Process Group

Beneficiary Management

Objective

Assign beneficiary to participating PCPs or primary health units based on rules (i.e., geography, load of beneficiary).
Allow beneficiary to select PCP or primary health units from available list.

Input

• beneficiary identifier

• Provider identifier

• Census

• Benefit class

• Benefit plan

• Physical proximity (e.g. work or home)

• List of available providers

• Family relationships

• Maximum number of beneficiaries to which a provider can attend

Output

• Provider capitation list

• Provider roster

• Notification of primary provider

Task Set

• List of available providers

• Roster size calculation

• Roster associations

Measurable Outcomes

• Providers receives beneficiary list/roster

• Beneficiary receives notification of primary provider

• Accurate list of beneficiary and selected/ assigned PCP or primary care unit

Task Flow Diagram

Sources

• Joint Learning Network, 2012

• File: NHIIS_Phase_1_Public_Report_JLN_IT_Workshop_FINAL_Jan182012_A4.pdf