The Provider Customer Service Representative can invoke the Benefits Eligibility Solution Scenario in Business Space by logging on to Business Space, initiating a request, providing details using forms, and submitting the data for processing. The data specified in the form is processed and the inquiry is closed or transferred to a specialist. The specialist can retrieve the form and update the data for the tasks transferred. A supervisor can then use Business Space to view and analyze information using the various graphs and diagrams displayed in the reports generated.
The fields in which data is required are labeled with a * and have a different color. The Submit button in the form is disabled until you provide a value in all such fields in a form.
You can start the Solution Scenario in Business Space to view the Getting Started Widget. The Getting Started Widget lists the assets and the steps for using the Solution Scenario.
Roles | Create Task | Task Definition List | All dashboard | Process Instance / Process Check |
---|---|---|---|---|
Provider | Yes | Yes | N/A | N/A |
EPO / HMO / Other Specialist | N/A | Yes | N/A | N/A |
LOB Manager | N/A | N/A | Yes | N/A |
Provider Administrator | N/A | N/A | N/A | Yes |
The Solution Scenario provided with the WebSphere Healthcare Content Pack includes different pages that are customized to display reports. These reports can be used for further analysis.
After you submit the request, the information can be viewed for analysis on the following pages.
The Benefit Eligibility Dashboard page contains widgets that provide information about alerts, request summary, request overview, and so on, related to the benefits eligibility request raised.
The details for the widgets displayed on the Benefit Eligibility Dashboard page are given in the following table.
Widget | Description |
---|---|
Nationwide Distribution of Requests | The map displays the total submitted claim requests for 50 states. |
Request Summary - Current Month | The total number of accepted and rejected requests, for the current month is displayed here. |
Nationwide Distribution of Requests | The graph displays the request statistic for each state. |
Request Overview - Current Month | The full gauge diagram displays an overview of the requests received for the current month. |
Alerts | The widget displays the business measure alerts. |
The Benefit Eligibility Performance page contains widgets that provide information about request overview, inactive patients overview, and rejected request overview related to the benefits eligibility request raised.
The details for the widgets displayed on the Benefit Eligibility Performance page are given in the following table.
Widget | Description |
---|---|
Request Overview by State | The full gauge diagram displays the percentage of requests received for a given state. |
Inactive Patients Overview by State | The half gauge diagram displays the percentage of inactive patients for a given state. |
Rejected Request Overview by State | The half gauge diagram displays a percentage of the number of rejected requests grouped using the reason for rejection for a given state. |
The Benefit Eligibility Analysis page contains widgets that provide information about Distribution of Reasons for Rejection and Reason for Rejection related to the benefits eligibility request raised.
The details for the widgets displayed on the Benefit Eligibility Analysis page are given in the following table.
Widget | Description |
---|---|
Distribution of Reasons for Rejection | The pie chart displays the number of requests received. You can select the month or the year, for the data that you want to analyze, from the list. |
Reason for Rejection Overview | The full gauge diagram displays an overview of the number of rejected requests grouped using the reason for rejection. |
The Benefit Eligibility Report page contains widgets that provide information about monthly rejected requests and monthly reject reasons related to the benefits eligibility request raised.
The details for the widgets displayed on the Benefit Eligibility Report page are given in the following table.
Widget | Description |
---|---|
Monthly Rejected Requests Report | The graph displays the number of requests rejected in the current month. |
Monthly Reject Reasons Report | The bar graph displays the number of requests rejected grouped by the reason for rejection in the current month. |
The Benefit Eligibility process flow can be viewed as published using WebSphere Business Compass or as an inflight process that displays the services used and the sequence in which they are executed.
View the Benefit Eligibility Process on the following pages.
The artifacts, users, and roles used in the Solution Scenario can be viewed in the Benefit Eligibility Process page.
The details for the widgets displayed on the Benefit Eligibility Process page are given in the following table.
Widget | Description |
---|---|
Draft Artifacts | Navigate and view the artifacts used in the Solution Scenario. |
Publishing Server Access Control | Navigate and view the users and roles provided for the Solution Scenario. |
The details for the widgets displayed on the Benefit Eligibility Process Check page are given in the following table.
Widget | Description |
---|---|
Instances | The instances of the requests and responses created can be viewed in this widget. |
Diagrams | This dynamic process flow diagram displays the state of the transaction. Select an item from the Instances widget to view the run time transaction flow in this widget. |