The Determination Service

Determination takes information gathered in the Cúram system as part of intake, and applies it against enterprise-specific and program-specific rules to create eligibility decisions. Determination is different for each program. It requires a ruleset that has been defined to evaluate a participant's eligibility for benefit from a particular product.

Determination is a full eligibility test. It requires a full set of business rules and the set of data on which these rules operate. The outcome of running these business rules is that the client has either been submitted for eligibility testing or failed during the submittal process.

At minimum, the following information is needed for determination.

• Configuration data covering the product and its associated set of business rules to define eligibility for this product must exist in the Cúram system.
• The participant must exist in the Cúram system. This can be achieved using the Register Person service.
• The case must exist in the Cúram system. This can be achieved using the Claim Intake service.
• All evidence used in determination must exist in the Cúram system, and be available for the case. This can be achieved using a combination of the Evidence maintenance services.
• The decisions created by determination will be stored in the Cúram system, but only the submitted for approval verification will be returned to the calling service.