Invoice Request for Individual Health Insurance Billing

Until now, the system enabled you to generate an adhoc regular or trial bill for an account through an invoice request for the fully insured group business. Now, this feature is extended to support the adhoc billing requirements of the fully insured individual business.

The system enables you to manually or automatically create an invoice request for the fully insured individual business. It enables you to create an invoice request for an account to which an individual membership is billed. Before creating an invoice request for an account of an individual membership, the system validates whether the individual membership is eligible for the invoice request creation. You can create an invoice request only for an account of those individual memberships where the Eligible For Invoice Request Creation (INVRACTE) characteristic is set to Y. Whenever an invoice request is created for the account of an individual membership, the system adds the appropriate log entries for the individual membership in the Log tab of the Membership screen.

The system enables you to create the following types of invoice request for the fully insured individual business:

• 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 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 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 automatically created for an account when an individual membership is enrolled, terminated, reinstated, or canceled 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: 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.

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

• The wait days using which the processing date is calculated 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.

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

  Note:

  The C1-INVRDTCIM algorithm is shipped in this release for the fully insured individual business. It is used to calculate the cutoff date, bill date, processing date, and accounting date for an automatic regular bill generation invoice request. If required, you can configure the algorithm such that the processing date does not fall on a holiday. In that case, you need to specify the work calendar which helps to determine the working day. You can specify the work calendar in the C1-INVRDTCIM algorithm. Alternatively, if the work calendar is not specified in the C1-INVRDTCIM algorithm, the system will use the work calendar of the account's division to ensure that the processing date falls on a working day.

  In addition, you can configure threshold days for the automatic invoice request creation. The system then determines whether the number of days between the bill cycle date and processing date is greater than the threshold days. If so, the automatic invoice request is created for the account. However, if the number of days between the bill cycle date and processing date is less than or equal to the threshold days, the automatic invoice request is created for the account such that cutoff date is calculated using the next window of the bill cycle.

While creating a manual invoice request, you need to specify the following - invoice request type, account, cutoff date, accounting date, and bill date. Note that before manually or automatically creating an invoice request for an account, you need to ensure that the following algorithms are attached to the respective system event of the corresponding customer class:

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

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

Related Topics

Parent Topic: Invoice Request for Health Insurance Business