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Scenario 6

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Description

Account contains only one enrollment span that is related to the transaction received and the enrollment span has only one premium span.

CSR Variant Change transaction is received with the dependent being added

Account in UMV

Member information in UMV prior to transaction receipt.

Member 1: Self

Business Unit

Subscriber Name

Relationship Type

Issuer Subscriber Id

Issuer Member Id

MP_GA

John Doe

Self

U70523453

U7052345301

Enrollment Spans

Enrollment Span Code

Start Date

End Date

QHP ID

Group Policy Id

Status

9800423

1/1/2023

12/31/2023

42354GA33463-01

2374734

ENROLLED

Premium Spans

Premium Span Code

Start Date

End Date

PRE AMT 1

PRE AMT TOT

APTC AMT

TOT RES AMT

Member Count

9800423-1

1/1/2023

5/31/2023

1000

1309.76

1300.00

9.76

2

9800423-1

6/1/2023

12/31/2023

1000

1309.76

900

409.76

2

Member 2: Spouse

Business Unit

Subscriber Name

Relationship Type

Issuer Subscriber Id

Issuer Member Id

MP_GA

Jane Doe

Spouse

U70523453

U7052345302

Enrollment Spans

Enrollment Span Code

Start Date

End Date

QHP ID

Group Policy Id

Status

9800424

1/1/2023

12/31/2023

42354GA33463-01

2374734

ENROLLED

Premium Spans

Premium Span Code

Start Date

End Date

PRE AMT 1

PRE AMT TOT

APTC AMT

TOT RES AMT

9800424-1

1/1/2023

5/31/2023

309.76

0

0

0

9800424-2

6/1/2023

12/31/2023

309.76

0

0

0

Transaction Received

Member

Received Date

Transaction Type

QHP ID

Group Policy Id

348 Date

PRE AMT TOT

Effective Date

PRE AMT TOT

APTC AMT

Effective Date

APTC AMT

TOT RES AMT

Effective Date

TOT RES AMT

John Doe

5/15/2023

CHANGE

42354GA33463-02

2374734

1/1/2023

3/25/2023

1623.07

3/1/2023

961.59

1/26/2023

661.48

Jane Doe

5/15/2023

CHANGE

42354GA33463-02

2374734

1/1/2023

N/A

N/A

N/A

N/A

N/A

N/A

Baby Doe

5/15/2023

ADD

42354GA33463-02

2374734

3/25/2023

N/A

N/A

N/A

N/A

N/A

N/A

Transaction Processing

Send transaction to Transaction initiator to create spin off transactions

Spin Off Transaction 1:

Create the transaction as follows

  1. Update all the effective date of all the amounts with the date that is received for APTC AMT effective date.

  2. Retrieve the PRE AMT TOT from the latest premium span and populate as PRE AMT TOT in the transaction

  3. Calculate the TOT RES AMT based on the equation => PRE AMT TOT - APTC AMT - OTH PAY AMT 1 - OTH PAY AMT 2

  4. Populate the APTC AMT as received in the transaction

  5. Populate the effective dates of PRE AMT TOT, TOT RES AMT, OTH PAY 1 (if present), OTH PAY 2 (if present), to be same as APTC AMT effective date

Dependents:

Include all the dependents exception for the dependents who has the transaction type ADD .

Member

Received Date

Transaction Type

QHP ID

Group Policy Id

348 Date

PRE AMT TOT

Effective Date

PRE AMT TOT

APTC AMT

Effective Date

APTC AMT

TOT RES AMT

Effective Date

TOT RES AMT

John Doe

5/15/2023

CHANGE

42354GA33463-01

2374734

1/1/2023

1/1/2023

1309.76

1/1/2023

961.59

1/1/2023

348.17

Jane Doe

5/15/2023

CHANGE

42354GA33463-01

2374734

1/1/2023

N/A

N/A

N/A

N/A

N/A

N/A

Enrollment Spans In UMV after the Spin Off Transaction # 1 is completed processing

Member 1: Self

Business Unit

Subscriber Name

Relationship Type

Issuer Subscriber Id

Issuer Member Id

MP_GA

John Doe

Self

U70523453

U7052345301

Enrollment Spans

Enrollment Span Code

Start Date

End Date

QHP ID

Group Policy Id

Status

9800423

1/1/2023

12/31/2023

42354GA33463-01

2374734

ENROLLED

Premium Spans

Premium Span Code

Start Date

End Date

PRE AMT 1

PRE AMT TOT

APTC AMT

TOT RES AMT

Member Count

9800423-1

1/1/2023

1/1/2023

1000

1309.76

1300.00

9.76

2

9800423-2

1/1/2023

12/31/2023

1000

1309.76

961.59

348.17

2

Member 2: Spouse

Business Unit

Subscriber Name

Relationship Type

Issuer Subscriber Id

Issuer Member Id

MP_GA

Jane Doe

Spouse

U70523453

U7052345302

Enrollment Spans

Enrollment Span Code

Start Date

End Date

QHP ID

Group Policy Id

Status

9800424

1/1/2023

12/31/2023

42354GA33463-01

2374734

ENROLLED

Premium Spans

Premium Span Code

Start Date

End Date

PRE AMT 1

PRE AMT TOT

APTC AMT

TOT RES AMT

9800424-1

1/1/2023

1/1/2023

309.76

0.00

0.00

0.00

9800424-2

1/1/2023

12/31/2023

309.76

0.00

0.00

0.00

Spin Off Transaction 2:

Create the transaction as follows

  1. Update all the effective date of all the amounts with the date that is received for PRE AMT TOT effective date.

  2. Populate all the amounts as they are received in the original transaction

  3. Populate the APTC AMT as received in the transaction

Dependents:

Include all the dependents present in the transaction

Member

Received Date

Transaction Type

QHP ID

Group Policy Id

348 Date

PRE AMT TOT

Effective Date

PRE AMT TOT

APTC AMT

Effective Date

APTC AMT

TOT RES AMT

Effective Date

TOT RES AMT

John Doe

5/15/2023

CHANGE

42354GA33463-01

2374734

1/1/2023

1/26/2023

1623.07

1/26/2023

961.59

1/26/2023

661.48

Jane Doe

5/15/2023

CHANGE

42354GA33463-01

2374734

1/1/2023

N/A

N/A

N/A

N/A

N/A

N/A

Baby Doe

5/15/2023

ADD

42354GA33463-01

2374734

1/26/2023

N/A

N/A

N/A

N/A

N/A

N/A

Final Enrollment Span Disposition

Member 1: Self

Business Unit

Subscriber Name

Relationship Type

Issuer Subscriber Id

Issuer Member Id

MP_GA

John Doe

Self

U70523453

U7052345301

Enrollment Span - 1

Enrollment Span Code

Start Date

End Date

QHP ID

Group Policy Id

Status

9800423

1/1/2023

3/24/2023

42354GA33463-01

2374734

ENROLLED

Premium Spans

Premium Span Code

Start Date

End Date

PRE AMT 1

PRE AMT TOT

APTC AMT

TOT RES AMT

Member Count

9800423-1

1/1/2023

2/28/2023

1000

1309.76

1300.00

9.76

2

9800423-2

6/1/2023

6/1/2023

1000

1309.76

900

409.76

2

9800423-3

3/1/2023

3/24/2023

1000

1309.76

961.59

661.48

2

Enrollment Span - 2

Enrollment Span Code

Start Date

End Date

QHP ID

Group Policy Id

Status

9800523

3/25/2023

12/31/2023

42354GA33463-02

2374734

ENROLLED

Premium Spans

Premium Span Code

Start Date

End Date

PRE AMT 1

PRE AMT TOT

APTC AMT

TOT RES AMT

9800523-1

3/25/2023

12/31/2023

309.76

0

0

0

Member 2: Spouse

Business Unit

Subscriber Name

Relationship Type

Issuer Subscriber Id

Issuer Member Id

MP_GA

Jane Doe

Spouse

U70523453

U7052345302

Enrollment Span - 1

Enrollment Span Code

Start Date

End Date

QHP ID

Group Policy Id

Status

9800424

1/1/2023

3/24/2023

42354GA33463-01

2374734

ENROLLED

Premium Spans

Premium Span Code

Start Date

End Date

PRE AMT 1

PRE AMT TOT

APTC AMT

TOT RES AMT

9800424-1

1/1/2023

2/28/2023

309.76

0.00

0.00

0.00

9800424-2

6/1/2023

6/1/2023

309.76

0.00

0.00

0.00

9800424-3

3/1/2023

3/24/2023

309.76

0.00

0.00

0.00

Enrollment Span - 2

Enrollment Span Code

Start Date

End Date

QHP ID

Group Policy Id

Status

9800524

3/25/2023

12/31/2023

42354GA33463-02

2374734

ENROLLED

Premium Spans

Premium Span Code

Start Date

End Date

PRE AMT 1

PRE AMT TOT

APTC AMT

TOT RES AMT

9800524-1

3/25/2023

12/31/2023

309.76

0.00

0.00

0.00

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