Membership Eligibility Inbound Message – Gaps For Healthcare Fully Insured Groups
(Doc ID 2473554.1)
Last updated on DECEMBER 15, 2020
Applies to:Oracle Financial Services Revenue Management and Billing - Version 184.108.40.206.0 and later
Information in this document applies to any platform.
The Membership Eligibility Inbound Message for fully insured groups has gaps in functionality required by the industry. At a high level, these include:
• Ability to monitor qualifying events and create a Membership Audit Event record to facilitate premium billing. This is required when ORMB is responsible for calculating monthly premium, rather than receiving monthly premium as a pass through amount from the source system.
• Ability to support direct bill scenarios, e.g. COBRA subscribers under a group can be billed directly.
• With healthcare fully insured groups, eligibility data are received from an external system. The Membership Eligibility Inbound Message must be flexible to allow mapping of data at different level/s to align with customer requirements and support extensibility by providing spots where client specific logic can be plugged in.
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