Benefits

This chapter describes the calculation of benefits. The benefits flow is schematically depicted by the following flow chart. Note that the pend reasons that are specified in decision point 'All reasons resolved?' are pend reasons with indicator 'Adjudication Only' set to false.

The majority of steps in the benefits flow are executed per line. However, during several points in this flow, the lines are aggregated back to claim level. Such an aggregation point implies that a line must wait for all other lines to reach the aggregation point (within the same claim) before it can continue to the next step in the flow. This addresses the fact that the sequence in which lines are processed is arbitrary while it could very well have an impact on how a line is processed. This is especially important in the context of adjudication case recognition