Defining a Geographic Rating Area Preference

Prerequisites

To define a geographic rating area preference, you should have:

  • Field mapping business objects defined in the application.

  • Geographic rating areas defined in the application

Procedure

To define a geographic rating area preference:

  1. Click the Menu (The Menu Icon) icon in the Application toolbar.
    A list appears.
  2. Click the Admin Menu option from the list.
    A sub-menu appears.
  3. Select F and then click the Add button corresponding to the Field Mapping option from the sub-menu.

    The Select Business Object screen appears. It contains the following field:

    Field Name Field Description Mandatory (Yes or No)
    Field Mapping Business Object Used to indicate the business object using which you want to create a geographic rating area preference. The valid values are:

    • Bill Route Method - Contact Method Mapping (i.e., C1_​​BillRouteCntMethMap) - Enables you to maintain a routing method - contact method mapping preference.

    • Field Mapping (i.e., C1-FieldMapping) - Enables you to maintain the following:

      • Automatic Refund/Write-Off Preference

      • Billing Preference

      • Binder Payment Preference

      • Configuration for Match Type - Handling Overpayment Preference

      • Delinquency Process Preference

      • Delinquency Process Type Preference

      • Geographic Rating Area Preference

      • Hold Request Preference

      • Individual Membership Preference

      • Medicare Preference

      • Member Reconciliation Preference

      • Member Relationship and Subscription Tier Preference

      • Membership Repricing Reasons Preference

      • MNI Derivation Input Preference

      • Statement Construct Preference

      • Transaction Paid Status Count Preference

    • Group Membership Status Reason Mapping (i.e., C1-MemStatusReasonMapGroup) - Enables you to maintain a group membership status reason preference.

    • Medicare Plan Benefit Package (i.e., C1-BenefitPackage) - Enables you to maintain a Medicare plan benefit package.

    • Membership Status Reason Mapping (i.e., C1-MemStatusReasonMapping) - Enables you to maintain an individual membership status reason preference.

    Note:
    The above business objects are shipped with the product. The list includes those business objects which are created using the Field Mapping (i.e., C1-FIELDMAP) maintenance object.
    		 Yes
    Note:
    Alternatively, you can access the Select Business Object screen by clicking the Add button in the Page Title area of the Field Mapping screen.
  4. Select the Field Mapping option from the Field Mapping Business Object list.
  5. Click OK.

    The Field Mapping screen appears. It contains the following sections:

    • Main - Used to specify basic details for the geographic rating area preference. It contains the following fields:

      Field Name Field Description Mandatory (Yes or No)
      Preference Used to specify the geographic rating area preference. Yes
      Description Used to specify the description for the geographic rating area preference. Yes
      Detailed Description Used to specify additional information about the geographic rating area preference. No
      Status Used to indicate the status of the geographic rating area preference. The valid values are:

      • Active

      • Inactive

      		 Yes

    • Preference Category - Used to specify the preference category. It contains the following field:

      Field Name Field Description Mandatory (Yes or No)
      Preference Category Used to indicate the category to which the preference belongs. The valid values are:

      • Automatic Refund/Write-Off

      • Billing

      • Binder Payment

      • Configuration for Match Type - Handling Overpayment

      • Delinquency Process

      • Delinquency Process Type

      • Geographic Rating Area

      • Hold Request

      • Individual Membership

      • Medicare

      • Medicare Plan Benefit

      • Member Reconciliation

      • Member Relationship and Subscription Tier

      • Membership Repricing Reasons

      • Membership Status Reason

      • MNI Derivation Input

      • Routing Method - Contact Method Mapping

      • Statement Construct

      • Transaction Paid Status Count

      Note:

      The list includes only those values which are defined in the FIELD_​CAT_​FLG lookup field.

      You must select the Geographic Rating Area option from the list while creating a geographic rating area preference.

      		 Yes

    • Preference Settings - Used to set the attributes in the geographic rating area preference. It contains the following fields:

      Field Name Field Description Mandatory (Yes or No)
      Attribute Used to indicate the attribute which you want to set in the geographic rating area preference. The valid values are:

      • Address Source Characteristic Type - Used when the system derives the geographic rating area for a membership.

      • Address Type Characteristic Type - Used when the system derives the geographic rating area for a membership.

      • Default Address Source - Used when the address source characteristic is not defined for any of the following entities:

        • Policy Plan

        • State where the Policy Plan is Issued

        • Policy

        • State where the Policy is Issued

      • Default Address Type - Used when the address type characteristic is not defined for any of the following entities:

        • Policy Plan

        • State where the Policy Plan is Issued

        • Policy

        • State where the Policy is Issued

      • Default Geographic Rating Area - Used when the system is unable to derive the geographic rating area for the following combination:

        • State and zip code (this combination is considered when the Use Plan Details attribute is set to No)

        • State, zip code, policy number, plan number, and source system (this combination is considered when the Use Plan Details attribute is set to Yes)

      • Geographic Rating Area Characteristic Type - Used when the system stores the geographic rating area for a membership.

      • Use Health Plan Details - Used to indicate whether the health plan number, health product number, plan characteristics, and pricing rule should be considered while deriving the geographic rating area for a membership.

      • Use Policy Plan Details - Used to indicate whether the policy number, plan number, and source system should be considered while deriving the geographic rating area for a membership.

      		 Yes
      Value Used to specify the attribute value. The attribute value that you can specify varies depending on the attribute you want to set in the geographic rating area preference. The valid values are:
      • Address Source Characteristic Type - The Value field is used to specify the characteristic type that indicates the address source. The system supports two address sources named Policy Holder and Main Subscriber. This type of characteristic can be defined for the following entities:

        • Policy Plan

        • State where the Policy Plan is Issued

        • Policy

        • State where the Policy is Issued

        Note:

        Here, you must specify a characteristic type where the characteristic entity is set to Policy Plan, State, and Policy.

        The C1-ADSRC characteristic type is shipped with the product.

      • Address Type Characteristic Type - The Value field is used to specify the characteristic type that indicates the address type. The system supports three address types named Person Mailing, Person Seasonal, and Account Override. This type of characteristic can be defined for the following entities:

        • Policy Plan

        • State where the Policy Plan is Issued

        • Policy

        • State where the Policy is Issued

        Note:

        Here, you must specify a characteristic type where the characteristic entity is set to Policy Plan, State, and Policy.

        The C1-ADTYP characteristic type is shipped with the product.

      • Default Address Source - The Value list is used to indicate the address source. The valid values are:

        • Main Subscriber

        • Policy Holder

        Note:
        The list includes only those values which are defined in the ADDRESS_​SRC_​FLG lookup field.
      • Default Address Type - The Value list is used to indicate the address type. The valid values are:

        • Person Mailing

        • Person Seasonal

        • Account Override

        Note:
        The list includes only those values which are defined in the ADDRESS_​TYPE_​FLG lookup field.
      • Default Geographic Rating Area - The Value field is used to specify the geographic rating area that is used as a default.
        Note:
        Here, you can specify a geographic rating area which is already defined in the system.
      • Geographic Rating Area Characteristic Type - The Value field is used to specify the characteristic type where you can store the geographic rating area. This type of characteristic is defined for the membership. Here, you must specify a characteristic type where the characteristic entity is set to Membership.
        Note:
        The C1-GEORT characteristic type is shipped with the product.
      • Use Health Plan Details - The Value field is used to indicate whether health plan details should be used as a source to derive the geographic rating area. The valid values are:

        • Yes - Used when you want to derive the geographic rating area using the health plan details.

        • No - Used when you want to derive the geographic rating area using the membership details, policy plan details, or person details.

      • Use Policy Plan Details - The Value field is used to indicate whether policy plan details should be used as a source to derive the geographic rating area. The valid values are:

        • Yes - Used when you want to derive the geographic rating area using the state, zip code, policy number, plan number, and source system combination.

        • No - Used when you want to derive the geographic rating area using the state and zip code combination.

      Note:
      The attribute value list appears only when the attribute is selected from the respective list.
      		 Yes
      Entity Type Used to indicate the type of entity for which the attribute is applicable. The valid values are:

      • Account

      • Adjustment

      • Billable Charge

      • Membership

      • Payment

      • Policy

      Note:
      At present, this data is stored for informational purposes only and is not considered in the business logic. If required, you can add more entity types to the MAP_​ENTITY_​FLG lookup field.
      		 No
      Note:
      While defining a geographic rating area preference, you must set at least one attribute in the geographic rating area preference.
  6. Select the Geographic Rating Area option from the Preference Category list.
    The Preference Category section disappears and the Preference Category field appears in the Main section.
  7. Enter the required details in the Main section.
  8. Select the required attributes in the geographic rating area preference.
  9. If you want to set more than one attribute in the geographic rating area preference, click the Add (The Add Icon) icon and then repeat step 8.
    Note:
    However, if you want to remove an attribute from the geographic rating area preference, click the Delete (The Delete Icon) icon corresponding to the attribute.
  10. Click Save.
    The geographic rating area preference is defined.

Related Topics

For more information on... See...
Field Mapping screen Field Mapping