Defining a Member Reconciliation Preference

Prerequisites

To define a member reconciliation preference, you should have:

  • Field mapping business objects defined in the application.

  • Required statuses defined in the lifecycle of the C1-MemberReconciliation and C1-PayInstruction business objects.

  • Required characteristic types defined in the application (where the characteristic entity is set to Adjustment).

  • Required characteristic types defined in the application (where the characteristic entity is set to Member Reconciliation).

Procedure

To define a member reconciliation 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 member reconciliation 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 the basic details for the member reconciliation preference. It contains the following fields:

      Field Name Field Description Mandatory (Yes or No)
      Preference Used to specify the member reconciliation preference. Yes
      Description Used to specify the description for the member reconciliation preference. Yes
      Detailed Description Used to specify additional information about the member reconciliation preference.
      Note:
      You can resize the text box depending on your requirement by clicking the Resize Handle (The Resize Handle Icon) icon at the bottom right corner of the text box.
      		 No
      Status Used to indicate the status of the member reconciliation 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 Member Reconciliation option from the list while creating a member reconciliation preference.

      		 Yes

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

      • Billed Transfer Recon Adjustment Type - Used when a reconciliation adjustment type is applied to the billed transactions for offsetting the corresponding bill segment.

      • Payment Event Characteristic Type - Used when a pay instruction is reconciled at the member level through the C1-RCPM batch.

      • Pay Instruction Completed Status - Used when a pay instruction is fully reconciled at the member level through the C1-RCPM batch.

      • Pay Instruction Open Status - Used when a pay instruction is not fully reconciled at the member level through the C1-RCPM batch.

      • Payment Instruction Recon Adjustment Type - Used when you want the system to create an adjustment on the reconciliation contract when the payment instruction is reconciled.

      • Reconciliation Char Type - Used when you want the system to store the reconciliation ID for adjustments created on reconciliation.

      • Recon Adj Type for Offsetting Debits using Billed Credits - Used when you want the system to create adjustments for offsetting billed debits against billed credits during the reconciliation process.

      • Reconciliation Matching Level Characteristic Type - Used when reconciliation is created for a pay instruction file where all pay instructions have member data.

      • Reconciliation Open Status - Used when one or more pay instructions of a file are not yet fully reconciled at the member level through the C1-RCPM batch.

      • Subscriber Match Level Char Value - Used when you want the system to determine the characteristic type specified in the Payment Instruction Match Level Char Type parameter, indicating that the payment instruction to be reconciled at member level.

      		 Yes (Conditional)
      Note:
      This field is required while setting an attribute in the member reconciliation preference.
      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 member reconciliation preference. The valid values are:

      • Billed Transfer Recon Adjustment Type - The Value field is used to specify the reconciliation adjustment type applied to offset the bill segment for billed transfer transactions.

      • Payment Event Characteristic Type - The Value field is used to specify the characteristic type where you can store the payment event ID. This type of characteristic is defined for the reconciliation adjustments. It indicates the payment event whose payment is distributed against the bill segment. Here, you must specify a characteristic type where the characteristic entity is set to Adjustment.
        Note:
        The C1PAYEVT characteristic type is shipped with the product.
      • Pay Instruction Completed Status - The Value field is used to specify the status code to which you want to transition the pay instruction when it is fully reconciled.
        Note:
        Here, you must specify the status code which is already defined in the lifecycle of the C1-PayInstruction business object.
      • Reconciliation Matching Level Characteristic Type - The Value field is used to specify the characteristic type which indicates all pay instructions in the file must be reconciled at the member level. This type of characteristic is defined for the reconciliation when all pay instructions in a file have member data. Here, you must specify a characteristic type where the characteristic entity is set to Member Reconciliation.
        Note:
        The C1-MTLVL characteristic type is shipped with the product.
      • Pay Instruction Open Status - The Value field is used to specify the status code to which you want to transition the pay instruction when it is not fully reconciled.
        Note:
        Here, you must specify the status code which is already defined in the lifecycle of the C1-PayInstruction business object.

      • Payment Instruction Recon Adjustment Type - The Value field is used to specify the reconciliation adjustment type which transfers the applicable balance to the reconciliation contract when the payment instruction is reconciled.

      • Reconciliation Char Type - The Value field is used to specify the characteristic defined on the adjustments which are created on reconciliation.
        Note:
        Here, you must specify a characteristic type where the characteristic entity is set to Adjustment Type.

      • Recon Adj Type for Offsetting Debits using Billed Credits - The Value field is used to specify the adjustment type used to create adjustments for offsetting billed debits against billed credits during the reconciliation process.

      • Reconciliation Open Status - The Value field is used to specify the status code to which you want to transition the reconciliation when the status of the pay instruction is changed to Open.
        Note:
        Here, you must specify the status code which is already defined in the lifecycle of the C1-MemberReconciliation business object.

      • Subscriber Match Level Char Value - The Value field is used to specify the characteristic type specified in the Payment Instruction Match Level Char Type parameter which indicates that the payment instruction must be reconciled at member level.

      		 Yes (Conditional)
      Note:
      This field is required while setting an attribute in the member reconciliation preference.
      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 member reconciliation preference, you must set at least one attribute in the member reconciliation preference.
  6. Select the Member Reconciliation 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 attributs in the member reconciliation preference.
  9. If you want to set more than one attribute in the member reconciliation preference, click the Add (The Add Icon) icon and then repeat step 8.
    Note:
    However, if you want to remove an attribute from the member reconciliation preference, click the Delete (The Delete Icon) icon corresponding to the attribute.
  10. Click Save.
    The member reconciliation preference is defined.

Related Topics

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