Scenario A
This scenario explains the activities involved in the financial processing. These activities are Select Financial Transactions into Set, Supersede Financial Transactions and Generate Financial Message. These activities must be executed sequentially to process the financial data to generate the financial message(s).
Policy 1001
Policy 1001 has the following properties:
- Policy Code
-
POL1001
- Group Account
-
-
- Collection Frequency
-
2 [1]
- Member
-
2110112 (lives in a state where a regional tax applies)
- Enrollment Product
-
BASIC PLAN with start date 01-Jan-2015
- Add-on
-
Preventive Care with start date 01-Jan-2015
Suppose the Calculate Premium activity has generated the following calculation results for policy POL1001 for the input calculation period Jan'15.
Calculation Results
Calculation Result
| Policy Code | Policy Version | Calculation Result Version | Calculation Period | Total Base Premium | Total Adjustment | Total Surcharge | Total Result |
|---|---|---|---|---|---|---|---|
POL1001 |
1 |
1 |
Jan'15 |
110.25 |
-5.51 |
4.33 |
109.07 |
POL1001 |
1 |
1 |
Feb'15 |
110.25 |
-5.51 |
4.33 |
109.07 |
Calculation Result Lines
| Calculation Result | Seq. | Input Amount | % | Result Amount | Add-on | Schedule Definition |
|---|---|---|---|---|---|---|
01-Jan-2015 |
1 |
- |
- |
105.00 |
BASIC PLAN Premium |
|
2 |
105.00 |
5 |
5.25 |
Preventive Care |
||
3 |
110.25 |
2.5 |
2.76 |
Regional Tax |
||
4 |
110.25 |
-5 |
-5.51 |
Office Visit Co-payment |
||
5 |
104.74 |
1.5 |
1.57 |
Surcharge |
||
01-Feb-2015 |
1 |
- |
- |
105.00 |
BASIC PLAN Premium |
|
2 |
105.00 |
5 |
5.25 |
Preventive Care |
||
3 |
110.25 |
2.5 |
2.76 |
Regional Tax |
||
4 |
110.25 |
-5 |
-5.51 |
Office Visit Co-payment |
||
5 |
104.74 |
1.5 |
1.57 |
Surcharge |
Financial Data
The financial data that gets generated corresponding to these calculation results is as follows
Financial Data Related to Calculation Result for Jan'15
Base Financial Object
| Calculation Period Start Date | Policy GID [2] | Status |
|---|---|---|
01-Jan-2015 |
1001 |
Initial |
Financial Transaction
| Input Calculation Period Start Date | Policy Version | Reversal? | Total Amount | Fin Transaction Version | Financial Message Bulking Group | Financial Message ID | Financial Message Result | Alias [3] |
|---|---|---|---|---|---|---|---|---|
01-Jan-2015 |
1 |
N |
109.07 |
1 |
- |
- |
- |
Jan15_FTV1 |
Financial Transaction Details
| Component Code | Member Code | Enrollment Product Code | Amount | Sequence Number | Invoice Indicator | Invoice Line Grouping Indicator | Accounting Detail Grouping Indicator |
|---|---|---|---|---|---|---|---|
BASIC PLAN Premium |
2110112 |
BASIC PLAN |
105.00 |
1 |
Y |
N |
N |
Preventive Care |
2110112 |
BASIC PLAN |
5.25 |
2 |
Y |
N |
N |
Regional Tax |
2110112 |
BASIC PLAN |
2.76 |
3 |
Y |
N |
N |
Office Visit Co-payment |
2110112 |
BASIC PLAN |
-5.51 |
4 |
Y |
N |
N |
Surcharge |
2110112 |
BASIC PLAN |
1.57 |
5 |
Y |
N |
N |
Financial Data Related to Calculation Result for Feb'15
Base Financial Object
| Calculation Period Start Date | Policy GID | Status |
|---|---|---|
01-Feb-2015 |
1001 |
Initial |
Financial Transaction
| Input Calculation Period Start Date | Policy Version | Ind Reversal | Total Amount | Version | Financial Message Bulking Group | Financial Message ID | Financial Message Result | Alias |
|---|---|---|---|---|---|---|---|---|
01-Jan-2015 |
1 |
N |
109.07 |
1 |
- |
- |
- |
Feb15_FTV1 |
Financial Transaction Detail
| Component Code | Member Code | Product Code | Amount | Component Display Sequence | Sequence Number | Invoice Indicator | Invoice Line Grouping Indicator | Accounting Detail Grouping Indicator |
|---|---|---|---|---|---|---|---|---|
BASIC PLAN Premium |
2110112 |
BASIC PLAN |
105.00 |
1 |
1 |
Y |
N |
N |
Preventive Care |
2110112 |
BASIC PLAN |
5.25 |
2 |
2 |
Y |
N |
N |
Regional Tax |
2110112 |
BASIC PLAN |
2.76 |
3 |
3 |
Y |
N |
N |
Office Visit Co-payment |
2110112 |
BASIC PLAN |
-5.51 |
4 |
4 |
Y |
N |
N |
Surcharge |
2110112 |
BASIC PLAN |
1.57 |
5 |
5 |
Y |
N |
N |
The financial processing starts by executing Select Financial Transactions into a new Financial Transaction Set. In this example we execute this activity with the parameter Financial Transaction Set Code 'Premium Calculation Jan'.
The activity creates the Financial Transaction Set with code 'Premium Calculation Jan', adds the above financial transactions and updates the status of the Base Financial Objects to 'Changed'.
The financial processing continues with the activity Supersede Financial Transaction. This activity supersedes the financial transactions that are not required by the financial message generation process. In this example no old financial transactions exist that also have a newer version in the set, so there are no supersedes.
The activity sets the status of the Base Financial Objects to 'Supersede and Reversal Done' and the General Financial Processing Completed DateTime is set to the execution date and time of the Supersede activity.
The Financial Transaction Set is now ready for the financial message generation activity: Generate Financial Message. In this example the Financial Transaction Process Data do not specify a financial message bulking group. The system groups the financial transactions related to a Policy (GID) into one message. The financial transactions of the BFO-Jan and BFO-Feb are grouped into one message.
The contents of the various parts of the financial message are as follows
Financial Message
| Job ID | Message Date | Message Bulking Group |
|---|---|---|
132432 |
01-Jan-2015 |
1001 |
Financial Message - Invoice
| ID | Invoice Type | Invoice Amount |
|---|---|---|
89070 |
Standard |
218.14 |
Financial Message - Invoice Line
| Invoice Line ID | Line Number | Line Type | Amount |
|---|---|---|---|
123572 |
1 |
ITEM |
105.00 |
123573 |
2 |
ITEM |
5.25 |
123574 |
3 |
ITEM |
2.76 |
123575 |
4 |
ITEM |
-5.51 |
123576 |
5 |
ITEM |
1.57 |
123577 |
6 |
ITEM |
105.00 |
123578 |
7 |
ITEM |
5.25 |
123579 |
8 |
ITEM |
2.76 |
123580 |
9 |
ITEM |
-5.51 |
123581 |
10 |
ITEM |
1.57 |
Financial Message - Accounting Detail
| Accounting Detail ID | Ledger ID | Accounting Date | Amount |
|---|---|---|---|
8719049 |
32423432 |
01-Jan-2015 |
105.00 |
8719050 |
32423432 |
01-Jan-2015 |
5.25 |
8719051 |
32423430 |
01-Jan-2015 |
2.76 |
8719052 |
32423431 |
01-Jan-2015 |
-5.51 |
8719053 |
32423430 |
01-Jan-2015 |
1.57 |
8719054 |
32423432 |
01-Jan-2015 |
105.00 |
8719055 |
32423432 |
01-Jan-2015 |
5.25 |
8719056 |
32423430 |
01-Jan-2015 |
2.76 |
8719057 |
32423431 |
01-Jan-2015 |
-5.51 |
8719058 |
32423430 |
01-Jan-2015 |
1.57 |
Here, the ledger account 32423430 is used to account the surcharge amounts, 32423431 is used to account the adjustments and 32423432 for the premiums.
The premium calculation process uses the dynamic logic function 'Financial Transaction' to set the general ledger account number on the Financial Transaction Detail Process Data for each financial transaction detail. The 'Generate Financial Message’activity then uses this field to fill the ledger id in the accounting details.
The activity then updates various fields of the financial data structure to reflect the status of financial processing. They are as follows:
Base Financial Object
| Calculation Period Start Date | Policy GID | Status |
|---|---|---|
01-Jan-2015 |
1001 |
Financial Message Handled |
01-Feb-2015 |
1001 |
Financial Message Handled |
Financial Transaction Process Data
| Financial Transaction Alias | Financial Message Handled Datetime | Financial Message Result |
|---|---|---|
Jan15_FTV1 |
01-Jan-2015 |
M |
Feb15_FTV1 |
01-Jan-2015 |
M |
Financial Transaction Detail Process Data
The invoice id, invoice line id and accounting details id fields of the Financial Transaction Detail Process Data are set. These fields provide information about the invoice, invoice line and accounting detail in which the financial transaction detail has been included in the financial message.
| Alias | Component Code | Member Code | Product Code | Amount | Invoice ID | Invoice Line ID | Accounting Detail ID |
|---|---|---|---|---|---|---|---|
Jan15_FTV1 |
BASIC PLAN Premium |
2110112 |
BASIC PLAN |
105.00 |
89070 |
123572 |
8719049 |
Preventive Care |
2110112 |
BASIC PLAN |
5.25 |
89070 |
123573 |
8719050 |
|
Regional Tax |
2110112 |
BASIC PLAN |
2.76 |
89070 |
123574 |
8719051 |
|
Office Visit Co-payment |
2110112 |
BASIC PLAN |
-5.51 |
89070 |
123575 |
8719052 |
|
Surcharge |
2110112 |
BASIC PLAN |
1.57 |
89070 |
123576 |
8719053 |
|
Feb15_FTV1 |
BASIC PLAN Premium |
2110112 |
BASIC PLAN |
105.00 |
89070 |
123577 |
8719054 |
Preventive Care |
2110112 |
BASIC PLAN |
5.25 |
89070 |
123578 |
8719055 |
|
Regional Tax |
2110112 |
BASIC PLAN |
2.76 |
89070 |
123579 |
8719056 |
|
Office Visit Co-payment |
2110112 |
BASIC PLAN |
-5.51 |
89070 |
123580 |
8719057 |
|
Surcharge |
2110112 |
BASIC PLAN |
1.57 |
89070 |
123581 |
8719058 |