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Manually Assigning Benefits to Cases


Instead of automatically assigning benefits to a case, an agent might temporarily manually assign benefits to the case because of emergency or other non-routine considerations. When you manually assign benefits to a case, you enter values in the fields for the plans, associated benefits, and benefit payments. An application that determines benefits does not populate these field values.

Later, you can automatically assign benefits to the case. For this assignment, administrators can configure Oracle Policy Automation to consider the data for the manual plans, associated benefits, and benefit payments or to ignore this data. When you reassign benefits to a case, the data for existing manual plans and associated benefits is archived in the Benefit History view, and not purged.

You can create (or update) a benefit plan only for cases that have a Status field that is not Closed or Inactive. To associate benefits with a benefit plan, the benefits case must have at least one contact.

After the agent assigns benefits to a case, the case can be automatically routed to a manager for review and approval. For more information about automatic approval routing, see Submitting Cases for Approval and Approving Cases in the Inbox.

This task is a step in Process of Managing Benefits for Cases.

To manually assign benefits to a case

  1. Navigate to the Cases screen, then the Case List view.
  2. Drill down on the Case Name field of the case to which you want to manually assign benefits.
  3. Navigate to the Plans view, then the Benefit Plans view.
  4. In the Benefit Plans list, create a new record, and complete the fields as appropriate.

    NOTE:  If you delete a plan record, then the associated records in the Benefits list and Payments list are also deleted, but the associated records in the Orders view (in the Plans view of the Cases screen) are not deleted. For these order records, the values in the Benefit field and the Benefit Id field are cleared.

    The following table describes some of the fields.

    Field
    Description

    Plan Name

    Displays the name of the primary contact for the benefits case, but you can change this value to another benefit plan name.

    Status

    Displays a status of Active for the benefit plan. Values include Pending, Approved, Active, Inactive, and Archived. After you click the Eligibility button to automatically create benefit plans, the Status field of those plans is Active. If you change the Status field of a benefit plan to Inactive, then the plan record, associated benefit records, and benefit payment records become read-only, but you can change the Status field of the benefit plan.

    Type

    Displays the type of benefit plan according the plan creation method as follows:

    • If you navigate to the Cases screen, then the Case List view, and click Screening in the Case form to create the plan, then this field value is Screening.
    • If you navigate to the Cases screen, then the Case List view, and click Eligibility in the Case form to create the plan, then this field value is Benefit Plan.
    • If you manually create the plan as described in this topic, then this field value is Benefit Plan.
    • If you navigate to the Cases screen, then the Case List view, drill down on the Case Name field of a case, navigate to the Plans view, then the Service Plans view, and click Create Benefit in the Activities list to create the plan, then this field value is Service Plan.

    You cannot change this field value.

    Program

    Select the name of the program for the benefit plan. You cannot select a value of Service Plan in this field. This value is automatically populated in this field the first time that you create a benefit for a service plan that is associated with the case. You cannot change this Service Plan value. For more information, see Creating Service Plans for Cases.

    Administrators set up programs in the Program Benefits Administration view of the Administration - Case screen. For more information, see Setting Up Benefits Programs and Setting Up Benefits for Service Plans.

    Created Date

    Displays the date and time that you create the benefit plan record.

    Effective Date

    Select the date and time that the benefit plan is in effect.

    Locked

    Displays no check in the check box when you manually create a plan. Displays a check in the check box when you automatically generate a plan. You cannot change this field. Automatically generated plans are locked so that users cannot change the predetermined information in those plans. However, users can change the Status field in locked plans.

    Expiration Date

    Select the date and time that the benefit plan is no longer in effect.

    Comments

    Type relevant information about the benefit plan.

  5. In the Benefits list, create new records for the plan, and complete the fields as appropriate.

    NOTE:  If you delete a benefit record, then the associated records in the Payments list are also deleted, but the associated records in the Orders view (in the Plans view of the Cases screen) are not deleted.

    The following table describes some of the fields.

    Field
    Description

    Benefit Name

    Select the name of the benefit in the program. You can select only benefits that are associated with the program. Administrators associate benefits with programs in the Program Benefits Administration view of the Administration - Case screen.

    Benefit Id

    Displays an automatically generated number that uniquely identifies the benefit.

    Product

    Displays the specific product or service for the benefit. You can change this field value even if you automatically assign benefits to cases. You can select a value in this field if the Type field in the Benefits list is Product or Service. Administrators associate products with benefits in the Program Benefits Administration view of the Administration - Case screen, but you can click the Show All button in the Pick a Product dialog box to select a product that is not associated with the benefit.

    To see the attributes that are associated with the selected product, select Attributes in the visibility filter that is below the Benefits list. Administrators associate attributes with products in the Administration - Product screen, but you can change the Value fields for attributes. For more information about products, see Siebel Product Administration Guide.

    Status

    Displays a status of Pending for the benefit. Values include Pending, Approved, In Progress, Inactive, Cancelled, and Completed. After you click the Eligibility button to automatically create benefits, the Status field of those benefits is Pending. You can update only benefits with a Status field value of Pending, Approved, In Progress, or Inactive.

    Amount

    Type the monetary amount of the benefit if the Type field in the Benefits list is Cash or Cash Equivalent. When you click the select button in this field, you can select a currency code and an exchange date for the amount.

    Frequency

    Select a denotation of how often the citizen receives the benefit. Values include Daily, Weekly, Monthly, and One-Time.

    Start Date

    Select the date and time that the benefit is in effect. This field value must be between the field value for the Effective Date field and the Expiration Date field of the associated benefit plan record.

    End Date

    Select the date and time that the benefit is no longer in effect. This field value must be between the field value for the Effective Date field and the Expiration Date field of the associated benefit plan record.

    Locked

    Displays no check in the check box when you manually assign a benefit to a plan. Displays a check in the check box when you automatically generate a plan. You cannot change this field. Automatically generated benefits are locked so that users cannot change the predetermined benefits in available plans. However, users can change the Status field in locked benefits.

    Unit of Measure

    Select the unit of measure for the value in the Qty field.

    Last Name

    Displays the last name of the primary contact for the benefits case, but you can change this value to the last name of the citizen who receives the benefit. You can select only the citizens who are associated with the benefits case. If multiple citizens are associated with the benefits case, and if each of these citizens receives this benefit, then create a separate benefit record for each citizen. You can drill down on this field and then click the Benefits view tab in the Contacts List to see all benefits for this citizen.

    First Name

    Displays the first name of the citizen who receives the benefit.

    Relationship to Primary Contact

    Select the relationship of the citizen who receives the benefit to the primary contact for the case. Values include Child and Spouse.

    Qty

    Type the number of items in the benefit if the Type field in the Benefits list is Product or Service.

    Type

    Select the type of benefit. Values include:

    • Cash. Benefits of this type include payments for disability insurance, unemployment insurance, and social security.
    • Cash Equivalent. Benefits of this type include food stamps and transportation vouchers.
    • Product. Benefits of this type include wheelchairs and other special equipment for disabled individuals.
    • Service. Benefits of this type include child care, job training, and drug or family counseling.

    Order #

    Displays an automatically generated number that uniquely identifies the referral order for a benefit that is a product or service. You can drill down on this field to see the Line Items view for the order in the Service Orders screen. If you delete or cancel the referral order, then this field is cleared. For more information about creating referral orders, see Siebel Partner Relationship Management Administration Guide.

    Provider

    Select the service provider, if any, that supplies the benefit. In the dialog box that appears when you click the select button in this field, you see all accounts with a Status field of Active. In the dialog box, the accounts for service providers have a check in the Service Provider field. You can designate field values to find an appropriate account.

    To see more information about a service provider, navigate to the Service Providers screen, and then the Service Provider List view.

  6. In the Payments list, create new records for each benefit, and complete the fields as appropriate.

    NOTE:  You normally create payment records only for benefits with a Type field of Cash or Cash Equivalent. To see the Payments list, select Payments in the visibility filter that is below the Benefits list.

    The following table describes some of the fields.

    Field
    Description

    Payment #

    Displays an automatically generated number that uniquely identifies the benefit payment.

    Payment Date

    Select the date that the benefit payment was made or will be made.

    Amount

    Type the monetary amount of the benefit payment.

    Payment Method

    Select the payment method for the benefit payment. Values include Cash, Check, Direct Deposit, and Wire Transfer.

    Type

    Select the type of payment. Values include Expense, Disbursement, Refund, and Reimbursement.

    Payee

    Displays the name of the citizen who receives the benefit payment. You can select only citizens who are associated with the benefits case.

    Status

    Displays a status of Pending for the benefit payment. Values include Pending, Approved, Rejected, Inactive, Cancelled, Submitted-Pending, Processed, Request Failed, and Paid. After you click the Eligibility button to automatically create payments, the Status field of those payments is Pending. Payments with a Status field of Processed or Paid are read-only.

    Locked

    Displays no check in the check box when you manually assign a payment to a benefit. Displays a check in the check box when you automatically generate a plan. You cannot change this field. Automatically generated benefit payments are locked so that users cannot change the predetermined payments for available benefits. However, users can change the Status field, Payment Method field, and Comments field in locked payments.

    Payment Profile Name

    Select a payment profile for the benefit payment. This profile identifies the bank, branch, and account number for the benefit payment. You can select a value in this field only if you select a value of Direct Deposit or Wire Transfer in the Payment Method field. Only payee payment profiles with a value of Active in Profile Status field are available for selection in this field. For more information, see Setting Up Payment Profiles.

    Comments

    Type relevant information about the benefit payment.

  7. To see the attributes for a product in a benefit, select the benefit in the Benefits list, and then select Attributes in the visibility filter that is below the Benefits list.

    You cannot delete these attributes.

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