The second part of the eligibility and entitlement process is to store the created decisions. As part of storing case decisions, the eligibility and entitlement engine creates a case event for each decision and stores each CaseDecision, each decision's CaseDecisionObjective list, and each decision's CaseDecisionObjectiveTag list. Case decisions are the determination of eligibility and entitlement based on the application of rules to evidence. Decision eligibility indicates whether or not the client or clients being assessed for a particular product are eligible for that product. Eligibility determination indicates how much the client or clients being assessed are eligible for (entitlement can be a payment amount or a billing amount depending on the product type).
Each case decision is made up of one or more case decision objectives. These case decision objectives are the eligible rules objectives. Rules objectives are the targets for a rule set. When determining product eligibility, these rules objectives are normally rates. The value of a case decision objective is based on the case decision objective tags associated with the case decision objective. These case decision objective tags are the objective tags for the eligible rules objectives. Where the case decision objective is numeric, the frequency pattern on the case decision objective tags are used to determine the value of the case decision objective for a given period.
Rules objectives define all possible objectives for a rule set, whereas, case decision objectives define only the eligible rules objectives for a case decision. For information on rules, see the Cúram Rules Definition Guide.
The following is an example of a case decision made up of a single case decision objective. The case decision objective consists of two case decision objective tags:
Case Decision: Client is eligible
Case Decision Objective: Max Personal
Case Decision Objective Tag 1 for Max Personal: Daily Rate of 10
Case Decision Objective Tag 2 for Max Personal: Weekly Rate of 70
Customers can use the postInsertExamineDecisions hook to add custom processing to the store decisions process. The custom processing added to this hook will be called after the new decisions have been stored.