Bill Group's Account

The claim charges, specific stop-loss credits, aggregate stop-loss credits, claim based fees, enrollment based fees, ancillary charges, discount, and level funding charges are billed to the bill group's account. Therefore, every bill group should have at least one account in the system. You can create multiple accounts for a bill group. You can create an account for a bill group through a customer registration object or a health care inbound message.

Depending on the employer's preference, the claim charges, specific stop-loss credits, aggregate stop-loss credits, claim based fees, enrollment based fees, ancillary charges, discount, and level funding charges can be billed on the same or different accounts of the bill group. The system enables you to create different types of accounts (such as, standard and retention) for a bill group. You can specify the type of account by defining the Invoice Type (C1INVTYP) characteristic for the account.

Note: At present, we have not shipped any predefined values for the Invoice Type (C1INVTYP) characteristic type. You must define the predefined characteristic values as per the business requirements.

You can also set the priority for an account based on the invoice type while specifying the billing account information for a price item in a pricing rule type.

For example, the following table illustrates the accounts of different types to which the charges of P1 and P2 should be billed based on the given priority:
Price Item Priority Invoice Type Account
P1 10 Standard A1
20 Retention A2
P2 10 Retention A2
20 Standard A1

Now, when a claim transaction is mapped to P1, the system checks whether an account where the Invoice Type (C1INVTYP) characteristic type is set to Standard exists for the bill group. If so, it considers the standard account (A1) of the bill group for billing. However, if an account where the Invoice Type (C1INVTYP) characteristic type is set to Standard does not exist for the bill group, the system checks whether an account where the Invoice Type (C1INVTYP) characteristic type is set to Retention exists for the bill group. If so, it considers the retention account (A2) of the bill group for billing. If an account where the Invoice Type (C1INVTYP) characteristic type is set to Retention does not exist for the bill group, the status of the transaction is changed to Error.

Similarly, when a claim transaction is mapped to P2, the system considers the account of the bill group which is available based on the priority. The system derives the billing account for only those price items for which the effective pricing rule is derived.

The system searches the account of the bill group based on the priority when the Invoice Type Characteristic Type option type of the C1-ASOBLLNG feature configuration is set to C1INVTYP.

Related Topics

For more information on... See...
How to setup the C1-ASOBLLNG feature configuration Setting the C1-ASOBLLNG Feature Configuration