Delinquency Management

Most often, the fully insured group and individual businesses come across scenarios wherein customers fail to pay premium for their policy or health plans, respectively, on time, resulting in delinquency. For the fully insured group business, ORMB enables you to establish a delinquency process at the person (i.e. parent customer or bill group) level to whom the policies are billed or at the account (i.e. parent customer's or bill group's account) level to which the policies are billed. However, for the fully insured individual business, ORMB enables you to establish a delinquency process only at the account level to which individual memberships are billed. A delinquency process signifies a set of procedures and policies that are in place to manage overdue or unpaid insurance premiums.

The system refers the collection class of the person or account, respectively, to control its collection lifecycle. The system monitors the account's debt using the bills of the account as the collection objects. However, the system monitors the person's debt using the bills of all its accounts in its hierarchy as the collection objects. The following screens are introduced for the Delinquency Management feature:

• Delinquency Control

• Delinquency Event Type

• Delinquency Process Type

• Delinquency Process Search

• Delinquency Process

The system can create a delinquency process only when the following prerequisites are configured:

• If you want to create a delinquency process for a person or an account, you need to set the collection method of the respective collection class to Self-Control Delinquency. If you want to evaluate the debt of a person or an account while monitoring the parent person's delinquency, you need to set the collection method of the respective collection class to Parental Delinquency. However, if you want to ignore a person or an account while monitoring the delinquency, you need to set the collection method of the respective collection class to Not Eligible for Collection. For more information, see Collection Class.

• A delinquency control is defined for the required collection classes. For more information, see Delinquency Control.

• The required delinquency event types and delinquency process types are defined in the system. For more information about the delinquency event type and delinquency process type, see Delinquency Event Type and Delinquency Process Type.

• A preference of the following preference categories is defined in the system:

  • Delinquency Process (Used for Viewing)

  • Delinquency Process Type

  • Individual Membership (required only for the fully insured individual business)

  • Bill Route Method - Contact Method Mapping Preference

• The parameters required to create the business rule criteria are defined in the system.

• The business rules of the following categories are defined in the system:

  • Delinquency Events Attribute Business Rule

  • Delinquency Grace Period Business Rule

  • Delinquency Miscellaneous Options Business Rule

  • Delinquency Termination Date Rule Business Rule

• Required rule types and rules are defined to determine whether the delinquency event is eligible to be included in the delinquency process of a person or an account. For more information, see Delinquency Event Eligibility Evaluation and Trigger Date Calculation.

• The outbound message types are defined for the following business objects:

  • C1-MemberTermRequest (required only for the fully insured individual business)

  • C1-MemberCancRequest (required only for the fully insured individual business)

  • C1-PolicyTerminateRequest (required only for the fully insured group business)

  • C1-PolicyReinstateRequest (required only for the fully insured group business)

• The following option types are defined in the C1-ASOBLLNG feature configuration:

  • Individual Membership Configurations (required only for the fully insured individual business)

  • Membership Active Status (required only for the fully insured individual business)

  • Membership Terminated Status (required only for the fully insured individual business)

  • Policy Active Status (required only for the fully insured group business)

  • Policy Pending Reinstatement Status (required only for the fully insured group business)

  • Policy Pending Termination Status (required only for the fully insured group business)

  For more information about these option types, see C1-ASOBLLNG Feature Configuration.

• Set the batch control type of the following batches to Timed and execute them in the below given sequence:

  • C1-DPMON

  • C1-PRDLQ (required only for the fully insured group business)

  • C1-ACDLQ

  • C1-DPEVL

  • C1-MBRNT (required only for the fully insured group business)

  • C1-HLMON

  • C1-ADMON (required only if the advance deposit feature is opted for the fully insured group business)

  • C1-MTOMT (required only for the fully insured individual business)

Oracle Revenue Management and Billing allows you to manage delinquency for the individual health care business. For more information, see Individual Health Insurance Delinquency

Parent Topic: Oracle Revenue Management and Billing Insurance Business Processes