Pre-requisites

To set the billing system for a fully-insured group customer, you need to do the following:

• Define the required policy types in the system.

• Define the required policy person roles in the system.

• Define the values for the C1-SourceSystemLookup extendable lookup.

• Define the required characteristic types where the characteristic entity is set to Policy Type.

• Define the required characteristic types where the characteristic entity is set to Policy.

• Define the status reasons for the Terminated status of the C1-POLICY business object in the Status Reason screen.

• Define the status reasons for the Reinstated status of the C1-POLICY business object in the Status Reason screen.

• Define the required price items in the system.

• Define the required age based, tier based, pass-through billable charge, additional fee, and/or benefit pricing rule types.

• Define the required characteristic types where the characteristic entity is set to Policy Plan.

• Define the required contract relationship types in the system.

• Define the required characteristic types where the characteristic entity is set to Membership.

• Define the required characteristic types where the characteristic entity is set to Membership Person.

• Define the required characteristic types where the characteristic entity is set to Benefits.

• Define the required contracts (which you want to associate with a membership) in the system.

• Define the values for the BILL_​TO_​TYPE_​FLG, BENEFIT_​TYPE_​FLG, BENEFIT_​SUB_​TYPE_​FLG, and BENEFIT_​SRC_​FLG lookup fields

• Define the required parameter values in the following algorithm which is attached to the C1-POLICY business object:

  • C1-POLBOVAL

• Define the required parameter values in the following algorithms which are used in the lifecycle of the C1-POLICY business object:

  • C1-EVCSTSTAT

  • C1-PLCYTRMRQ

  • C1-POLCYTERM

  • C1-DELTRMLTR

  • C1-PLCYREIRQ

  • C1-POLCYREIN

  • C1-CCPOLRE1

• Define a predefined characteristic type named Active Employee Coverage Billing Arrangement with the following characteristic values:

  Characteristic Value	Description
  DRT	Direct Billing
  GRP	Group Billing

  You must set the characteristic entity of the Active Employee Coverage Billing Arrangement characteristic type to Person.

• Define a predefined characteristic type named Benefit Billing Arrangement with the following characteristic values:

  Characteristic Value	Description
  DRT	Direct Billing
  GRP	Group Billing

  You must set the characteristic entity of the Benefit Billing Arrangement characteristic type to Person, Policy, and Policy Plan.

• Define a predefined characteristic type named COBRA Billing Arrangement with the following characteristic values:

  Characteristic Value	Description
  DRT	Direct Billing
  GRP	Group Billing
  TPA	TPA Billing

  You must set the characteristic entity of the COBRA Billing Arrangement characteristic type to Person, Policy, and Policy Plan.

• Define the required person relationship types and account relationship types in the system.

• Define the required geographic rating areas in the system.

• Define the required member relationship/subscription tier structures in the system.

• Define the required geographic rating area preference and member relationship and subscription tier preference through the Field Mapping screen.

• Define the required Medicare plan benefit packages in the system.

• Set the values for the following option types in the C1-PERSTYPE feature configuration:

  • Bill Group Person Type

  • Parent Person Type

  • TPA Person Type

• Set the values for the following option types in the C1-ASOBLLNG feature configuration:

  • Membership ID Characteristic for Billable Charge

  • Parent Customer Policy Person Role

  • Bill Group Policy Person Role

  • Membership Inactive Status

  • Membership Person Inactive Status

  • Rating Area Field Mapping for Group

  • Relation Structure Code Field Mapping

  • Billing Arrangement

  • Benefit Billing Arrangement

  • Cobra Billing Arrangement

  • TPA Person Relationship Type

  • TPA Account Relationship Type

  • TPA Policy Person Role

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