CSV File Format for Billable Charge Creation (Fully Insured Group)
Before uploading a billable charge file, you need to ensure that the CSV file contains the following columns:
| Column Name | Description | Mandatory (Yes or No) |
|---|---|---|
| Account Identifier Type | Used to specify the account identifier type. | Yes (Conditional) Note: This data is required when the Account ID is not specified.
|
| Account Identifier | Used to specify the account identifier of the account for which you want to create the billable charge. | Yes (Conditional) Note: This data is required when the Account ID is not specified.
|
| Account ID | Used to specify the account for which you want to create the billable charge. | Yes (Conditional) Note: This data is required when the Account Identifier Type and Account Identifier is not specified.
|
| Source System | Used to indicate the external system from where the policy is originated. | Yes (Conditional) Note: This data is required when the Contract ID is not specified.
|
| Policy Number | Used to indicate the policy number. | Yes (Conditional) Note: This data is required when the Contract ID is not specified.
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| Plan Number | Used to indicate the plan number of the policy. | Yes (Conditional) Note: This data is required when the Contract ID is not specified.
|
| Contract Id | Used to specify the contract against which you want to create the billable charge. | Yes (Conditional) Note: This data is required when either theSource System, Policy Number, or Plan Number is not specified
|
| Start Date | Used to specify the start date of the billable charge. Note: You need to specify the start date in YYYY-MM-DD format.
|
Yes |
| End Date | Used to specify the end date of the billable charge. Note: You
need to specify the end date in YYYY-MM-DD format.
|
Yes |
| Charge Type | Used to indicate the charge type. | Yes |
| Description On Bill | Used to specify description for a billable charge. | No |
| Frequency | Used to specify the invoice frequency at which the recurring bill segments must be created. | Yes (Conditional) Note: This data is required if Recurring Flag is set to FR.
|
| Bill After | Used to specify the date after which the bill must be generated for the billable charge. | No |
| Adhoc Bill | Used to indicate whether the billable charge should be considered during adhoc or regular billing. | No |
| Description On Bill1, Description On Bill2, Description On Bill3, Description On Bill4, Description On Bill5 | Used to specify description for the billable charge lines. | Yes (Conditional) Note: This data is required when the charge
amount is specified.
|
| Currency1, Currency2, Currency3, Currency4, Currency5 | Used to specify description for the billable charge lines. | Yes (Conditional) Note:
This data is required when charge amount for bill line is specified. This data provided for Distribution Code column is required when N is specified in the Memo Only column corresponding to the bill line description. |
| Amount1, Amount2, Amount3, Amount4, Amount5 | Used to specify the charge amount. | Yes (Conditional) Note:
This data is required when charge amount for bill line is specified. This data provided for Distribution Code column is required when N is specified in the Memo Only column corresponding to the bill line description. |
| Show On Bill1, Show On Bill2, Show On Bill3, Show On Bill4, Show On Bill5 | Used to indicate whether the charge should appear on the person’s
printed bill or not. The valid values are:
Note: By default, the value will be set to true if the column does not contain any value.
|
Yes (Conditional) Note:
This data is required when charge amount for bill line is specified. This data provided for Distribution Code column is required when N is specified in the Memo Only column corresponding to the bill line description. |
| Appears In Summary1, Appears in Summary2, Appears in Summary3, Appears in Summary4, Appears in Summary5 | Used to indicate whether the charge should be included in the
summary line or not. The valid value are:
Note: By default, the value will be set to true if the column does not contain any value.
|
Yes (Conditional) Note:
This data is required when charge amount for bill line is specified. This data provided for Distribution Code column is required when N is specified in the Memo Only column corresponding to the bill line description. |
| Memo Only1, Memo Only2, Memo Only3, Memo Only4, Memo Only5 | Used to indicate whether the charge should be included in the
bill amount or not. The valid values are:
Note: By default, the value will be set to false if the column does not contain any value.
|
Yes (Conditional) Note:
This data is required when charge amount for bill line is specified. This data provided for Distribution Code column is required when N is specified in the Memo Only column corresponding to the bill line description. |
| Distribution Code1, Distribution Code2, Distribution Code3, Distribution Code4, Distribution Code5 | Used to specify the distribution code which indicates the account associated with the charge. | Yes (Conditional) Note:
This data is required when charge amount for bill line is specified. This data provided for Distribution Code column is required when N is specified in the Memo Only column corresponding to the bill line description. |
| Subscriber Identifier Type | Used to derive the group or individual membership against which the billable charge should be created. | Yes (Conditional) Note: This data is required when the Membership ID is not specified.
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| Subscriber Identifier | Used to derive the group or individual membership against which the billable charge should be created. | Yes (Conditional) Note: This data is required when the Membership ID is not specified.
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| Membership Type | Used to derive the group or individual membership against which the billable charge should be created. | No Note: This data is required when the Membership
ID is not specified.
|
| External Membership ID | Used to specify the external membership ID. Note: Here, you
need to specify a membership ID which is maintained in the external
source system.
|
No Note: This data is required when the Membership
ID is not specified.
|
| Price Item | Used to specify the price item code. | Yes (Conditional) Note: This data is required when Variance Parameter or, Price Item Parameter and Price Item Parameter Value is specified.
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| Variance Parameter | Used to indicate the variance that must be used along with the price item for determining the price item pricing. | Yes (Conditional) Note: This data is required when Price Item is specified and Price Item Parameter and Price Item Parameter Value are not specified.
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| Price Item Parameter1, Price Item Parameter2, ....., Price Item Parameter15 | Used to indicate the price item parameter that must be used
along with the price item for determining the price item pricing. Note: If the data in these columns will be used for price item parameter
mapping, you must not use the equal to (=) and tilde (~) symbols in
these columns.
|
Yes (Conditional) Note: This data is required when Price Item is specified and Variance Parameter is not specified.
|
| Price Item Parameter Value1, Price Item Parameter Value2, ....., Price Item Parameter Value15 | Used to specify the parameter value. Note: If the data in these
columns will be used for price item parameter mapping, you must not
use the equal to (=) and tilde (~) symbols in these columns.
|
Yes (Conditional) Note: This data is required when Price Item is specified and Variance Parameter is not specified.
|
| SQI1, SQI2, SQI3, SQI4, SQI5 | Used to indicate the service quantity identifier that must be used for calculating the price item charges. | Yes (Conditional) Note: This data is required when the service
quantity is specified.
|
| SQI Value1, SQI Value2, SQI Value3, SQI Value4, SQI Value5 | Used to specify the number of units of the service quantity. | Yes (Conditional) Note: This data is required when the service
quantity identifier is specified.
|
| Effective Date1, Effective Date2, ....., Effective Date20 | Used to indicate the effective date of the characteristics. | Yes (Conditional) Note:
This data is required when either one of the field - Effective Date or Characteristic Type or Characteristic Value is specified. This data is for user defined fields, keeping as optional we can expand it if required. |
| Char Type1, Char Type2, ....., Char Type20 | Used to indicate the characteristic that must be defined for the billable charge. | Yes (Conditional) Note: This data is required when Effective Date or Char Val is
specified.
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| Char Value1, Char Value2, ....., Char Value20 | Used to specify the value of the characteristic type. | Yes (Conditional) Note: This data is required when Effective Date or Char Type is
specified.
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