xRM Formula #159 - US Dept. of Veterans Affairs: Health Benefits Priority Groups
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Scenario Overview
Today’s Veterans have a comprehensive medical benefits package, which VA administers through an annual patient enrollment system. The enrollment system is based on priority groups to ensure health care benefits are readily available to all enrolled Veterans.
This example shows how to evaluate which Medical Priority Group a Veteran would belong to using the multi-sheet Decision Table capabilities of North52's business rules engine for Microsoft Dynamics 365.
The documentation for these requirements can be found on the VA website:
To be eligible you must fit into one of the following categories:
Veterans awarded special eligibility classification under Title 38, U.S.C., § 1151,
"benefits for individuals disabled by treatment or vocational rehabilitation"
Veterans who served in the Republic of Vietnam between January 9, 1962 and May 7, 1975
Veterans of the Persian Gulf War who served between August 2, 1990 and November 11, 1998
Veterans who served on active duty at Camp Lejeune for at least 30 days between August 1, 1953 and
December 31, 1987
Veterans who served in a theater of combat operations after November 11, 1998 as follows:
Currently enrolled Veterans and new enrollees who were discharged from active duty on or
after January 28, 2003, are eligible for the enhanced benefits for five years post discharge.
Combat Veterans who were discharged between January 2009 and January 2011, and did not enroll
in the VA health care during their five-year period of eligibility have an
additional one year to enroll and receive care.
The additional one-year eligibility period began February 12, 2015 with the signing of
the Clay Hunt Suicide Prevention for America Veterans Act.
Veterans with gross household income above the VA and the geographically-adjusted income limits for
their resident location and who agrees to pay copays
North52 Decision Suite Solution
The North52 Decision Suite solution works like this:
A Formula of type Save - Perform Action is created on the Contact entity
The Source Properties are set to the fields used by the Multi-Sheet Decision Table
The Event is set to Create & Update
Exit this Decision Table on First Match is turned On on all Decision Tables
Exit All Decision Tables on First Match is turned On on all Decision Tables
Multi-Sheet Decision Table
Priority Group 1
Priority Group 2
Priority Group 3
Priority Group 4
Priority Group 5
Priority Group 6
Priority Group 7 & 8
Note: In this example the Dynamics 365 system doesn't store all the data and instead lifts it from other systems via web service calls etc. This way the Decision Table is able to execute without the need to store vast amounts of data within the Dynamics CRM system itself.
This example uses publicly available information on the owners website and has not been endorsed by the owner of the information.
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North52 Decision Suite lets you:
North52 Decision Suite enables you to:
Author business rules to define automated decisions using industry-leading approaches
Measure and maximize decision quality using decision analytics
Deploy, progress and optimize decisions that drive your ongoing business operations
