Health Product and Plan Inbound Message XML Format

Note: We recommend you to refer the Health Product and Plan Inbound Message schema in parallel while understanding the below mentioned tags. This will help you to understand how the tags are nested in the schema.

Before calling the C1-HCProdHlthPlnInboundMessage inbound web service, you need to ensure that the health product and plan inbound message contains the following tags:

Tag Name Tag Description Mandatory (Yes or No)
schema Used to specify the tags of a health product and plan inbound message. Yes
messageType Used to indicate the health product and plan inbound message type using which the health product and plan inbound message should be created in the system.
Note: You must specify a valid health product and plan inbound message type which is created using the C1-HCProdHlthPlnInboundTyp business object and which is in the Active status. The system then derives the business objects using which the health product and plan inbound message, health products, and health plans should be created from the health product and plan inbound message type.
 Yes
sourceSystem Used to indicate the external system from where the health product and plan inbound message is received.
Note: You must specify a source system which is already defined in the C1-SourceSystemLookup extendable lookup. It must be in the Active status.
 Yes
externalTransactionId Used to indicate the transaction in the external source system which resulted in the health product and plan inbound message. No
externalBatchId Used to indicate the external batch job or batch run number through which the health product and plan inbound message is created. Yes
externalSourceId Used to specify the external source system ID. Yes
characteristics

You can use this tag within the following tags:

  • schema - Here, the characteristics tag is used to specify a list of characteristics for the health product and plan inbound message.

  • healthPlanPricingRuleData - Here, the characteristics tag is used to specify a list of characteristics for the pricing rule of a health plan.

 No
inboundMessageCharacteristic Used to specify a characteristic for the health product and plan inbound message. No
adhocCharacteristicValue Used to specify the value for the adhoc characteristic type. Yes (Conditional)
Note: This data is required while defining or editing an adhoc characteristic of the health product and plan inbound message.
characteristicType

You can use this tag within the following tags:

  • inboundMessageCharacteristic - Here, the characteristicType tag is used to specify the characteristic type. Here, you must specify a characteristic type where the characteristic entity is set to Inbound Message.

  • productCharacteristics - Here, the characteristicType tag is used to specify the characteristic type. Here, you must specify a characteristic type where the characteristic entity is set to Product.

  • healthPlanCharacteristics - Here, the characteristicType tag is used to specify the characteristic type. Here, you must specify a characteristic type where the characteristic entity is set to Health Plan.

  • characteristicsList - Here, the characteristicType tag is used to specify the characteristic type. Here, you must specify a characteristic type where the characteristic entity is set to Pricing Rule.

 Yes (Conditional)
Note: This data is required while defining or editing a characteristic of the respective entity.
effectiveDate

You can use this tag within the following tags:

  • inboundMessageCharacteristic - Here, the effectiveDate tag is used to specify the date from when the characteristic is effective for the health product and plan inbound message.

  • productCharacteristics - Here, the effectiveDate tag is used to specify the date from when the characteristic is effective for the health product.

  • healthPlanCharacteristics - Here, the effectiveDate tag is used to specify the date from when the characteristic is effective for the health plan.

  • characteristicsList - Here, the effectiveDate tag is used to specify the date from when the characteristic is effective for the pricing rule of a health plan.

Note: You must specify the date in the YYYY-MM-DD format.
 Yes (Conditional)
Note: This data is required while defining or editing a characteristic of the respective entity.
characteristicValue

You can use this tag within the following tags:

  • inboundMessageCharacteristic

    - Here, the characteristicValue tag is used to specify the value for the predefined characteristic type.

  • productCharacteristics - Here, the characteristicValue tag is used to specify the value for the characteristic type.

  • healthPlanCharacteristics - Here, the characteristicValue tag is used to specify the value for the characteristic type.

  • characteristicsList - Here, the characteristicValue tag is used to specify the value for the characteristic type.

 Yes (Conditional)
Note: This data is required while defining or editing a characteristic of the respective entity.
characteristicValueForeignKey1 Used to specify the first value for the foreign key characteristic type. Yes (Conditional)
Note: This data is required while defining or editing a foreign key characteristic of the health product and plan inbound message.
characteristicValueFK2 Used to specify the second value for the foreign key characteristic type. No
characteristicValueFK3 Used to specify the third value for the foreign key characteristic type. No
characteristicValueFK4 Used to specify the fourth value for the foreign key characteristic type. No
characteristicValueFK5 Used to specify the fifth value for the foreign key characteristic type. No
productHealthPlanMessage Used to specify the details of a health product, health plan, or pricing rule for a health plan. Yes
HealthProductData Used to specify the details of a health product. Yes (Conditional)
Note: This data is required while defining or editing a health product.
healthProductCode

You can use this tag within the following tags:

  • HealthProductData - Here, the healthProductCode tag is used to specify the unique identifier for the health product.

  • healthPlanData - Here, the healthProductCode tag is used to indicate the health product for which you want to define the health plan.

 Yes
description

You can use this tag within the following tags:

  • HealthProductData - Here, the description tag is used to specify the description for the health product.

  • healthPlanData - Here, the description tag is used to specify the description for the health plan.

 Yes
productType Used to indicate how the health product can be classified based on the provider network.
Note: You must specify a value which is already defined in the PRODUCT_​TYPE_​FLG lookup field. It must be in the Active status.
 Yes
productSubType Used to indicate the type of medical accounts that are linked to the health product.
Note: You must specify a value which is already defined in the PRODUCT_​SUB_​TYPE_​FLG lookup field. It must be in the Active status.
 No
productHCCategory Used to indicate the health care category to which the health product belongs.
Note: You must specify a value which is already defined in the PRODUCT_​CATEGORY_​FLG lookup field. It must be in the Active status.
 No
productAdministration Used to specify the name of the agency which administers the health product. No
productLOB Used to indicate the line of business to which the health product belongs.
Note: You must specify a value which is already defined in the PRODUCT_​LOB_​FLG lookup field. It must be in the Active status.
 No
productLOBCategory Used to indicate the line of business category to which the health product belongs.
Note: You must specify a value which is already defined in the PRODUCT_​LOB_​CAT_​FLG lookup field. It must be in the Active status.
 No
bundledProduct Used to indicate whether the health product is a bundled product. The valid values are:

  • Y

  • N

 Yes
bundledProducts Used to specify the health products which are included in the bundled product. Yes (Conditional)
Note: This data is required when the health product is a bundled product (i.e. when the bundledProduct tag contains Y).
startDate

You can use this tag within the following tags:

  • HealthProductData - Here, the startDate tag is used to specify the date from when the health product is effective.

    Note: The health product start date cannot be later than the health product end date.

  • healthPlanData - Here, the startDate tag is used to specify the date from when the health plan is effective.

    Note:

    The health plan start date cannot be later than the health plan end date.

    The health plan start date cannot be earlier than the health product start date and later than the health product end date.

  • healthPlanPricingRuleData - Here, the startDate tag is used to specify the date from when the pricing rule of a health plan is effective.

    Note:

    The pricing rule start date cannot be later than the pricing rule end date.

    The pricing rule start date cannot be earlier than the health plan start date and later than the health plan end date.

Note: You must specify the date in the YYYY-MM-DD format.
 Yes
endDate

You can use this tag within the following tags:

  • HealthProductData - Here, the endDate tag is used to specify the date till when the health product is effective.

    Note: The health product end date cannot be earlier than the health product start date.

  • healthPlanData - Here, the endDate tag is used to specify the date till when the health plan is effective.

    Note:

    The health plan end date cannot be earlier than the health plan start date.

    The health plan end date cannot be earlier than the health product start date and later than the health product end date.

  • healthPlanPricingRuleData - Here, the endDate tag is used to specify the date till when the pricing rule of a health plan is effective.

    Note:

    The pricing rule end date cannot be earlier than the pricing rule start date.

    The pricing rule end date cannot be earlier than the health plan start date and later than the health plan end date.

Note: You must specify the date in the YYYY-MM-DD format.
 No
status

You can use this tag within the following tags:

  • HealthProductData - Here, the status tag is used to indicate the status of the health product. The valid values are:

    • ACTIVE

    • INACTIVE

  • healthPlanData - Here, the status tag is used to indicate the status of the health plan. The valid values are:

    • ACTIVE

    • INACTIVE

  • healthPlanPricingRuleData - Here, the status tag is used to indicate the status of the pricing rule. The valid values are:

    • PENDING

    • ACTIVE

    • INACTIVE

 Yes
productCharacteristics Used to specify a list of characteristics for the health product. No
healthProductDivision Used to specify a list of divisions where the health product is available. Yes (Conditional)
Note: This data is required while associating a health product with a division.
division Used to indicate the division where the health product is available.
Note: If you associate the health product with a division, the system only allows the persons belonging to the division to enroll for different health plans of the health product. However, if you do not associate the health product to any division, the system allows the persons belonging to different divisions to enroll for different health plans of the health product.
 Yes
healthPlanData Used to specify the details of the health plan. Yes (Conditional)
Note: This data is required while defining or editing a health plan.
healthPlanCode Used to specify the unique identifier for the health plan. Yes
charitablePlan Used to indicate whether the health plan provides subsidized health insurance coverage. The valid values are:

  • Y

  • N

Note: If you do not specify the value, by default, it is set to N.
 No
standardPlan Used to indicate whether the health plan provides standard health insurance coverage. The valid values are:

  • Y

  • N

Note: If you do not specify the value, by default, it is set to N.
 No
acaQhp Used to indicate whether the health plan provides Affordable Care Act (ACA) qualified health insurance coverage. The valid values are:

  • Y

  • N

Note: If you do not specify the value, by default, it is set to N.
 No
grandFatherPlan Used to indicate whether the health plan is a grandfathered health plan. The valid values are:

  • Y

  • N

Note: If you do not specify the value, by default, it is set to N.
 No
ancillaryBenefits Used to indicate whether the health plan provides ancillary benefits. The valid values are:

  • Y

  • N

Note:

Ancillary benefits are a secondary type of health insurance coverage that covers miscellaneous medical expenses that are incurred during a stay at the hospital. For example, it can cover expenses such as ambulance transportation, blood, drugs, and medical supplies like bandages.

If you do not specify the value, by default, it is set to N.

 No
riderBenefits Used to indicate whether the health plan provides rider benefits. The valid values are:

  • Y

  • N

Note:

A rider is an additional benefit that can be included to the basic health insurance plan. By adding riders, the insurance coverage can be expanded as per the requirement and at a lower cost.

If you do not specify the value, by default, it is set to N.

 No
addOnPlan Used to indicate whether the health plan is an add-on health plan. The valid values are:

  • Y

  • N

Note:

If you do not specify the value, by default, it is set to N.

An add-on health plan may provide ancillary or rider benefits. It is also known as a supplemental health plan. As these add-on plans provide additional benefits over the base plan, they are not considered as the standalone plan.

 No
hiosId Used to specify the Health Insurance Oversight System ID. Yes (Conditional)
Note: This data is required while associating the hiosId for a health plan.
healthPlanCharacteristics Used to specify a list of characteristics for the health plan. Yes (Conditional)
Note: This data is required while defining or editing the characteristics of a health plan.
healthPlanPricingRuleTypes Used to associate the pricing rule types with the health plan. Yes (Conditional)
Note: This data is required while associating a pricing rule type with the health plan.
pricingRuleType

You can use this tag within the following tags:

  • healthPlanPricingRuleTypes - Here, the pricingRuleType tag is used to specify the pricing rule type.

  • healthPlanPricingRuleData - Here, the pricingRuleType tag is used to indicate the pricing rule type using which you want to define the pricing rule.

Note: At present, you can only specify those pricing rule types where the category is set to Age Based, Tier Based, Discount Charge, Additional Fee, and Benefit.
 Yes (Conditional)
Note: This data is required while associating a pricing rule type with the health plan and while defining or editing a pricing rule for a health plan.
healthPlanPricingRuleData Used to specify the details of the pricing rule. Yes (Conditional)
Note: This data is required while defining or editing a pricing rule defined for the health plan.
sequence

You can use this tag within the following tags:

  • healthPlanPricingRuleData - Here, the sequence tag is used to indicate the order in which the pricing rules should be created in the system.

  • baseRate - Here, the sequence tag is used to indicate the order in which the price component should be created using the given base rate information.

  • pricingParameter - Here, the sequence tag is used to indicate the order in which the pricing eligibility criteria should be created using the parameter information.

  • modifierInformation - Here, the sequence tag is used to indicate the order in which the pricing eligibility criteria should be created using the modifier information.

  • pricingRuleEligibility - Here, the sequence tag is used to indicate the order in which the pricing rule eligibility should be created for the health plan.

 Yes (Conditional)
Note: This data is required while defining or editing the respective information.
entityIdentifiers Used to specify a list of entities (i.e. policy, source system, and plan) using which you can derive the plan to which you want to associate the pricing rule. Yes
entityIdentifiersList Used to specify the details of the entity. Yes
entityIdentifierType Used to specify the entity type. The valid values are:

  • PLAN - Used when you want to specify the health plan number.

  • PLCY - Used when you want to specify the policy number.

  • SSYS - Used when you want to specify the source system

 Yes (Conditional)
Note: This data is required while defining or editing a pricing rule defined for the health plan.
entityIdentifierValue Used to specify the entity identifier (i.e. plan number, policy number, or source system). Yes (Conditional)
Note: This data is required while defining or editing a pricing rule defined for the health plan.
priceItemCd Used to indicate the price item for which you want to define the pricing rule.
Note: You must specify a price item which is already associated with the respective pricing rule type.
 Yes (Conditional)
Note: This data is required while defining or editing a pricing rule defined for the health plan.
rateOption Used to indicate the rate option using which you want to create price assignment for the pricing rule of a health plan.
Note:

You must specify a rate option which is already defined in the C1-ExtLookRetTypeRateOpt extendable lookup. It must be in the Active status.

If the rate option is not given for an age-based pricing rule, by default, it is set to:

  • The value specified in the Default Rate Option - Flat option type of the C1-ASOBLLNG feature configuration when the modifier method is set to FLAT

  • The value specified in the Default Rate Option - Percentage option type of the C1-ASOBLLNG feature configuration when the modifier method is set to EXPT or INPT

However, if the rate option is not given for a tier-based pricing rule, by default, it is set to a value specified in the Default Rate Option - Flat option type of the C1-ASOBLLNG feature configuration when the modifier method is set to FLAT or NULL.

 No
pricingType Used to indicate the type of pricing defined for the pricing rule. The valid values are:

  • Flat

  • Percentage

 Yes
modifierApplicability Used to indicate whether you want to increase or decrease the premium of an eligible member based on certain modifiers (i.e. parameters, such as tobacco usage, alcohol usage, and so on). The valid values are:

  • Y

  • N

Note: If you do not specify the value, by default, it is set to N.
 No
modifierMethod Used to indicate whether the system should consider the modifier rate as a flat amount or percentage. The valid values are:

  • FLAT - Indicates that the system should consider the modifier rate as a flat amount.

  • INPT - Indicates that the system should consider the modifier rate as inclusive percentage.

  • EXPT - Indicates that the system should consider the modifier rate as exclusive percentage.

 Yes (Conditional)
Note: This data is required when the modifierApplicability tag contains Y.
baseRate Used to specify the base fees for employees with a particular set of attributes. You can define different base fees for employees with different set of attributes.
Note: While creating a price assignment for the pricing rule, the system creates one price component for each given set of base rate information.
 Yes (Conditional)
Note: This data is required while defining a pricing rule for the health plan.
baseFee Used to specify the base fees for the health plan. Yes (Conditional)
Note: This data is required while defining a pricing rule for the health plan.
lowerAgeLimit Used to specify the lower age limit. It is used to define lower age limit pricing eligibility criteria in the price component.
Note:

The system defines the lower age limit pricing eligibility criteria using the parameter which is specified in the Age Based Parameter option type of the C1-ASOBLLNG feature configuration.

This data is ignored when given in a tier-based pricing rule information.

 Yes (Conditional)
Note: This data is required while defining or editing an age-based pricing rule for the health plan.
upperAgeLimit Used to specify the upper age limit. It is used to define upper age limit pricing eligibility criteria in the price component.
Note:

The system defines the upper age limit pricing eligibility criteria using the parameter which is specified in the Age Based Parameter option type of the C1-ASOBLLNG feature configuration.

This data is ignored when given in a tier-based pricing rule information.

 Yes (Conditional)
Note: This data is required while defining an age-based pricing rule for the health plan.
pricingParameter Used to specify a set of employee attributes based on which the base fees may vary. Yes (Conditional)
Note: This data is required while defining a tier-based pricing rule for the health plan.
parameterCode

You can use this tag within the following tags:

  • pricingParameter - Here, the parameterCode tag is used to specify the employee attribute (i.e. parameter, such as employee status, employee location, and so on) using which you want to define the pricing eligibility criteria.

  • modifierInformation - Here, the parameterCode tag is used to specify the modifier (i.e. parameter, such as tobacco usage, alcohol usage, and so on) using which you want to define the pricing eligibility criteria.

Note:

You must define the employee attributes and modifiers as parameters in the system. Note that you must set the parameter usage for these parameters to Pricing Eligibility Criteria. The system creates an pricing eligibility criteria for each parameter and/or modifier specified in the pricing rule information.

You cannot specify any special character except underscore (_​) in the parameter name.

 Yes (Conditional)
Note: This data is required while specifying the respective information.
parameterValue

You can use this tag within the following tags:

  • pricingParameter - Here, the parameterCode tag is used to specify the value for the parameter (i.e. employee attribute).

  • modifierInformation - Here, the parameterCode tag is used to specify the value for the parameter (i.e. modifier).

Note: You can specify any special characters except ampersand (&), comma (,), underscore (_​), equal to (=), tilde (~), and semi-colon(;) in the parameter value.
 Yes (Conditional)
Note: This data is required while specifying the respective information.
modifierInformation Used to specify the modifier based on which you want to increase or decrease the base fees.
Note: While creating a price assignment for the pricing rule, the system creates one price component for each given set of modifier information and then links these modifier price components with the respective base rate price component.
 Yes (Conditional)
Note: This data is required while specifying the modifier information.
rate Used to specify the flat amount or percentage by which you want to increase or decrease the premium of an eligible member. Yes (Conditional)
Note: This data is required while specifying the modifier information.
characteristicsList Used to specify a characteristic for the health plan. Yes (Conditional)
Note: This data is required while defining or editing a characteristic of the respective entity.
pricingRuleEligibility Used to specify a set of attributes based on which the pricing rule eligibility is decided. Yes (Conditional)
Note: This data is required while defining or editing an age or tier-based pricing rule for the health plan.
priceParmCode Used to specify the pricing attribute using which you want to define the pricing eligibility criteria. Yes (Conditional)
Note: This data is required while specifying the respective information.
priceParmVal Used to specify the value for the parameter (i.e. pricing attribute). Yes (Conditional)
Note: This data is required while specifying the respective information.

The following table lists and describes the tags which are available in the health care inbound message schema, but should not be included in the XML file:

Tag Name Tag Description
c1InboundMessage Displays the inbound message ID.
bo Indicates the business object using which the health product and plan inbound message is created in the system.
boStatus Displays the status of the health product and plan inbound message.
statusReason Indicates the reason why the status of the health product and plan inbound message is changed.
statusDateTime Displays the date and time when the status of the health product and plan inbound message is changed in the system.
creationDateTime Displays the date and time when the health product and plan inbound message is created in the system.
version

This tag appears within the following parent tags:

  • schema - Here, the version tag displays the version of the health product and plan inbound message.

  • inboundMessageCharacteristic - Here, the version tag displays the version of the characteristic defined for the health product and plan inbound message.
searchCharacteristicValue At present, this tag is not supported in a health product and plan inbound message.
toDoRetry Displays the information about the retry option used for the health product and plan inbound message.
Note: This information appears at the bottom of the inbound message in the Inbound Message Content zone once the health product and plan inbound message is validated and processed either through the user interface or batch process.
retryDateTime Displays the date and time when the retry option is used to change the status of the health product and plan inbound message from Rejected to Pending.
numberOfRetries Indicates the number of times the retry option is used for the health product and plan inbound message.
currentErrorState Indicates the status to which the health care inbound message is transitioned when its validation or processing fails. The valid value is:

  • REJECTED
isRetried Indicates whether the retry option is used to change the status of the health product and plan inbound message. The valid values are:

  • true

  • false

Related Topics

For more information on... See...
Health Product and Plan Inbound Message Schema Health Product and Plan Inbound Message Schema
Sample Health Product and Plan Inbound Message for Health Product Setup Sample Health Product and Plan Inbound Message for Health Product Setup
Sample Health Care Inbound Message for Health Plan Setup Sample Health Product and Plan Inbound Message for Health Plan Setup
Sample Health Care Inbound Message for Health Plan Pricing Rules Setup Sample Health Product and Plan Inbound Message for Health Plan Pricing Rules Setup
How to setup the C1-ASOBLLNG feature configuration Setting the C1-ASOBLLNG Feature Configuration