JLN Process - Premium Collection

Process Group

Premium Management

Objective

Timely, accurate collection of money due from beneficiary and their sponsors (government, employer)

Input

• List of beneficiaries

• Beneficiary identifier

• Sponsor classification (i.e., company, government)

• Benefit class

• Premium rate

• Payment status (arrears, current)

• Eligibility status

Task Set

• Bill sent to beneficiary and/or sponsor

• Financial transaction to general ledger (GL) to show premiums due

• Financial transaction to GL when premium payment is received

• Update eligibility status

• Update payment status

Measurable Outcomes

• Percentage of collected vs. outstanding premium

• Lower per transaction costs to cost as a percentage of the overall transaction cost

• Received all premiums due equal to predicted amount

• Minimize number of delinquent premium

Sources

• Joint Learning Network, 2012

• File: NHIIS_Phase_1_Public_Report_JLN_IT_Workshop_FINAL_Jan182012_A4.pdf