Medicare Part A, Part B, and Part D Pricing

The system enables you to calculate premium for the Medicare Part A, Part B, and Part D membership benefits using the age-based or tier-based pricing rule. You can use the Medicare plan benefit package and membership benefit as the pricing parameters in the age-based or tier-based pricing rule. The system enables you to restrict the billing of a membership benefit using a parameter where the source entity is set to Algorithm and source type code is set to Get benefit coverage for the given date (C1-PPRAMCOV) in the age-based or tier-based pricing rule. In the C1-PPRAMCOV algorithm, you can specify the following:

• Benefit Sub Type - Used to indicate that the pricing for the Medicare Part A, Part B, and Part D membership benefits should be determined based on the specified value. Here, you can specify the parameter values as A, B, and/or D separated by a comma. For example, if the parameter is set to A, B, the system will derive the base fee where the parameter is set to AB even though the membership has availed Medicare Part D benefit. This is because you have configured the system such that Medicare Part D membership benefit should not be considered for billing.