutAdminOption></runOutAdminOption>
<renewalDate></renewalDate>
<advanceDepositApplSW></advanceDepositApplSW>
<advanceDepositAmount></advanceDepositAmount>
<advanceDepositGraceDays></advanceDepositGraceDays>
<advanceDepositAccountIdentifierType>
</advanceDepositAccountIdentifierType>
<advanceDepositAccountIdentifierValue>
</advanceDepositAccountIdentifierValue>
<policyPersons>
<idType></idType>
<idValue></idValue>
<policyPerRole></policyPerRole>
<startDate></startDate>
<endDate></endDate>
</policyPersons>
<terminationInformation>
<terminateDate></terminateDate>
<terminationReason></terminationReason>
</terminationInformation>
<reinstateInformation>
<reinstatementDate></reinstatementDate>
<reinstateReason></reinstateReason>
</reinstateInformation>
<characteristics>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</characteristics>
<planData>
<planNumber>HMO_MED_SL_R022</planNumber>
<priceItemCode></priceItemCode>
<planName>HMO_MED_SILVER_RETIRED</planName>
<pricingRuleTypeList>
<pricingRuleType></pricingRuleType>
</pricingRuleTypeList>
<startDate>2021-01-01</startDate>
<endDate>2021-12-31</endDate>
<primaryPlanSw></primaryPlanSw>
<benefitTypeFlag>MA</benefitTypeFlag>
<characteristics>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</characteristics>
<policyPlanProrationRuleList>
<effectiveDate></effectiveDate>
<prorationEventType></prorationEventType>
<prorationType></prorationType>
<numberOfDays></numberOfDays>
<membershipType></membershipType>
</policyPlanProrationRuleList>
</planData>
</policyData>
</personData>
<pricingRuleData>
<sequence></sequence>
<entityIdentifiers>
<entityIdentifiersList>
<entityIdentifierType></entityIdentifierType>
<entityIdentifierValue></entityIdentifierValue>
</entityIdentifiersList>
</entityIdentifiers>
<status></status>
<startDate></startDate>
<endDate></endDate>
<pricingRuleType></pricingRuleType>
<priceItemCd></priceItemCd>
<rateOption></rateOption>
<pricingType></pricingType>
<modifierApplicability></modifierApplicability>
<modifierMethod></modifierMethod>
<baseRate>
<sequence></sequence>
<baseFee></baseFee>
<lowerAgeLimit></lowerAgeLimit>
<upperAgeLimit></upperAgeLimit>
<pricingParameter>
<sequence></sequence>
<parameterCode></parameterCode>
<parameterValue></parameterValue>
</pricingParameter>
<modifierInformation>
<sequence></sequence>
<parameterCode></parameterCode>
<parameterValue></parameterValue>
<rate></rate>
</modifierInformation>
</baseRate>
<characteristics>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</characteristics>
</pricingRuleData>
<statementConstructsData>
<personStatementConstructs>
<personIdentifier></personIdentifier>
<personIdentifierType></personIdentifierType>
<statementConstructIdentifier>
</statementConstructIdentifier>
<statementAddressSource></statementAddressSource>
<statementCycle></statementCycle>
<statementRouteType></statementRouteType>
<effectiveStatus></effectiveStatus>
<addressId></addressId>
<numberOfCopies></numberOfCopies>
<statementFormat></statementFormat>
<description></description>
<statementConstructDetails>
<serviceAgreement></serviceAgreement>
<accountNumber></accountNumber>
<accountNumberTypeCd></accountNumberTypeCd>
<division></division>
<statementPrintDescription>
</statementPrintDescription>
<printOrder></printOrder>
<startDate></startDate>
<endDate></endDate>
</statementConstructDetails>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</personStatementConstructs>
</statementConstructsData>
</customerStructureData>
</customerStructureMessage>
<toDoRetry>
<retryDateTime></retryDateTime>
<numberOfRetries></numberOfRetries>
<currentErrorState></currentErrorState>
<isRetried></isRetried>
</toDoRetry>
</schema>Note: We have given the above sample to illustrate how the tags should
be nested while sending an inbound message from the external system.
However, you should not seamlessly use this sample in your environment
because the required pre-requisite data may not be available in your
environment. In such case, the system will give erroneous results.