JLN Process - Enroll beneficiary

Process Group

Beneficiary Management

Objective

Verify identity and eligibility in a timely manner of persons seeking access to benefit plan services

Input

• Demographics

• Financial information

• Geographic information

• Qualifying criteria (see qualifying conditions)

• Proof of identity (e.g., national identification card personal identification number, biometric information, photos)

• Medical history

• Current medical condition

Output

• Time-based eligibility determination

• Beneficiary identifier

• Benefit plan number

• Benefits class

• Benefits plan detail

• Proof of coverage

• Feed into data repository

Task set

• Validate identity documents

• Record information in data repository

Measurable Outcomes

• Eligibility is determined as approved or rejected.

• Approved person receives proof of coverage (e.g. I.D. card)

• Assign benefits class

• Benefits plan

• Accurate list of beneficiary

Task Flow Diagram

Sources

• Joint Learning Network, 2012

• File: Determining Common Requirements for National Health Insurance Information Systems (JLN, 2012)