Delinquency Process Types Based on Insurance Coverage

The system enables you to configure a delinquency process type for each insurance coverage type through the delinquency process type preference. The system then creates a delinquency process using the respective delinquency process type whenever the person’s or account’s debt is overdue.

The system enables you to specify a delinquency process type for each insurance coverage type in the respective attribute of a delinquency process type preference:

The following table lists how you can specify a delinquency process type for each insurance coverage type in the respective attribute of a delinquency process type preference:
Line of Business	Insurance Coverage Type	Attribute
Fully Insured Group	Active Health Plan Coverages	Active Group Customers – Account Level (used when the delinquency is monitored at the account level)
	Active Health Plan Coverages	Active Group Customers – Person Level (used when the delinquency is monitored at the person level)
	Inactive Health Plan Coverages	Inactive Group Customers – Account Level (used when the delinquency is monitored at the account level)
	Inactive Health Plan Coverages	Inactive Group Customers – Person Level (used when the delinquency is monitored at the person level)
Fully Insured Individual	Active Health Plan Coverages	Active Individual Delinquency
	Non-Medical Health Plan Coverages	Effectuated Individual Delinquency for Ancillary
	Medical Health Plan Coverages without Benefits	Effectuated Individual without Benefit
	Medical Health Plan Coverages with Benefits	Effectuated Individual with Benefit Note: The system considers this delinquency process type only when the membership benefits created using the benefit sub type specified in the delinquency process type preference are billed for the earliest unpaid coverage period.
	Non-Effectuated Health Plan Coverages	Non-Effectuated Individual Delinquency
	Inactive Health Plan Coverages	Termed Individual Delinquency
Direct Billed Group Membership	Non-Effectuated Health Plan Coverages	Non-Effectuated Individual Delinquency
	Active Health Plan Coverages	Active Group Customers – Account Level
	Inactive Health Plan Coverages	Inactive Group Customers – Account Level

For more information, see Delinquency Process Type Preference. You need to create a separate delinquency process type preference for each line of business (i.e., Fully Insured Group, Fully Insured Individual, and Direct Billed Group Membership).

In the fully insured individual business, there might be scenarios wherein an individual customer may shift from to a medical health plan coverage without benefits to a medical health plan coverage with benefits and vice versa. In such cases, the system enables you to send the revised benefit data through a health care inbound message. On repricing, either the new billable charges are created for the membership benefit, or the existing billable charges of the membership benefit are updated. The system automatically cancels a delinquency process when either of the following condition is met:

Membership benefit charges is billed in the earliest unpaid coverage period and now the benefit charge is no longer applicable from the earliest unpaid coverage period.
Membership benefit charges was not billed in the earliest unpaid coverage period, but the benefit charge is now applicable from the earliest unpaid coverage period.

The above two cancel criteria are validated by the C1-CANDPAPTC algorithm that is attached to the Cancel Criteria system event of the respective delinquency process type. This algorithm is invoked when the C1-DPMON batch is executed. If any of the above two conditions is met, the system cancels the existing delinquency process in the C1-DPMON batch.

The C1-CANDPAPTC algorithm also checks whether there is any bill in the delinquency process with the due date earlier than the delinquency due date. If so, the system does the following:

Add a record for the delinquent account in the CI_ADM_RVW_SCH table.
The next credit review date of the account is set to the processing date (i.e., batch business date).

The system will create a delinquency process for the account using the appropriate delinquency process type when the C1-ACDLQ batch is executed subsequently.