Process Group
Beneficiary Management
Objective
Provide accurate and timely indication of whether presenting individual is eligible for health care coverage at this point in time at this location and if specific services to be rendered are covered by the individual’s benefits plan
Input
Beneficiary identifier
Provider identifier
Benefits class
Encounter date
Beneficiary accumulator
Demographic criteria
Clinical criteria
Output
Time-based eligibility status
Benefit cap
Beneficiary accumulators
Task Set
Identity verification
Measurable Outcomes
Provider understands the extent to which services rendered are covered by the individual’s health care plan
Individual is informaed of the extent to which services are covered under their health care plan