Defining a Geographic Rating Area Preference

Prerequisites

To define a geographic rating area preference, you should have:

  • Values defined in the ADDRESS_​SRC_​FLG, ADDRESS_​TYPE_​FLG, and MAP_​ENTITY_​FLG lookup fields

  • Geographic rating areas defined in the application

Procedure

To define a geographic rating area preference:

  1. Click the Admin link in the Application toolbar.
    A list appears.
  2. From the Admin menu, select F and then click Field Mapping.
    A sub-menu appears.
  3. Click the Add option from the Field Mapping sub-menu.

    The Select Business Object screen appears. It contains the following field:

    Field Name Field Description Mandatory (Yes or No)
    Field Mapping Business Object Used to indicate the business object using which you want to create the geographic rating area preference. The valid values are:

    • Field Mapping

    • Medicare Plan Benefit Package

    • Membership Status Reason Mapping

    		 Yes
    Note: Alternatively, you can access the Select Business Object screen by clicking the Add button in the Page Title area of the Field Mapping screen.
  4. Select the Field Mapping option from the Field Mapping Business Object list.
  5. Click OK.

    The Field Mapping screen appears. It contains the following sections:

    • Main - Used to specify basic details of the geographic rating area preference. It contains the following fields:

      Field Name Field Description Mandatory (Yes or No)
      Preference Used to specify the geographic rating area preference. Yes
      Description Used to specify the description for the geographic rating area preference. Yes
      Detailed Description Used to specify additional information about the geographic rating area preference. No
      Status Used to indicate the status of the geographic rating area preference. The valid values are:

      • Active

      • Inactive

      		 Yes

    • Preference Category - This section contains the following field:

      Field Name Field Description Mandatory (Yes or No)
      Preference Category Used to indicate the category to which the preference belongs. The valid values are:

      • Billing

      • Binder Payment

      • Geographic Rating Area

      • Individual Membership

      • Medicare

      • Medicare Plan Benefit

      • Member Reconciliation

      • Member Relationship and Subscription Tier

      • Membership Status Reason

      • Statement Construct

      		 Yes

    • Preference Settings - Used to set the attributes in the geographic rating area preference. It contains the following fields in a grid:

      Field Name Field Description Mandatory (Yes or No)
      Attribute Used to indicate the attribute which you want to set in the geographic rating area preference. The valid values are:

      • Address Source Characteristic Type - Used when the system derives the geographic rating area for a membership.

      • Address Type Characteristic Type - Used when the system derives the geographic rating area for a membership.

      • Default Address Source - Used when the address source characteristic is not defined for any of the following entities:

        • Policy Plan

        • State where the Policy Plan is Issued

        • Policy

        • State where the Policy is Issued

      • Default Address Type - Used when the address type characteristic is not defined for any of the following entities:

        • Policy Plan

        • State where the Policy Plan is Issued

        • Policy

        • State where the Policy is Issued

      • Default Geographic Rating Area - Used when the system is unable to derive the geographic rating area for the following combination:

        • State and zip code (this combination is considered when the Use Plan Details attribute is set to No)

        • State, zip code, policy number, plan number, and source system (this combination is considered when the Use Plan Details attribute is set to Yes)

      • Geographic Rating Area Characteristic Type - Used when the system stores the geographic rating area for a membership.

      • Use Plan Details - Used to indicate whether the policy number, plan number, and source system should be considered while deriving the geographic rating area for a membership.

      		 Yes (Conditional)
      Note: This field is required while setting an attribute in the geographic rating area preference.
      Value Used to specify the attribute value. The attribute value that you can specify varies depending on the attribute you want to set in the geographic rating area preference:
      If the attribute is set to... Then, this field is...
      Address Source Characteristic Type Used to specify the characteristic type that indicates the address source. The system supports two address sources named Policy Holder and Main Subscriber. This type of characteristic can be defined for the following entities:

      • Policy Plan

      • State where the Policy Plan is Issued

      • Policy

      • State where the Policy is Issued

      Here, you must specify a characteristic type where the characteristic entity is set to Policy Plan, State, and Policy.

      Note: The C1-ADSRC characteristic type is shipped with the product.
      Address Type Characteristic Type Used to specify the characteristic type that indicates the address type. The system supports three address types named Person Mailing, Person Seasonal, and Account Override. This type of characteristic can be defined for the following entities:

      • Policy Plan

      • State where the Policy Plan is Issued
      		Yes (Conditional)
      Note: This field is required while setting an attribute in the geographic rating area preference.

      • Policy

      • State where the Policy is Issued

      Here, you must specify a characteristic type where the characteristic entity is set to Policy Plan, State, and Policy.

      Note: The C1-ADTYP characteristic type is shipped with the product.
      Default Address Source Used to specify the address source. The valid values are:

      • Main Subscriber

      • Policy Holder

      Note: The list includes only those values which are defined in the ADDRESS_​SRC_​FLG lookup field.
      Default Address Type Used to specify the address type. The valid values are:

      • Person Mailing

      • Person Seasonal

      • Account Override

      Note: The list includes only those values which are defined in the ADDRESS_​TYPE_​FLG lookup field.
      Default Geographic Rating Area Used to specify the geographic rating area.
      Note: Here, you can specify a geographic rating area which is already defined in the system.
      Geographic Rating Area Characteristic Type Used to specify the characteristic type where you can store the geographic rating area. This type of characteristic is defined for the membership. Here, you must specify a characteristic type where the characteristic entity is set to Membership.
      Note: The C1-GEORT characteristic type is shipped with the product.
      Use Plan Details Used to indicate whether the policy plan details should be considered while deriving the geographic rating area for a membership. The valid values are:

      • Yes - Used when you want to derive the geographic rating area using the state, zip code, policy number, plan number, and source system combination.

      • No - Used when you want to derive the geographic rating area using the state and zip code combination.
      Entity Type Used to indicate the type of entity for which the attribute is applicable. The valid values are:

      • Account

      • Billable Charge

      Note: At present, this data is stored for informational purposes only and is not considered in the business logic. If required, you can add more entity types to the MAP_​ENTITY_​FLG lookup field.
      		 No
      Note: While defining a geographic rating area preference, you must set at least one attribute in the geographic rating area preference.
  6. Select the Geographic Rating Area option from the Preference Category list.
  7. Enter the required details in the Main section.
  8. Select the required attribute and value from the respective fields.
  9. If you want to set more than one attribute in the geographic rating area preference, click the Add (The Add Icon) icon and then repeat step 8.
    Note: However, if you want to remove an attribute from the geographic rating area preference, click the Delete (The Delete Icon) icon corresponding to the attribute.
  10. Click Save.
    The geographic rating area preference is defined.

Related Topics

For more information on... See...
Field Mapping screen Field Mapping