Invoice Request for Group Health Insurance Billing

Oracle Revenue Management and Billing enables you to generate an adhoc regular or trial bill for an account through an invoice request. The system enables you to create an invoice request manually or automatically. It enables you to create an invoice request for a person or an account. You can create an invoice request for an account where the Eligible For Invoice Request Creation (INVRACTE) characteristic is set to Y.

If you create an invoice request for a person, the system will consider all those accounts of the person where the Eligible For Invoice Request Creation (INVRACTE) characteristic is set to Y. You can then exclude an account from the invoice request, if required. The system also enables you to consider all accounts of the person and its child persons where the Eligible For Invoice Request Creation (INVRACTE) characteristic is set to Y.

In other words, the system enables you to create the following types of invoice request:

• Manual Regular Bill Generation Invoice Request - It is used to generate an adhoc regular bill for an account. You can create a manual regular bill generation invoice request for a person or an account from the user interface.

• Manual Trial Bill Generation Invoice Request - It is used to generate an adhoc trial bill for an account. You can create a manual trial bill generation invoice request for a person or an account from the user interface.

• Automatic Regular Bill Generation Invoice Request - It is used to generate an adhoc regular bill for an account. You can configure the system such that an automatic regular bill generation invoice request is created for an account automatically when a fully-insured group policy is activated, terminated, reinstated, or renewed from the user interface or through a health care inbound message.

While creating an invoice request, you need to specify an invoice request type using which you want to create the invoice request. The system enables you to create the invoice request types with the following combinations:

It is the invoice request type which helps the system to determine:

• The business object using which the invoice request should be created in the system

  Note: Two invoice request business objects named Invoice Request - Regular Bill Generation (C1-InvoiceRequest) and Invoice Request - Trial Bill Generation (C1-InvoiceRequestTrial) are introduced in this release. If the Bill Generation Type field is set to Regular, you must select the Invoice Request - Regular Bill Generation business object from the Invoice Request Business Object list. However, if the Bill Generation Type field is set to Trial, you must select the Invoice Request - Trial Bill Generation business object from the Invoice Request Business Object list.

• Whether a manual or automatic invoice request should be created in the system

• Whether a regular or trial bill generation invoice request should be created in the system

• Whether a manual regular bill generation invoice request for an account should be processed in the online or deferred mode

  Note:

  The system will process a manual regular bill generation invoice request for an account in the deferred mode when the number of billable charges of the account exceeds the defer processing billable charge count.

  The defer processing billable charge count is not considered when a manual regular bill generation invoice request is created for a person.

  You can specify the defer processing billable charge count when the invoice mode is set to Manual and bill generation type is set to Regular.

• Whether the approval is required for the invoice request

  Note: You can only set the Approval Required flag when the invoice mode is set to Manual and bill generation type is set to Regular.

• The wait days which is used to calculate the processing date for an invoice request

  Note:

  If the invoice request is processed in the online mode, the system will process the invoice request when the processing date is earlier than or equal to the system date. However, if the invoice request is processed in the deferred mode, the system will process the invoice request when the processing date is earlier than or equal to the batch business date.

  If required, you can configure the system such that the processing date does not fall on a holiday. To implement this requirement you need to specify the work calendar which helps to determine the working day.

• The date calculation algorithm which is used to calculate the processing date for an automatic regular bill generation invoice request

  Note: In addition, you can configure threshold days for automatic invoice request creation. It is used to determine whether the number of days between the bill cycle date and processing date is greater than the threshold days. This parameter is used in Invoice Request Date Calculation algorithm to check whether the processing date of the invoice request is within threshold period. If so, the automatic invoice request is not created for the account. This parameter is only applicable while activating or renewing a fully-insured group policy.

While creating a manual invoice request, you need to specify the following – invoice request type, entity (i.e. person or account for which the invoice request should be created), cutoff date, accounting date, and bill date.

For more information about the types of invoice request, see Types of Invoice Request for Fully-Insured Group Business.

For more information on how to setup the invoice request feature, see Prerequisites.

Related Topics

Parent Topic: Invoice Request for Health Insurance Business