This chapter provides an overview of eligibility and entitlement processing where a change in circumstance has occurred and reassessment is required. The purpose of case reassessment is to compare the outputs of eligibility and entitlement results that cover the same period of time. This comparison detects differences between these outputs so that the necessary over/under payments/bills are created. An over/under payment/billing occurs when a new decision is created for a period that overlaps with an existing decision or decisions that have already been processed for payment or billing and that new decision differs from the existing decision or decisions. Changes in circumstance that lead to decision changes include evidence changes, rate changes, rules changes, and time based changes, such as a change to a participant's age due to the passing of time.
To check if reassessment is required, the eligibility and entitlement engine compares the cover period from date of each new decision to the cover to date of the case. The cover to date of the case is the latest cover period to date for all ILIs, i.e., the output of all processed financial components. If any new decision from date is before the cover to date, reassessment must occur. The eligibility and entitlement engine then defines the reassessment period and determines if any over/under payments/bills exist by comparing the ILIs to financial data associated with the new case decisions.
There are five examples in this chapter which demonstrate how reassessment processing works. The first example demonstrates reassessment processing for a benefit case. The second example demonstrates reassessment processing for a liability case. The third example demonstrates reassessment processing where more than one rules objective is assigned to the same nominee. The fourth example demonstrates reassessment processing where more than one nominee is assigned to the same rules objective over a period of time. The final example demonstrates reassessment processing where more than one reassessment occurs within the same time period.