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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 set up a Multi-Sheet Decision Table to evaluate which Medical Priority Group a Veteran would belong to.

The documentation for these requirements can be found here.

To be eligible you must fit into one of the following categories:

Priority Group 1:
Priority Group 2:
Priority Group 3:
  • Veterans who are Former Prisoners of War (POWs)
  • Veterans awarded a Purple Heart medal
  • Veterans whose discharge was for a disability that was incurred or aggravated in the line of duty
  • Veterans with VA-rated service-connected disabilities 10% or 20% disabling
  • Veterans awarded special eligibility classification under Title 38, U.S.C., § 1151,
    "benefits for individuals disabled by treatment or vocational rehabilitation"
  • Veterans awarded the Medal Of Honor (MOH)
Priority Group 4:
  • Veterans who are receiving aid and attendance or housebound benefits from VA
  • Veterans who have been determined by VA to be catastrophically disabled
Priority Group 5:
  • Nonservice-connected Veterans and noncompensable service-connected Veterans rated 0% disabled
    by VA with annual income below the VA’s and geographically
    (based on your resident zip code) adjusted income limits
  • Veterans receiving VA pension benefits
  • Veterans eligible for Medicaid programs
Priority Group 6: 
  • Compensable 0% service-connected Veterans
  • Veterans exposed to Ionizing Radiation during atmospheric testing or during the
    occupation of Hiroshima and Nagasaki
  • Project 112/SHAD participants
  • 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.
Priority Group 7:
Priority Group 8:


 

N52 Formula Manager Solution

The Formula Manager 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 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 1 : 

      In this example the CRM 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 CRM system itself.