Defining a Member Reconciliation Preference

Prerequisites

To define a member reconciliation preference, you should have:

  • Required characteristic types defined in the application

  • Required statuses defined in the lifecycle of the C1-MemberReconciliation and C1-PayInstruction business objects

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

Procedure

To define a member reconciliation 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 member reconciliation 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 member reconciliation preference. It contains the following fields:

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

      • Payment Event Characteristic Type - Used when a pay instruction is reconciled at the member level through the C1-RCPM batch.

      • Pay Instruction Completed Status - Used when a pay instruction is fully reconciled at the member level through the C1-RCPM batch.

      • Reconciliation Matching Level Characteristic Type - Used when reconciliation is created for a pay instruction file where all pay instructions have member data.

      • Pay Instruction Open Status - Used when a pay instruction is not fully reconciled at the member level through the C1-RCPM batch.

      • Reconciliation Open Status - Used when one or more pay instructions of a file are not yet fully reconciled at the member level through the C1-RCPM batch.

      		 Yes (Conditional)
      Note: This field is required while setting an attribute in the member reconciliation 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 member reconciliation preference:
      If the attribute is set to... Then, this field is...
      Payment Event Characteristic Type Used to specify the characteristic type where you can store the payment event ID. This type of characteristic is defined for the reconciliation adjustments. It indicates the payment event whose payment is distributed against the bill segment. Here, you must specify a characteristic type where the characteristic entity is set to Adjustment.
      Note: The C1PAYEVT characteristic type is shipped with the product.
      		Yes (Conditional)
      Note: This field is required while setting an attribute in the member reconciliation preference.
      Pay Instruction Completed Status Used to specify the status code to which you want to transition the pay instruction when it is fully reconciled.
      Note: Here, you must specify the status code which is already defined in the lifecycle of the C1-PayInstruction business object.
      Reconciliation Matching Level Characteristic Type Used to specify the characteristic type which indicates all pay instructions in the file must be reconciled at the member level. This type of characteristic is defined for the reconciliation when all pay instructions in a file have member data. Here, you must specify a characteristic type where the characteristic entity is set to Member Reconciliation.
      Note: The C1-MTLVL characteristic type is shipped with the product.
      Pay Instruction Open Status Used to specify the status code to which you want to transition the pay instruction when it is not fully reconciled.
      Note: Here, you must specify the status code which is already defined in the lifecycle of the C1-PayInstruction business object.
      Reconciliation Open Status Used to specify the status code to which you want to transition the reconciliation when the status of the pay instruction is changed to Open.
      Note: Here, you must specify the status code which is already defined in the lifecycle of the C1-MemberReconciliation business object.
      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 member reconciliation preference, you must set at least one attribute in the member reconciliation preference.
  6. Select the Member Reconciliation 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 member reconciliation preference, click the Add (The Add Icon) icon and then repeat step 8.
    Note: However, if you want to remove an attribute from the member reconciliation preference, click the Delete (The Delete Icon) icon corresponding to the attribute.
  10. Click Save.
    The member reconciliation preference is defined.

Related Topics

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