Defining an Individual Membership Preference

Prerequisites

To define an individual membership preference, you should have:

  • Field mapping business objects defined in the application.

  • Required characteristic type defined for the health plan in the application.

Procedure

To define an individual membership 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 the individual membership 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 individual membership preference. It contains the following fields:

      Field Name Field Description Mandatory (Yes or No)
      Preference Used to specify the individual membership preference. Yes
      Description Used to specify the description for the individual membership preference. Yes
      Detailed Description Used to specify additional information about the individual membership preference. No
      Status Used to indicate the status of the billing 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 Individual Membership option from the list while creating a individual membership preference.

      		 Yes

    • Preference Settings - Used to set the attributes in the individual membership 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 individual membership preference. The valid values are:

      • Active Selection Characteristics - Used when you want to specify the characteristic that determine or represent an individual’s active selection for processing the membership or enrollment in the individual membership preference.

      • Health Plan Characteristics - Used when you want to derive the health plan ID for an individual membership based on the configured health plan characteristics in the individual membership preference.

      Note:
      The attribute list appears only when the preference category is selected from the respective list.
      		 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 individual membership. The valid values are:

      • Active Selection Characteristics - The Value field is used to specify the configured characteristic for an active selection.

      • Health Plan Characteristics - The Value field is used to specify the characteristic type which indicates the plan ID of the health plan. This characteristic type is defined for a health plan. The system uses this plan ID to create a health plan specific contract. The system then uses this characteristic type to determine the account of the financial responsible person for whom the billable charges should be generated.

      Note:

      The attribute value list appears only when the attribute is selected from the respective list.

      The list includes only those characteristics which are already defined in the system.

      		 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 an individual membership preference, you must set at least one attribute in the individual membership preference.
  6. Select the Individual Membership 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. Set the required attributes in the individual membership preference.
  9. If you want to set more than one attribute in the individual membership preference, click the Add (The Add Icon) icon and then repeat step 8.
    Note:
    However, if you want to remove an attribute from the individual membership preference, click the Delete (The Delete Icon) icon corresponding to the attribute.
  10. Click Save.
    The individual membership preference is defined.

Related Topics

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