Delinquency Miscellaneous Options Business Rule

Oracle Revenue Management and Billing enables you to define business rules for determining the following during the delinquency management:

  • Whether the trigger dates of delinquency events should be recalculated when the hold on the delinquency process is released

  • Whether the trigger dates of delinquency events should be recalculated when the delinquency process is resumed after cancellation

  • Whether you want to send an outbound message to the enrollment system for terminating the individual memberships billed to the delinquent account immediately, at the end of the month when the termination event is triggered, or after X number of days (i.e. termination wait days) from the termination event trigger date

  • The number of days that you want to add to the base date while calculating the termination effective date

The insurance company may offer different delinquency arrangements to different individuals based on certain parameters, such as division, customer class, region, and jurisdiction in which the individual customer has availed for the health plan coverage. The system will then accordingly use the business rule to calculate the following:

  • Trigger dates for the delinquency events

  • Termination request date when you want to send the outbound message to the external system requesting to terminate the individual membership

  • Termination effective date for the delinquency event type that requests to terminate the individual memberships billed to the delinquent account

The system considers the delinquency miscellaneous options business rules to determine the following:

  • The value for the Trigger Date Recalculation On Hold Release flag when the trigger date recalculation on hold release source is set to Algorithm in the respective delinquency process type. If the trigger date recalculation on hold release source is set to Algorithm, the system executes the C1-DERRTDBR algorithm attached to the Trigger Date Recalculation Option Derivation system event of the delinquency process type when you execute the C1-DPMON batch. For more information on how the value is derived for the Trigger Date Recalculation On Hold Release flag, refer to the respective algorithm description in the Delinquency Process Type Algorithms section.

  • The value for the Trigger Date Recalculation On Resume flag when the trigger date recalculation on resume source is set to Algorithm in the respective delinquency process type. If the trigger date recalculation on resume source is set to Algorithm, the system executes the C1-DERRTDBR algorithm attached to the Trigger Date Recalculation Option Derivation system event of the delinquency process type when you execute the C1-DPMON batch. For more information on how the value is derived for the Trigger Date Recalculation On Resume flag, refer to the respective algorithm description in the Delinquency Process Type Algorithms section.

  • The value for the Trigger Termination Process flag and the termination wait days when the termination reinstatement configuration source is set to Algorithm in the respective delinquency process type. If the termination reinstatement configuration source is set to Algorithm, the system executes the C1-DERTROBR algorithm attached to the Termination and Reinstatement Configuration Derivation system event of the delinquency process type when you execute the C1-DPMON batch. For more information on how the value is derived for the Trigger Termination Process flag, refer to the respective algorithm description in the Delinquency Process Type Algorithms section.

  • The number of days that you want to add to the base date while deriving the termination effective date. The system executes the C1-DETTERMDT algorithm attached to the Event Activation system event of the respective delinquency event type whenever the delinquency event is triggered manually or automatically on the trigger date.

    • Add Days to Coverage End Date

    • Add Days to Paid Through Date

    • Add Months to Paid Through Date

    • Add Days to Grace End Date

    • Add Days to Date of Processing of Termination Request

While defining the delinquency miscellaneous options business rule criteria, you can use the parameters which are defined on the following entities:

  • Account

  • Customer Class

  • Delinquency Event Type

  • Division

  • Health Plan

  • Health Product

  • Membership

  • Membership Person

  • Policy

  • Policy Plan

You can define, edit, and delete a delinquency miscellaneous options business rule through the Business Rule screen. While defining a delinquency miscellaneous options business rule, you need to set its category to Delinquency Miscellaneous Options Business Rule and specify the following details:

  • Criteria Description - Used to indicate the business criteria that an individual membership must satisfy in order to derive the required parameters from the business rule.

  • Effective Date - Used to specify the date from when the business rule is effective.

  • Status - Used to indicate the status of the business rule. The valid values are Active and Inactive.

  • Trigger Date Recalculation On Hold Release - Used to indicate whether the trigger dates of delinquency events should be recalculated when the hold on the delinquency process is released. The valid values are - Yes and No.

  • Trigger Date Recalculation On Resume - Used to indicate whether the trigger dates of delinquency events should be recalculated when the delinquency process is resumed after cancellation. The valid values are - Yes and No.

  • Trigger Termination Process - Used to indicate when you want the system to send an outbound message to the enrollment system for terminating the individual memberships billed to the delinquent account. The valid values are:

    • Immediate - Used when you want the system to send an outbound message for termination on the same day when the termination event is triggered.

    • Month End - Used when you want the system to send an outbound message for termination at the end of the month when the termination event is triggered.

    • After X Days - Used when you want the system to send an outbound message for termination after X number of days from the date when the termination event is triggered.

  • Termination Wait Days - Used to specify the number of days after which an outbound message for termination should be sent to the enrollment system. This parameter is required only when the Trigger Termination Process parameter in the business rule is set to After X Days.

  • Add Days to Coverage End Date - Used to specify the number of days that you want to add to coverage end date in order to derive termination effective date.

  • Add Days to Paid Through Date - Used to specify the number of days that you want to add to the paid through date (of the account) in order to derive termination effective date.

  • Add Months to Paid Through Date - Used to specify the number of months that you want to add to the paid through month (derived from the paid through date of the account) in order to derive termination effective date.

  • Add Days to Grace End Date - Used to specify the number of days that you want to add to grace end date in order to derive termination effective date.

  • Add Days to Date of Processing of Termination Request - Used to specify the number of days that you want to add to termination request date in order to derive termination effective date.

Note: The Allow Automatic Reinstatement, Maximum Automatic Reinstatement Count, Trigger Reinstatement Process, Reinstatement Wait Days, Reinstatement Threshold (%), Days Since Termination, and Member Notification Days parameters in the delinquency miscellaneous options business rule are not applicable for the fully insured individual business.

You can view the delinquency miscellaneous options business rules through the Business Rule screen.

Parent topic: Business Rules