Billable Charges Are Not Getting Cancelled or End Date Not Updated Due To Retro Events (Doc ID 2897215.1)

Last updated on SEPTEMBER 26, 2022

Applies to:

Symptoms

On RMB v3.1.0.0.0, Billable charges are not getting cancelled and end date is not getting updated if that charge becomes not eligible due to some retro events.

The environment had an issue where CI_PRCE_CALC records not getting updated as Invalid in case of Retro Membership change activity.
PD provided <Patch 34160744> to resolve the issue and now after this patch old Rate records are updated as 'I' in BO_Status_CD coulmn instead of 'C'.
But now Batch FIBCR is not cancelling the Billable charge and causing invalid Billing run.

This is not sure if the issue existed before as this scenario was not coming up as records were not updated as 'invalid' before.

But now the below behavior occurs after running Repricing batches with following base case scenarios:

Scenario 1)
1) Add related pricing rule type (Capitation or Discount) on primary pricing rule type Age base pricing.
2) Created health plan and primary pricing rule with eligibility parameters.
3) Add the pricing for related pricing rule with eligibility parameters like State char - CA effective.
4) Create Individual Membership start from 01-Jan-2022 to 31-Dec-2022 with State char - CA effective from 01-Jan-2022.
5) Run the repricing batches for membership. Membership premium should be calculated for Primary Age base pricing as well as the related pricing.
6) Update the char, which is mapped with the eligibility parameter. Like, Add state char - OH effective from 01-Jul-2022.
7) Run repricing batches.

We expect the application should update the end date for billable charges of related pricing rule as 30-Jul-2022.

Scenario 2)
1) Same pricing rule setup as Scenario 1.
2) Create Individual Membership start from 01-Jan-2022 to 31-Dec-2022 with State char - CA effective from 01-Jan-2022.
3) Run the repricing batches for membership. Membership premium should be calculated for Primary Age base pricing as well as the related pricing.
4) Update the char, which is mapped with the eligibility parameter. Like, Update state char - OH effective from 01-Jan-2022.
5) Run repricing batches.

We expect that for this scenario, the application should cancel the existing billable charge for the related pricing rule.

Cause

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