Prerequisites for Group Delinquency

To setup the group delinquency feature, you need to do the following:

  • Define the required business rules using the following business rule categories:

    • Delinquency Grace Period Business Rule

    • Delinquency Event Attributes Business Rule

    • Delinquency Termination Date Rule Business Rule

    • Delinquency Miscellaneous Options Business Rule

    Note: You can define the above business rules through the Business Rules screen.
  • Define the required access permissions for the Account and Person entities in the delinquency process.

  • Define a fully insured group customer with the following information:

    • A fully insured group policy using a policy type where the policy category is set to Fully Insured Group.

    • Different types of plans defined in a fully insured group policy.

    • Different types of memberships defined for a fully insured group policy plan.

  • Define the Membership Terminate Request (C1-MemberTermRequest) business object which is used to setup the outbound message type for creating the membership termination request in the XML format.
    Note: The outbound message type is configured in the Membership Termination Outbound Message Trigger (C1-MTOMT) batch which creates an outbound message whenever the membership termination process request is initiated.
  • Define an algorithm of the C1-EVALDPAPP algorithm type to evaluate the approval configuration on the delinquency process type when a manual intervention happens in the delinquency process.

  • Define the algorithms of the C1-DETTERMDT and C1-DETTRTGDT algorithm type as the event activation algorithm if you want to calculate the termination date and termination trigger date in a single event.

    Note: To calculate the termination date and termination trigger date separately, you need to configure the above algorithms under respective events separately as the event activation algorithm.
  • Define the appropriate collection method in the collection class of a person or an account whose overdue debt you want to monitor through the delinquency management. For more information, see Collection Class

  • Define the required collection methods, such as, Self-Control Delinquency (SDEL) and Parental Delinquency (DELP) in the COLL_​METH_​FLG lookup field.
    Note: You must define a collection class for an account and a person with the respective collection method through the Collection Class screen.

    The following table describes how you can setup the system for an account or a person based on the respective collection method:

    Scenario System Behavior
    A collection class is defined for an Account entity where the collection method is set to Self-Control Delinquency.
    • The account entity has its own distinct delinquency process.

    • The debt of the account is monitored at predefined system events and the delinquency process is commenced whenever the account’s debt is overdue.

    Note: The system creates a delinquency process for an account only when at least one bill of the account is overdue.
    A collection class is defined for a Person entity where the collection method is set to Self-Control Delinquency.
    • The person entity has its own distinct delinquency process.

    • The child person’s accounts and its grandchild’s accounts are not considered in the parent person’s delinquency.

    Note: The system creates a delinquency process for a person only when at least one bill of any account (considered) in its hierarchy is overdue.
    A collection class is defined for a Person entity where the collection method is set to Parental Delinquency.
    • The person entity has its own distinct delinquency process.

    • The persons, child person, and grandchild accounts are considered in the parent person’s delinquency.

    • Any such account in the person’s hierarchy where the collection is set to Self-Control Delinquency is not considered in the parent person’s delinquency.

  • Define the following fields in the XML schema of the Health Care Inbound Message (C1-HCInboundMessage) business object:

    • Collection Class

    • Postpone Credit Review Until

    • Drag Days

    Note: You can specify the values for the above fields while creating the health care inbound message.
  • Configure the delinquency control along with its respective algorithms in the system.

  • Configure the delinquency event type along with its respective algorithms in the system.

  • Configure the delinquency process type along with its respective algorithms in the system.

  • Define the required field mapping preference categories in the system

    • Routing Method - Contact Method Mapping

    • Delinquency Process Type

    • Delinquency Process

  • Create a delinquency event type for advance deposit, attach the C1-APPADVDEP algorithm to the Event Activation system event, and configure the delinquency event type while creating a delinquency process type for advance deposit purposes.

  • Define values for the Delinquency Process Field Mapping, Policy Characteristic Type for Customer Contact, and Routing Method - Contact Method Mapping option types in the DELINPROC feature configuration.

  • Define a delinquency process type preference for the fully insured group business and specify the preference code in the Delinquency Process Type Field Mapping – Group parameter of the C1-DLNQMNRL and C1-DLNQMNRAC algorithm.

  • Attach the C1-DLNQMNRL algorithm to the Delinquency Monitor Rule system event in the Delinquency Control screen for creating a group delinquency process at Person level.

  • Attach the C1-DLNQMNRAC algorithm to the Delinquency Monitor Rule system event in the Delinquency Control screen for creating a group delinquency process at Account level.

  • Set the rule type category as Parameter Based if you have selected Delinquency Event Type Eligibility as the rule type usage while defining a rule type.

  • Attach the C1-TRNTERTRG algorithm to the Delinquency Monitor Rule system event in the Delinquency Event Type screen for transitioning the delinquency process to pending termination.

  • Assign the Delinquency Process Approval Notification (C1-DPAPR) To Do type to a To Do role which is also specified as the Submitter and Approval To Do role.

  • Set the values for the following option types in the C1-ASOBLLNG feature configuration:

    • Membership Active Status

    • Membership Terminated Status

    • Policy Active Status

    • Policy Pending Termination Status

    • Policy Pending Reinstatement Status

  • Define the required parameter configurations for the delinquency business rules.

  • Define the required customer contact event to create a customer contact.

  • To setup the advance deposit feature, define the following entities:
    • Define the required account relationship type and advance deposit contract type in the system.

    • Define the Advance Deposit Account Relationship Type and Advance Deposit Contract Type field mapping attributes in the Delinquency Process field mapping preference.

    • Define an algorithm of the C1-FIACCPP algorithm type and attach it to the Post-Processing system event of the C1-AccountBO business object.

    • Define an algorithm of the C1-ACTPOSP algorithm type and attach it to the Post-Processing system event of the C1-AccountBO business object.

    • Define an algorithm of the C1-FIPOLPP algorithm type and attach it to the Post-Processing system event of the C1-POLICY business object.

    • Define a new offset request type where the offset category is set to Advance Deposit.

    • Define an offset request type as a soft parameter in the C1-APPADVDEP algorithm.

    • Define the debit adjustment type and credit adjustment as soft parameters in the C1-APPADVDEP algorithm and attach both the adjustment types in the Adjustment Type Profile tab of the Contact Type screen.

  • Define the following customer contacts in the system:
    • Configure the Customer Contact Type, Customer Contact Class, and Default Contact Method parameters in the Advance Deposit Monitor (C1-ADMON) batch to create a customer contact when the payment is not received.

    • Configure the Customer Contact Type, Customer Contact Class, and Default Contact Method parameters in the C1-NOTADREC algorithm to create a customer contact when the advance deposit payment is received.

    • Configure the Customer Contact Type, Customer Contact Class, and Default Contact Method parameters in the C1-NOTADCAN algorithm to create a customer contact when the advance deposit payment is canceled.

    • Configure the Customer Contact Type For Partial Usage Of Deposit, Customer Contact Class For Partial Usage Of Deposit and parameters in the C1-APPADVDEP algorithm to create a customer contact when the advance deposit is partially considered.

    • Configure the Customer Contact Type For Partial Usage Of Deposit, Customer Contact Class For Partial Usage Of Deposit, and Default Contact Method parameters in the C1-APPADVDEP algorithm to create a customer contact when the advance deposit amount is depleted.

  • Define a match type for advance deposit and configure the payment distribution override algorithm (in the match type) using the C1-MATSATYP algorithm type.

  • Define the required third party payor for payment agreement purposes.

  • Attach the C1-CDPPAYCAN and C1-RODPDUEPX algorithms to the Algorithm Types for Payment Cancellation System Event system event of a customer class to resume the delinquency process for the respective accounts on the payment cancellation. For more information about the algorithms, see the Resuming a Delinquency Process on Payment Cancellation.

Related Topics

For more information on... See...
How to setup the DELINPROC feature configuration Setting the DELINPROC Feature Configuration
How to define a delinquency control Defining a Delinquency Control
How to define a delinquency event type Defining a Delinquency Event Type
How to define a delinquency process type Defining a Delinquency Process Type

Parent topic: Individual Health Insurance Delinquency