Delinquency Event Attributes Business Rule

Oracle Revenue Management and Billing enables you to define business rules to determine how much to wait before an event is triggered in a delinquency process. The insurance company may offer different wait period for different delinquency event types (such as, while sending letters, To Do notification, or initiating the termination request) based on certain parameters, such as health or policy plan, division, policy or membership characteristic, etc. The system will accordingly derive wait days or wait months and day of month based on the wait period (configured in the respective delinquency process type) and calculate trigger date for the delinquency event.

While executing the C1-DPEVL batch, the system derives the business rules with the Delinquency Event Attributes Business Rule category that are effective on the batch business date. Note that the system considers only those effective business rules which are in the Active status. The system then executes the criteria of each effective business rule and considers the business rule that meet the criteria. If two or more business rules meet the criteria, the system considers the business rule with the highest priority.

The system stamps the delinquency event attributes business rule against the fully insured group policy, direct billed group membership, or individual membership, respectively in the C1_​ENT_​BUS_​RULE table. The system derives wait days or wait months and day of month based on the wait period (configured in the respective delinquency process type) from the business rule. The system derives the wait days or wait month and day of month for each active policy billed to the delinquent person or account. Similarly, the system derives the wait days or wait month and day of month for each active direct billed group membership or individual membership billed to the delinquent account. Among the wait days or wait months derived for different policies or memberships, the system considers the wait days or wait months of the policy or membership with maximum limit and calculates trigger date for the respective delinquency event using the maximum limit.

Note: The system considers the delinquency event attributes business rules to determine the wait period only when the wait period source is set to Algorithm in the respective delinquency process type. If the wait period source is set to Algorithm, the system executes the C1-DERWDBR algorithm attached to the Wait Days Derivation system event of the delinquency process type. For more information about the algorithm, see C1-DERWDBR.

The system also derives the Send Membership Level Notification parameter from the business rule. The system checks whether the Send Membership Level Notification parameter is set to Send Membership Level Notification Required for at least one policy, direct billed group membership, or individual membership, respectively, billed to the delinquent entity. If so, the system sets the Send Membership Level Notification parameter of the delinquency event to Send Membership Level Notification Required. However, if the Send Membership Level Notification parameter is set to Send Membership Level Notification Not Required for all the policies, direct billed group memberships, or individual memberships, respectively, billed to the delinquent entity, the system sets the Send Membership Level Notification parameter of the delinquency event to Send Membership Level Notification Not Required.

Note: The system considers the delinquency event attributes business rules to determine the Send Membership Level Notification parameter only when the send membership level notification source is set to Algorithm in the respective delinquency process type. If the send membership level notification source is set to Algorithm, the system executes the C1-DERMLNBR algorithm attached to the Send Member Level Notification Option Derivation system event of the delinquency process type. For more information about the algorithm, see C1-DERMLNBR.

While defining criteria for a delinquency event attributes business rule, you can use the parameters that are defined on the following source entities:

  • Account

  • Customer Class

  • Delinquency Event Type

  • Division

  • Health Plan

  • Health Product

  • Membership

  • Membership Person

  • Policy

  • Policy Plan

  • Algorithm

You can define, edit, and delete a delinquency event attributes business rule through the Business Rule screen. While defining a delinquency event attributes business rule, you need to set the category to Delinquency Event Attributes Business Rule. The delinquency event attributes business rule enables you to define the following parameters:

  • Wait Days – Used to indicate the number of days for which you want to delay a delinquency event in a delinquency process.

  • Wait Month – Used to indicate the number of months for which you want to delay a delinquency event in a delinquency process.

  • Wait Day of Month – Used to indicate the day of the month when you want to trigger a delinquency event in a delinquency process.

  • Send Membership Level Notification – Used to indicate whether you want to create a customer contact for the main subscriber of each membership billed to the delinquent customer or account.

You can use the same criteria in multiple business rules to derive different event attributes but with different effective date. You can view the delinquency event attributes business rules through the Business Rule screen.

Parent topic: Business Rules