Binder Payment Monitoring

A new batch named C1-BPMNT is introduced to monitor the binder payments for the individual memberships. It checks whether there are any individual memberships where:

  • Individual membership status is set to the value specified in the Membership Status Code for Pending Effectuation attribute of the binder payment preference.

  • Membership status reason is set to the value specified in the Membership Status Reason when Awaiting Binder Payment attribute of the binder payment preference.

Note: The batch considers the binder payment preference which is specified in the Binder Payment Field Mapping option type of the C1-ASOBLLNG feature configuration.

If so, the batch checks whether the Binder Payment Applicability option is set to Y for the individual membership. If so, the system calculates grace date using the membership start date and grace days. If the grace date is equal to or earlier than system date, the batch derives the account for the individual membership. While deriving the account for the individual membership, the system checks whether the characteristic types specified in the Account Identifier Type Char Type and Account Identifier Value Char Type option types of the C1-ASOBLLNG feature configuration are defined for the individual membership. If so, the system derives the account using these characteristics defined for the individual membership. If these characteristics are not defined for the individual membership, the system derives the account of financially responsible member person. The system checks whether a payment with the binder payment identification characteristic exists against any contract of the account. If so, the system derives the value from the Binder Payment Identification ID Type attribute of the binder payment preference. The system then checks whether the binder payments are received for the individual membership using the values from the following:

  • Binder Payment Identification Characteristic

  • Binder Payment Identification ID Type attribute of the binder payment preference

If the binder payments are received for the individual membership, the system does the following:

If the Consider Binder Lability Amount set to… Then...
Y The system validates whether the sum of binder payments is equal to or greater than the threshold amount. If so, the system does the following:

  • Creates a To Do using the To Do type which is specified in the To Do Type for Binder Payment Received attribute of the binder payment preference.

  • Updates the membership status reason to the value specified in the Membership Status Reason when Binder Payment Received attribute of the binder payment preference.

  • Updates the member person status reason using the membership status reason preference which is specified in the Status Reason Mapping option type of the C1-ASOBLLNG feature configuration.

  • Changes the bill after date of the billable charges when the Hold Billing option for the individual membership is set to Y.
N The system does not validate the binder payment against the threshold amount. If the binder payment amount is greater than zero, the system does the following:

  • Creates a To Do using the To Do type which is specified in the To Do Type for Binder Payment Received attribute of the binder payment preference.

  • Updates the membership status reason to the value specified in the Membership Status Reason when Binder Payment Received attribute of the binder payment preference.

  • Updates the member person status reason using the membership status reason preference which is specified in the Status Reason Mapping option type of the C1-ASOBLLNG feature configuration.

Note: In this case, the system does not update the bill after date of the billable charges when the Hold Billing option for the individual membership is set to Y. The system updates the bill after date of the billable charges when the status of the individual membership is changed to Active through a health care inbound message.

If the grace date is later than the system date, the batch does the following irrespective of whether the Consider Binder Lability Amount attribute is set to Y or N:

  • Creates a To Do using the To Do type which is specified in the To Do Type for Binder Payment Not Received attribute of the binder payment preference.

  • Updates the membership status reason to the value specified in the Membership Status Reason when Binder Payment Not Received attribute of the binder payment preference.

  • Updates the member person status reason using the membership status reason preference which is specified in the Status Reason Mapping option type of the C1-ASOBLLNG feature configuration.