Billing Rates Composite Rates

The following table provides at a glance the rate template for Billing Rates Composite Rates.

Group Benefit Plan Setup

Rate Template (header) file & Import Fields

A benefit plan setup as follows:

Insurance Class = Medical, Dental or Vision

Family Rated Premiums = No

Termination Date = [blank] OR Date > current date

Tobacco Banded Rates = No

Gender Banded Rates = No

Spouse Gender Banded = No

Wellness Banded Rates = No

Age Banded Medical Rates = No

Billing Rates Vary By Network = No

Benefit Plan ID

Rate Group

Plan Type

Effective Date

From Age (must be 0, will default to 0 if blank)

To Age (must be 99, will default to 99 if blank)

Total Bill Amount

Employee Bill Amount

Dependents Bill Amount

Note: You must have access to the Billing Rates Groups to perform this action.

Please make a note of the following errors to avoid while preparing your import file using this template:

For Plan ID

You can only select an active plan for the import. If you select a plan that is terminated you will get an error message stating Plan ID is Terminated. Not valid for Import.

If the Family Rate Premiums field under the Other Processing Parameters section on the Group Benefit Plans form is checked, then exclude family rated plans from the import. If not you will get an error message stating Plan ID has Family Rated Premiums. Not supported for Import.

Medical, Dental and Vision plans are currently supported. If you select any other insurance class plans, you will get an error message stating Plan ID is [NAME] Insurance Class. Not supported for Import.

Plans where the Manual Calculation field is set to Coverage & Premiums Entered Manually in the Group Benefits Plan form are excluded.

The following are required values on the import. [Benefit Plan ID, Rate Group, Plan Type, Effective Date, Total Bill Amount and Employee Bill Amount]. If the import file is missing any required values, you will see an error message stating {Import Field Name} is required.

If the Benefit Plan ID on the import file:

does not exist in PrismHR, then you will receive an error message stating Plan ID <Plan ID> does not exist.

is more than 25 characters, you receive an error message stating Benefit Plan ID must be 25 characters or less.

is NOT in the list of Benefit Plan IDs in the Template Builder you will receive an error message stating Plan ID <Plan ID> is not in the Template Builder and cannot be included in this Rate Template.

The Rate Group on the import file:

must be an existing Rate Group under the Billing Rate Groups form. Else you will get an error message stating Rate Group <Billing Rate Group> does not exist.

must be an active Rate Group under the Billing Rate Groups form i.e. the field Inactive must be unchecked. Else you will get an error message stating Rate Group <Billing Rate Group> is inactive.

If employee Plan Type on the import file does not exist under the section Plan Types on the Group Benefit Plan form, you will receive an error stating Plan Type <Plan Type> does not exist on the Plan ID <Plan ID>.

If the Effective Date on the import file is not in a valid US date format, you will receive and error message stating Effective Date must be in a valid date format.

Age Banded Medical Rates

Only one line of rates is allowed.

If import file is set up with more than one line for an effective date combo then you will receive an error message stating Plan ID <Plan ID> is not setup as age banded. Therefore, only one age band is allowed (0 to 99).

If the From Age and To Age fields are on the import file, then the From Age must be 0 and To Age must be 99. If any other value is entered, you will receive an error message stating From Age must be 0. To Age must be 99.

If the From Age and To Age fields are blank on the import file, then PrismHR will import the values of 0 for the From Age field and 99 for the To Age field.

If your import file has records which already exist in PrismHR having the same Benefit Plan ID, Plan Type and Effective Date, then you will receive an error message stating Effective Date <EFFECTIVE DATE.> already exists for this record. Updates cannot be imported. If a duplicate key exists on the import file, this validation will also present a line error for the second record and any subsequent duplicate records attempted to be imported.

If the rate on the import file has more than 2 decimals, then you will receive an error message stating Only 2 decimal places are allowed for Rates.

10.

If the rate is negative on the import file, you will receive an error message stating Negative amounts are not allowed.

11.

For Plan Type with coverage class selected as Single (employee) coverage, if Employee Premium is on the import file, then Employee Premium must equal Total Premium. Else, you will receive an error message stating Plan Type <Plan Type> has Coverage Class Single. Employee Premium must equal Total Premium. Refer to the Coverage Class field selection on the Group Benefit Plan Types form for details.

12.

If your import file has Dependent Premium > 0 for a Plan Type with coverage class selected as Single (employee) coverage, you will receive an error message stating Dependent Premium > 0 is not allowed for Plan Type <Plan Type>.

13.

Total Bill Amount must equal Employee Bill Amount PLUS Dependent Premium. Dependent Premium is a calculated amount based on Total Premium minus Employee Premium.

14.

If Dependent Bill Amount is on the import file and Plan Type with coverage class is not selected as Single (employee) coverage, the Employee Bill Amount PLUS the Dependent Bill Amount must equal the Total Bill Amount. Otherwise, you will receive an error stating Employee Bill Amount PLUS Dependent Bill Amount must equal the Total Bill Amount.

Note: If Dependent Bill Amount is blank on the import file, then the Dependent Bill Amount will be imported as a calculated amount. (Total Bill Amount minus Employee Bill Amount)