Defining a Medicare Preference

Prerequisites

To define a medicare preference, you should have:

  • Field mapping business objects defined in the application.

  • Value defined for the Medicare option type in the C1-ASOBLLNG feature configuration.

Procedure

To define a medicare 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 medicare 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 medicare preference. It contains the following fields:

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

      		 Yes

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

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

      • Late Enrollment Penalty - Used when you want to indicate the benefit sub type for Medicare Part D LEP in the medicare preference.

      • Low Income Subsidy - Used when you want to indicate the benefit sub type for Medicare Part D LIS in the medicare preference.

      • Medicare Prescription Drug Coverage - Used when you want to indicate the benefit sub type for Medicare Part D in the medicare 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 medicare preference. The valid values are:

      • Late Enrollment Penalty - The Value field is used to specify the benefit sub type that you want to use while creating charges for Medicare Part D LEP.

      • Low Income Subsidy - The Value field is used to specify the benefit sub type that you want to use while creating charges for Medicare Part D LIS.

      • Medicare Prescription Drug Coverage - The Value field the benefit sub type that you want to use while creating charges for Medicare Part D.

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

Related Topics

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