Defining an Individual Membership Preference

Prerequisites

To define an individual membership preference, you should have:

  • Values defined in the FIELD_​CAT_​FLG and FIELD_​NAME_​FLG lookup fields

  • Required characteristic type defined for the health plan in the application.

Procedure

To define an individual membership 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 billing 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 billing preference. It contains the following fields:

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

      • Health Plan Characteristics - Used when you want to derive the health plan ID for an individual membership.

      		 Yes (Conditional)
      Note: This field is required while setting an attribute in the individual membership 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 billing preference:
      If the attribute is set to... Then, this field is...
      Health Plan Characteristics Used to specify the characteristic type which indicates the plan ID of the health plan. This characteristic type is defined for a health plan. The system uses this plan ID to create a health plan specific contract. The system then uses this characteristic type to determine the account of the financial responsible person for whom the billable charges should be generated.
      Note: The list includes only those characteristics which are already defined in the system.
      		Yes (Conditional)
      Note: This field is required while setting an attribute in the individual membership preference.
      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 an individual membership preference, you must set at least one attribute in the individual membership preference.
  6. Select the Individual Membership 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 individual membership preference, click the Add (The Add Icon) icon and then repeat step 8.
    Note: However, if you want to remove an attribute from the individual membership preference, click the Delete (The Delete Icon) icon corresponding to the attribute.
  10. Click Save.
    The individual membership preference is defined.

Related Topics

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