Telus TPM Documentation
Rate Calculation
There are many factors which go into calculating rates for claims, and it is not as straight forward as it seems it should be. To get to the point we're able to calculate a rate, we need to have a bunch of data fall in place correctly. If the data doesn't line up properly, you will get a pend reason explaining what is wrong.
There are a few different types of rate calculations we support in GoSimple:
One of the three (Fixed Rate - Numeric) requires no extra work to get a usable rate, as it's input by the user in a usable format. The other two (Fixed Rate - Percent, Fixed Price - Numeric) require extra work to create a usable rate. These two need an accurate price to correctly calculate a rate.
In GoSimple, we currently support multiple systems of pricing. These pricing systems can be used in different combinations, and configured to act like a stack when looking for pricing. The order which each system is looked in, and what is enabled is configurable per-client. What that means, when looking for a price, we will look in system “1” first, and if a price is found use that, if not, we will look into system “2”, and continue until a price is found (or we run out of systems to look in).
To find the correct price, we have a few data points we will check for in each system.
The Product, Date, and Cost Basis Type are all simple and easy to understand what will be used. The company has some rules as to when the line distributor or the claimant will be used.
We will use the line distributor only if these conditions are met:
In all other cases, we will use the claimant.
With that data, we can look into the stack and get the price which correlates to those data points, pulling the first one that matches. We will take into account any price modifiers at this point, and apply them to the price returned which will potentially make it different than what we store as the price.
Once we have a accurate price, we are able to calculate a usable rate.
