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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 2.6.0.1.0 and later
Information in this document applies to any platform.

Goal

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.
 

Solution

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In this Document
Goal
Solution
References


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