C1_​ACCPRIMEM

This algorithm should be configured on Fully-Insured Pricing Rule Types.

• For Group - Based on Price Items and parameters configured on the Pricing Rule Type , available pricing rules for the policy are searched at parent person, policy, plan, state level. If processing Benefit record for benefit sub type has Value Type = 'Flat' and Price = 'N', Get the respective price items from the Benefit Pricing Rule Type based on the eligibility rule evaluation and derive the account of the bill group derived based on Invoice Type provided on Pricing Rule Type Price Item. Account of the bill group is searched with active contract of contract type corresponding to the price item and invoice type characteristic on the account matching the invoice type with priority as mentioned on the Pricing Rule Type for the Price Item.

• For Individual - Based on Price Items and parameters configured on the Pricing Rule Type , available pricing rules are searched at health plan level. If processing Benefit record for benefit sub type has Value Type = 'Flat' and Price = 'N', Get the respective price items from the Benefit Pricing Rule Type based on the eligibility rule evaluation and derive the account of the financial responsible person derived based on Invoice Type provided on Pricing Rule Type Price Item. Account of the financial responsible person is searched with active contract of contract type corresponding to the price item and invoice type characteristic on the account matching the invoice type with priority as mentioned on the Pricing Rule Type for the Price Item.

• For Group and Individual - If processing Benefit Sub Type is also having Reconciliation Required = Y, then for additional entry, get Reconciliation account id from Benefit Sub Type admin configuration.

  1. Price Item will be used which is provided on Benefit Sub Type in Reconciliation Price Item Code field.

  2. If not provided use then derived price item based on eligibility rule as per existing logic.