When a case is approved, activated, reassessed and/or eligibility is checked, eligibility decisions are generated based on the application of pre-defined rules to a client's real-world information. See Checking Eligibility for Active and In Edit Evidence for information on checking eligibility. Each decision generated indicates whether a person is eligible or ineligible and displays the person's benefit entitlement over a period of time. Each benefit entitlement consists of the financial and/or non financial results generated when eligibility is checked.
To aid case workers in understanding the eligibility results, the application provides a number of decision views. Each view gives a case worker a different level of information that describes how eligibility and entitlement decisions were reached.
The main purpose of decision views is to provide clarity on why a person is or is not entitled to benefits and to help case workers to understand how the system arrived at that eligibility result. For example, a client may be deemed ineligible for benefits, because he or she mixed up day and month on his or her benefit application. Decision views provide a level of clarity to the process of eligibility and entitlement determination. Providing case workers with visibility on why the person is or is not entitled reduces the likelihood of benefit fraud and also allows case workers to give clients a clear picture of their eligibility and entitlement results thus enabling case workers to do their jobs more effectively.
Each decision includes the client's total entitlement amount. The agency can configure in what frequency the entitlement amount is to be displayed, i.e., monthly, daily, or weekly. For example, the agency may wish to display entitlement amounts in a weekly format of $70 per week instead of a daily format of $10 per day. The frequency at which the entitlement amount is displayed is defined when a product is configured during administration.
A number of views are provided that allow case workers to understand the decisions made over the lifetime of the case. For example, a graphical view includes key decision factors that have influenced eligibility decisions. Key decision factors help case workers to understand how a client's real-world information impacts their eligibility and entitlement by providing an understandable explanation of the determination results. For example, if a client receiving single mother benefits reports a significant life event such as a marriage, that client may no longer be eligible to receive single mother benefits.
The following are examples of key decision factors: "Susan Smith got married", "head of the household moved out", "Susan Smith turned 19". This allows the agency to determine what a rule means in the real world and provide an explanation of the rule that the case worker and client can both understand. For information on configuring key decision factors, see Viewing Decisions over the Lifetime of a Case.
The decision details view of an individual decision provides a user-friendly explanation of how the decision was reached. The information displayed to the case worker can be grouped into categories and the information displayed on a number of different tabs e.g., a Household Information tab might display detailed information on the composition of the household and a Medical Expense tab detailed information on the family's medical expenses. The agency can configure the categories of information and the order that the decision information on each tab is displayed as part of the application administration.
Note that the agency must develop the rules used for determining eligibility and entitlement, displaying decisions, and displaying explanations. For more information, see Defining Rules and Assigning Them to Products.