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Calculating Benefits Eligibility
To determine an applicant's eligibility for services, the field agent typically asks the applicant a series of scripted questions and records the answers. Assessment information can be collected using Assessments, Oracle's Siebel SmartScript or Oracle's Siebel eAdvisor. These tools capture assessment data that is then used to match an applicant with one or more benefit fulfillment programs. In instances where the rules governing benefits delivery are highly complex, integration to back-office calculation systems or eligibility determination systems is required.
The final eligibility determination is made by a qualified field agent or manager who completes the evaluation based on program rules. The benefits determination also can be made using either the Siebel Business Rules Processor to integrate with existing legacy rules systems that determine benefits.
To perform assessments and determine benefits eligibility, you can employ the methods described in the following topics: