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Assessing Benefits Eligibility

To determine a citizen's eligibility for benefits, the agent can ask the citizen a series of scripted questions and record the answers. Agents can collect assessment information using Oracle's Siebel SmartScript and the Assessments view of Siebel Public Sector. These tools capture assessment data that is then used to match a citizen with one or more benefit plans. When the rules governing benefits delivery are highly complex, you can integrate Siebel Public Sector with back-office calculation applications or eligibility determination applications.

A qualified agent or manager, who has knowledge of program rules, completes an evaluation to determine benefits eligibility for a citizen. To determine benefits, you can integrate the Siebel Business Rules Processor with existing legacy applications that determine benefits.

To assess benefits eligibility, perform the following tasks:

• Using Siebel SmartScript to Gather Benefits Assessment Information
• Using Templates to Assess Benefits

This task is a step in Roadmap for Managing Benefits Cases.

Using Siebel SmartScript to Gather Benefits Assessment Information

The process of assessing eligibility can begin with an electronic document or form that you create using Siebel SmartScript. The form includes input fields that you use to collect information from citizens. These fields include yes or no answers to questions, multiple choice answers to questions, structured numeric entry, and text entry. Using the entered information, the form logically presents options (branching logic) so that you can gather additional information. For more information about creating and implementing SmartScripts, see Siebel SmartScript Administration Guide. For information about configuring and activating SmartScripts, see Using Siebel Tools.

To use SmartScript to gather benefits assessment information

1. Navigate to the SmartScripts screen, then the SmartScripts view.
2. Drill down on the Name field of the Smartscript that applies to the assessment.
3. In the SmartScript session, read the question to the citizen and record the appropriate answer.
4. At the conclusion of each question, click Next.
5. After completing all the questions, click Finish to end the SmartScript session.

   The responses to the questions are captured and stored with the citizen's Service Request or Case record.

Using Templates to Assess Benefits

A manager can assign assessment activities to agents on a case team. An activity plan specifies the list of activities or the business processes that agents working on a case must complete. The activity plan for a case might include an assessment activity to determine whether the benefits application is complete. The agent assigned to the activity can use a predefined assessment template to complete the activity.

Administrators set up activity plans with associated activities using the Activity Templates view of the Administration - Data screen, and set up assessment templates with associated attributes using the Sales Assessment Templates view of the Administration - Data screen. For information about creating and using activity and assessment templates, see Siebel Applications Administration Guide.

An assessment consists of a set of questions that you can ask to evaluate a case. For example, assessments might include the following questions:

• Does the application meet the basic criteria for acceptance?
• Did the citizen provide sufficient evidence to support receiving benefits?
• Do you need additional evaluations?
• Has the case reached a point of closure?

The agent assigned to an assessment activity begins the activity by opening the case record and associating a predefined assessment template with the case using the Assessments view. For information about completing assessments, see Assessing Child-Welfare Incidents.

For those assessments that are more complex, or that require data on a specific form, the agent can create a report and attach the report and supporting documentation to the case record. The agent conducting an assessment of the citizen's information might verify employment and household information, assets and liabilities, and medical diagnoses. A personal interview with the citizen might be necessary.