This section describes how fixed processing by the Engine and product-specific processing combine to calculate and display eligibility/entitlement results.
The calculation and display of a determination involves a mixture of:
- fixed processing contributed by the Engine; and
- custom product-specific processing contributed by you (i.e. the implementation of your product).
The Engine follows the following high-level steps to arrive at eligibility and entitlement data that can be displayed to a case worker:
- At Determination Calculation time:
- An action occurs which triggers the determination of a case (either an active or reactive determination);
- The Engine identifies the product periods (configured for the product) that cover the case's lifetime;
- The Engine uses CER rules (specific to the product) to calculate the eligibility and entitlement for each contributing product period;
- The Engine calculates the eligibility and entitlement across the lifetime of the case by "splicing together" the eligibility and entitlement from each contributing product period;
- The Engine calculates the eligibility and entitlement across the lifetime of the case by "splicing together" the eligibility and entitlement from each contributing product period;
- The Engine stores (on the database) a determination result containing the eligibility and entitlement data (as well as key decision factors and decision details, covered elsewhere in this document).
- At Determination View time:
- A case worker requests to view a determination on a case;
- The Engine retrieves the determination result from the database and identifies its coverage periods; and
- The Engine lists the coverage periods for the case, and uses the decision summary display strategy configured for the product to produce a summary of the entitlement for each coverage period.
The data interfaces and implementation for calculation of eligibility/entitlement, and subsequent display of eligibility/entitlement data are described in more detail below.