Defining a Medicare Preference

Prerequisites

To define a medicare preference, you should have:

  • Values defined in the MAP_​ENTITY_​FLG lookup field

  • Value defined for the Medicare option type in the C1-ASOBLLNG feature configuration.

Procedure

To define a medicare 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 billing preference. Yes
      Description Used to specify the description for the billing preference. Yes
      Detailed Description Used to specify additional information about the billing 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 billing 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 medicare preference. The valid values are:

      • Late Enrollment Penalty - Used when you want to indicate the benefit sub type for Medicare Part D LEP in the medicare preference.

      • Low Income Subsidy - Used when you want to indicate the benefit sub type for Medicare Part D LIS in the medicare preference.

      • Medicare Prescription Drug Coverage - Used when you want to indicate the benefit sub type for Medicare Part D in the medicare preference.

      		 Yes (Conditional)
      Note: This field is required while setting an attribute in the medicare 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...
      Late Enrollment Penalty Used to specify the benefit sub type that you want to use while creating charges for Medicare Part D LEP.
      Low Income Subsidy Used to specify the benefit sub type that you want to use while creating charges for Medicare Part D LIS.
      Medicare Prescription Drug Coverage Used to specify the benefit sub type that you want to use while creating charges for Medicare Part D.
      		Yes (Conditional)
      Note: This field is required while setting an attribute in the medicare 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 a medicare preference, you must set at least one attribute in the billing preference.
  6. Select the Medicare 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 medicare preference, click the Add (The Add Icon) icon and then repeat step 8.
    Note: However, if you want to remove an attribute from the medicare preference, click the Delete (The Delete Icon) icon corresponding to the attribute.
  10. Click Save.
    The medicare preference is defined.

Related Topics

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