Process Group
Beneficiary Management
Objective
Provide Indication of whether beneficiary is eligible for health insurance coverage and details on specific services covered by plan benefits
Input
Beneficiary identifier
Benefits class
Date of inquiry
Demographic criteria
Output
Time-based eligibility status
Status of co-pays/co-insurance
Beneficiary accumulators
Measurable Outcomes
Beneficiary receives information about services covered by benefits plan, indication of whether benefits cap has been reached and totals for payment/co-payments made to date (beneficiary accumulators)