AC1: Process Exchange Transaction with Auto-Generated Contract ID

Processing Steps:

1. Set EXSI-SSN-ID to REF02-REFERENCE-IDENTIFIER

2. Set business level and contract type information

3. Convert and validate date of birth

4. Validate gender code

5. Call HMH5B4C to generate auto contract ID

6. Extract first 16 characters from generated contract ID

7. Set CONTRACT-ID to extracted value

8. Set auto-generated flag = 'Y'

Output Fields:
CONTRACT-ID = Auto-generated contract ID
FLAG-0004 = 'Y' (Auto-generated Contract Flag)

Error Rules:
If date of birth conversion fails, set ERROR-CODE = 'MEHPI01547'
If gender code validation fails, set ERROR-CODE = 'MEHPI01548'
If contract generation fails, set CONTRACT-ID = EXSI-SSN-ID

Success Criteria:
CONTRACT-ID contains valid auto-generated contract ID
FLAG-0004 = 'Y'
FLAG-1728 = 'Y' (Success Indicator)

Failure Criteria:
ERROR-CODE contains error code
FLAG-1730 = 'Y' (Error Indicator)
FLAG-1728 = 'N' (Success Indicator)

AC2: Process Historical Transaction with Auto-Generated Contract ID

Processing Steps:

1. Set EXSI-SSN-ID to REF02-REFERENCE-IDENTIFIER

2. Trim the SSN using TIRFTRIM

3. Verify SSN length is 9

4. Set business level and contract type information

5. Convert and validate date of birth

6. Validate gender code

7. Call HMH5B4C to generate auto contract ID

8. Extract first 16 characters from generated contract ID

9. Set CONTRACT-ID to extracted value

10. Set auto-generated flag = 'Y'

Output Fields:
CONTRACT-ID = Auto-generated contract ID
FLAG-0004 = 'Y' (Auto-generated Contract Flag)

Error Rules:
If SSN length is not 9, extract first 16 characters from REF02-REFERENCE-IDENTIFIER
If date of birth conversion fails, set ERROR-CODE = 'MEHPI01547'
If gender code validation fails, set ERROR-CODE = 'MEHPI01548'
If contract generation fails, set CONTRACT-ID = EXSI-SSN-ID and FLAG-0107 = 'Y'

Success Criteria:
CONTRACT-ID contains valid auto-generated contract ID
FLAG-0004 = 'Y'
FLAG-1728 = 'Y' (Success Indicator)

Failure Criteria:
ERROR-CODE contains error code
FLAG-1730 = 'Y' (Error Indicator)
FLAG-1728 = 'N' (Success Indicator)

AC3: Process Historical Transaction without Auto-Generated Contract ID

Processing Steps:

1. Extract first 16 characters from REF02-REFERENCE-IDENTIFIER

2. Set CONTRACT-ID to extracted value

3. Set EMPLOYEE-GROUP-LEVEL-1-ID to group ID

4. Set business level information

5. Convert effective date

6. Call HMH5B50 to check if FlexLink

Output Fields:
CONTRACT-ID = Extracted contract ID
EMPLOYEE-GROUP-LEVEL-1-ID = Group ID

Error Rules:
If REF01-REFERENCE-ID-QUALIFIER ≠ '1L', set appropriate error code
For subscriber: ERROR-CODE = 'MEHPI01503'
For member: ERROR-CODE = 'MEHPI01505'

Success Criteria:
CONTRACT-ID contains valid extracted contract ID
EMPLOYEE-GROUP-LEVEL-1-ID contains valid group ID
FLAG-1728 = 'Y' (Success Indicator)

Failure Criteria:
ERROR-CODE contains error code
FLAG-1730 = 'Y' (Error Indicator)
FLAG-1728 = 'N' (Success Indicator)

AC4: Process FlexLink Group for Historical Transaction

Processing Steps:

1. Extract first 16 characters from REF02-REFERENCE-IDENTIFIER

2. Set CONTRACT-ID to extracted value

3. Set EMPLOYEE-GROUP-LEVEL-1-ID to group ID

4. Set business level information

5. Convert effective date

6. Call HMH5B50 to check if FlexLink

7. If FlexLink and interchange sender is '710':

Call HMH5BFLI to retrieve FlexLink contract ID
Set CONTRACT-ID to retrieved value
Set auto-generated flag = 'Y'

Output Fields:
CONTRACT-ID = FlexLink contract ID
EMPLOYEE-GROUP-LEVEL-1-ID = Group ID
FLAG-0004 = 'Y' (Auto-generated Contract Flag)

External Calls:
HMH5B50 for FlexLink check
HMH5BFLI for FlexLink contract ID retrieval

Success Criteria:
CONTRACT-ID contains valid FlexLink contract ID
FLAG-0004 = 'Y'
FLAG-1728 = 'Y' (Success Indicator)

Failure Criteria:
FLAG-1730 = 'Y' (Error Indicator)
FLAG-1728 = 'N' (Success Indicator)

AC5: Process Cancel/Term Transaction

Processing Steps:

1. Initialize cancel/term flag

2. Check for reason codes in 2700 loop

3. If reason code found:

If contains 'CANCEL', set cancel flag = 'Y'
If contains 'TERM', set term flag = 'N'

4. If no reason code found:

If EFFECTIVE-DATE > END-DATE, set cancel flag = 'Y'
Else, set term flag = 'N'

5. Call HMH5B4F to determine business levels

Output Fields:
FLAG-0519 = 'Y' for cancel, 'N' for term
Business level fields updated

External Calls:
HMH5B4F for business level determination

Success Criteria:
FLAG-0519 correctly set based on transaction type
Business level fields populated
FLAG-1728 = 'Y' (Success Indicator)

Failure Criteria:
FLAG-1730 = 'Y' (Error Indicator)
FLAG-1728 = 'N' (Success Indicator)

AC6: Process Subscriber Record for Enrollment Activity

Processing Steps:

1. Set business level information

2. Set employer group information

3. Format contract ID with appropriate padding and control plan

4. Set subscriber indicator

5. Search for member ID in member supplemental IDs

6. Set enrollment activity record fields

7. Search for product ID in health coverage plans

8. Extract benefit package ID from plan coverage description

9. Call HMH5B47 to create enrollment activity record

Output Fields:
Enrollment activity record created with appropriate fields

External Calls:
HMH5B47 for enrollment activity record creation

Success Criteria:
Enrollment activity record created successfully
FLAG-1728 = 'Y' (Success Indicator)

Failure Criteria:
FLAG-1730 = 'Y' (Error Indicator)
FLAG-1728 = 'N' (Success Indicator)

AC7: Process Cancel Date Based on Keyword Setting

Processing Steps:

1. Convert end date using CNVTXTDT

2. Set up business level information

3. Call NREF1DRI to retrieve keyword data

4. Extract cancel date processing flag from keyword description

5. If cancel date processing flag = 'Y' and end date is valid:

Call TIRFDDUR to subtract one day from the end date
Convert the adjusted date back to text format using CNVDTTXT
Update END-DATE with the adjusted date

Output Fields:
END-DATE = Adjusted date (one day earlier)

External Calls:
NREF1DRI for keyword data retrieval
TIRFDDUR for date subtraction
CNVDTTXT for date format conversion

Success Criteria:
END-DATE contains adjusted date (one day earlier than original)
FLAG-1728 = 'Y' (Success Indicator)

Failure Criteria:
END-DATE unchanged
Error in date conversion

AC8: Handle Invalid Date of Birth

Processing Steps:

1. Set TEXT-DATE-8 to DMG02-DATE-OF-BIRTH

2. Call CNVTXTDT to convert date format

3. If conversion fails (ERROR-CODE ≠ 0):

Set ERROR-CODE = 'MEHPI01547'
Call HMH5B4A to create contract error
Exit processing

Output Fields:
ERROR-CODE = 'MEHPI01547'
Contract error record created

External Calls:
CNVTXTDT for date conversion
HMH5B4A for error record creation

Success Criteria:
N/A (error scenario)

Failure Criteria:
ERROR-CODE = 'MEHPI01547'
Contract error record created
FLAG-1730 = 'Y' (Error Indicator)
FLAG-1728 = 'N' (Success Indicator)
Processing stops

AC9: Handle Invalid Gender Code

Processing Steps:

1. Set CODE-CATEGORY-IDENTIFIER = 'SX'

2. Set CODE-VALUE-IDENTIFIER = DMG03-GENDER

3. Call NREF1BRI to validate gender code

4. If validation fails (RETURN-CODE ≠ 1):

Set ERROR-CODE = 'MEHPI01548'
Call HMH5B4A to create contract error
Exit processing

Output Fields:
ERROR-CODE = 'MEHPI01548'
Contract error record created

External Calls:
NREF1BRI for gender code validation
HMH5B4A for error record creation

Success Criteria:
N/A (error scenario)

Failure Criteria:
ERROR-CODE = 'MEHPI01548'
Contract error record created
FLAG-1730 = 'Y' (Error Indicator)
FLAG-1728 = 'N' (Success Indicator)
Processing stops

AC10: Handle Missing Group ID for Subscriber

Processing Steps:

1. Extract first 16 characters from REF02-REFERENCE-IDENTIFIER

2. Set CONTRACT-ID to extracted value

3. Check if REF01-REFERENCE-ID-QUALIFIER = '1L'

4. If not and INS01-SUBSCRIBER-INDICATOR = 'Y':

Set ERROR-CODE = 'MEHPI01503'
Call HMH5B4A to create contract error
Set FLAG-1730 = 'Y'
Exit processing

Output Fields:
ERROR-CODE = 'MEHPI01503'
Contract error record created

External Calls:
HMH5B4A for error record creation

Success Criteria:
N/A (error scenario)

Failure Criteria:
ERROR-CODE = 'MEHPI01503'
Contract error record created
FLAG-1730 = 'Y' (Error Indicator)
FLAG-1728 = 'N' (Success Indicator)
Processing stops

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