Refund/Write Off Business Rules

Oracle Revenue Management and Billing enables you to define business rules to initiate automatic refund and write off. The refund/write off business rules are used while creating automatic refund/write off request for accounts when the fully insured group policy or individual membership is terminated.

While terminating a fully insured group policy or individual membership, the system derives the refund/write off business rule for the fully insured group policy or individual membership, respectively. While deriving the refund/write off business rule, the system considers the business rules with the Refund/Write Off Business Rule category that are effective on the termination 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 then stamps the refund/write off business rule against the fully insured group policy or individual membership in the C1_​ENT_​BUS_​RULE table.

While defining criteria for a refund/write off business rule, you can use parameters that are defined on the following source entities:

  • Membership

  • Membership Person

  • Health Plan

  • Health Product

  • Policy

  • Account

You can define, edit, and delete a refund/write off business rule through the Business Rule screen. While defining a refund/write off business rule, you need to set the category to Refund/Write Off Business Rule. The refund/write off business rule enables you to define the following parameters:

  • Refund Threshold Amount - Used to specify the threshold amount for refund. If the account balance is greater than or equal to the refund threshold amount, the system creates automatic refund for an account.

  • Defer Refund (in Days) - Used to specify the number of days till when you want to defer automatic refund for an account. It is used to calculate the automatic refund request creation date.

  • Write Off Threshold Amount - Used to specify the threshold amount for write off. If the account balance is less than or equal to the write off threshold amount, the system creates automatic write off for an account.

  • Defer Write Off (in Days) - Used to specify the number of days till when you want to defer automatic write off for an account. It is used to calculate the automatic write off request creation date.

You can use the same criteria in multiple business rules to derive different set of refund/write off parameters but with different effective date. You can view the refund/write off business rules through the Business Rule screen.

Parent topic: Business Rules