Process of Referring Benefits Cases to Service Providers

This process assumes that the agency has already completed the following:

• Created the benefits case. The case record must have Benefit in the Category field and must have at least one contact.

• Approved the benefits case for eligibility.

• Created the benefit plan.

For more information about these tasks, see Siebel Public Sector Guide.

To refer a benefits case to a service provider, perform the following tasks:

1. "Creating Referral Orders for Benefits"

2. "Submitting Referral Orders"

3. "Accepting or Rejecting Referrals (Service Provider)"

4. "Managing Inventory for Accepted Referral Orders (Service Provider)"

5. "Checking the Status of Referrals"

Creating Referral Orders for Benefits

After deciding which service provider you want to use, you can place a referral order with that service provider that is based on one benefit that has been determined for the benefits case.

This task is a step in "Process of Referring Benefits Cases to Service Providers".

The status of the benefits case must be Active to create a referral order. You can create only one referral order for each benefit. If necessary, you can cancel it, and then create a new referral order.

If a benefit does not have a value of Product or Service in the Type field and does not have any value in the Product field and the Service Provider field, you cannot create a referral order for the benefit, and the Create Order button is disabled.

When you create a referral order for a benefit, Siebel Public Sector:

• Populates the Order number (#) field for the benefit.

• Adds the created referral order to the Orders view in the Plans view of the Cases screen, to the Orders view of the Service Providers screen, and to the List view of the Service Orders screen.

You can click the Cancel Order button (or change the Status field for the referral order to Cancelled) to cancel the referral order and clear the Order number (#) field. Also, the Benefit and Benefit Id fields under the Service Order will be cleared when you click the Cancel Order button. Cancelling a referral order does not delete it. If you want to delete a referral order, you must delete it from an Orders view or the Service Orders screen. For more information about creating referral orders, see Siebel Order Management Guide.

To create a referral order for a benefit  

1. Navigate to the Cases screen, then the Case List view.

2. Drill down on the Case Name field for the benefits case that you want.

3. Display the Plans view.

4. In the Benefit Plans list, select the benefit plan for which you want to create the referral order.

5. In the Benefits list, select the benefit in this plan for which you want to create the referral order.

6. In the selected benefit, complete the necessary fields, as described in the following table.

   Field	Description
   Benefit Name	The name must be entered for you to create an order.
   Product	The product provided by this benefit must be entered for you to create an order.
   Type	Select Service or Product. You must use one of these two types to create an order.
   Provider	Select the provider for this referral order. Click the Single Select button to display the Benefit Provider dialog box. If necessary, click the Query button in this dialog box to display a query form that lets you find providers with the required combination of attributes, such as Postal Code, Expertise, Language, Religions, Food, and Wheelchair Access.

   
   

7. If necessary, click Cancel Order to cancel an existing referral order before creating a new referral order.

   If there is already an open order, the Create Order button is disabled and the Cancel Order button is enabled. After you click Cancel Order, the Create Order button is enabled.

8. Click Create Order.

   
   

   Note: The status of the provider must be Active at the time you click Create Order.

   
   

   The Line Items view for the referral order appears in the Service Orders screen, the Type field is populated with a value of Referral Order, and other fields in the referral order are populated with values from the benefits case. A line item is added for the product specified in the Benefits list. The contact, product and provider in the Benefit record and the contact in the Order become read only; these fields become editable if the order is cancelled.

9. If necessary, add to or change information in the referral order.

   
   

   Note: Attribute values that you change in the referral order are not changed on the benefits case.

   
   

Submitting Referral Orders

This task is a step in "Process of Referring Benefits Cases to Service Providers".

After an agent creates a referral order for a benefit or a benefits case, the agent can submit referral order data to a procurement application and consequently fulfill the referral order. The procurement application returns fulfillment data, such as the status of the referral order, to Siebel Public Sector.

Note: To implement the functionality for submitting referral orders, administrators must integrate Siebel Public Sector with a procurement application. This integration allows the transfer of referral order data between Siebel Public Sector and the procurement application. For more information about integrating Siebel Public Sector Provider Portal with other applications, see "Integrating Siebel Public Sector Provider Portal with External Applications".

To submit a referral order  

1. Navigate to the Service Orders screen, then the Order Entry List view.

2. Drill down on the Order number (#) field for the referral order that you want to submit.

3. In the order form, click Submit.

   The Status field for the referral order changes from Pending to Submitted-Pending.

Accepting or Rejecting Referrals (Service Provider)

The referral order appears in the list of service orders on this provider's home page in Siebel Public Sector Provider Portal. The service provider can use Siebel Public Sector Provider Portal to accept the referral order, put the referral order on its waiting list, or reject the referral order.

If the referral order is put on a waiting list, the service provider can come back to the referral order later to accept or reject the referral order. For example, it can accept the referral order after the resource becomes available. However, the agency might assign the referral order to another service provider in the interim, and then this service provider would no longer have the opportunity to accept it.

This task is a step in "Process of Referring Benefits Cases to Service Providers".

To accept the order, put the order on a waiting list, or reject the order  

1. Log in to Siebel Public Sector Provider Portal.

2. On the home page, click the Order number (#) field of the new service order.

   The order form appears.

3. In the Status field, select Accepted, Rejected, or Waitlisted.

Managing Inventory for Accepted Referral Orders (Service Provider)

If the service provider has accepted the referral order, then it must also manage its inventory to indicate that this resource is no longer available. For example, if it has accepted a new foster child, it must manage its inventory to indicate that the asset representing this foster-child bed has been taken.

This task is a step in "Process of Referring Benefits Cases to Service Providers".

The agency adds items to the inventory list when the service provider agrees to provide this product to the agency. For more information, see "Adding Agreements with Service Providers". In Siebel Public Sector Provider Portal, the service provider indicates the availability of assets by changing the value in the Status field.

To manage inventory  

1. In Siebel Public Sector Provider Portal, navigate to the Assets screen, then the List view.

2. In the appropriate Asset record, in the Status field, select the value used to indicate that the asset is being used and is not available.

   This value depends on how the values in the picklist were configured in the setup task "Modifying Lists of Values for Managing Public Sector Providers".

Checking the Status of Referrals

After the service provider has had time to respond to the referral order, the case worker checks the referral order to see whether the service provider has accepted it. The initial status of the order is Submitted-Pending. The service provider acts on the order by changing the status to Accepted, Rejected, or Waitlisted.

If the service provider has rejected the referral order, the case worker refers it to another service provider. If the service provider has put the referral order on a waiting list, the case worker can either refer it to another service provider, or wait to see whether the service provider accepts the referral order.

This task is a step in "Process of Referring Benefits Cases to Service Providers".

To check the status of the referral  

1. Navigate to the Service Providers screen.

2. Drill down on the name of the service provider that you want.

3. Display the Orders view.

4. Look at the Status field of the referral order.

5. If necessary, cancel the referral order, and create a new referral order.

   See "Creating Referral Orders for Benefits". You must select Cancelled in the Status field for the old order before you create the new order.