Prerequisites for Individual Delinquency

To setup the individual 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 entity in the delinquency process.

• 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 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 delinquency process. Bills belonging to the respective account are skipped when the person of the respective account is evaluated for delinquency.
  A collection class is defined for an Account entity where the collection method is set to Parental Delinquency.	The account simply follows the collection class configuration defined for the main person of the account. Bills belonging to the respective account are considered only when a person or any parent within the person's hierarchy is evaluated for delinquency.
  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 delinquency process. Bills belonging to the respective person's account or any account falling under its hierarchy are not considered when any of the parent persons within the hierarchy is evaluated for delinquency. Note: When you skip a person from its parent person's delinquency process, the system always skips that particular person along with the hierarchy that resides under that person.
  A collection class is defined for a Person entity where the collection method is set to Parental Delinquency.	The person simply follows the collection class configuration defined for its parent person. The system also checks the following conditions: If a parent person is not defined: The person entity has its own delinquency process. Bills belonging to the respective person's account or any account falling under its hierarchy are not considered when any of the parent persons within the hierarchy is evaluated for delinquency. If a parent person is defined: The person and hierarchy falling under the person is considered under that parent person's delinquency management.

• 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

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

• Attach the C1-DLNQMNRAC algorithm to the Delinquency Monitor Rule system event in the Delinquency Control screen for creating an individual 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.

• 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 a new characteristic type named Active Selection Characteristics and set it as an attribute where the preference category is Individual Membership.

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

  • Individual Membership Configurations

  • Membership Active Status

  • Membership Terminated Status

  • Policy Active Status

  • Policy Pending Termination Status

  • Policy Pending Reinstatement Status

• Define the required customer contact type where the Membership (C1MMBRSH) characteristic type is mapped in the customer contact type’s characteristic type.

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

• Set the default value Y for the Skip Termination of Guaranteed Available Memberships(Valid Values - Y, N) parameter of the C1-MEMTRMRSN algorithm.

• 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.

• 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

Parent topic: Individual Health Insurance Delinquency