Case Management

Question 1

Case

Answer 1

Case = interaction between participant and SPM org.
Contains information on participants who want to receive the benefit or service, information on others involved, evidence, eligibility decision information, financial transactions, comms, notes, events.
Case triggers sequential chain of events/case lifecycle

Question 2

Case Types

Answer 2

Differ by when and where they are used in the case lifecycle
7 types are:
Screening
Assessment
Application
Integrated
Product Delivery
Issue
Investigation

Question 3

Screening Case

Answer 3

First-level, used to handle and store several program specific assessment cases.
Evidence for multiple assessments can be entered at this level.
Can get evaluation of eligibility for multiple programs

Question 4

Assessment Case

Answer 4

Determine potential eligibility for a benefit or service
Can determine potential eligibility for an individual program without creating a Product Delivery Case
Each case represents a program/product
Each case has a rule set assigned to it, to determine eligibility

Question 5

Application Case

Answer 5

Captures Client’s initial application for benefits and services, such as household members, evidence
Usually includes: Client applying, evidence required, and information relating to application (date etc)
Can be created online via online application
Contains any programs client is applying to
After eligibility check, case can trigger creation of Integrated case and one or more Product Delivery Cases

Question 6

Integrated Case

Answer 6

Like a screening case, as acts as container for consolidating information
Used to consolidate case information for one + participants
Used as a folder to store and manage multiple cases of any type for one or more members of a household/family
Once created has the status of open. Lifecycle incl. Open and Closed
Each case in Integrated Case has its own Lifecycle

Question 7

Product Delivery Case

Answer 7

Determines whether participant meets actual eligibility criteria for single benefit/liability product
Contains functions needed to manage delivery of product
Each PDC has rule set assigned to it, to determine actual eligibility
Eligibility determination usually results in benefit or bill being delivered
Benefits delivered to persons in ongoing monetary payment
Liabilities delivered in form of a bill

Question 8

Issue Case

Answer 8

Used to capture and manage differences in evidence & info received from participant/3rd party
E.g. reason for leaving different from employers
In ongoing case maintenance, supply info to org to aid reassess of eligibility.
Issue types are templates on which issue cases are based. Usually named for type of evidence collected
Issue Resolutions - mark end point or decision at conclusion of issue. “Agree with Client” “Agree with Employer”
Issue Resolution Approval Checks - can configure issue cases to manual or auto approval

Question 9

Investigation Case

Answer 9

Inquires into circumstances of allegation/incident
e.g. child abuse, fraud
Can record all relevant details that concern any type of investigation
Info recorded: interviews, assessments, notes, comms
Provide org with info to complete findings, record decision, and resolve
Features/Functionality: allegations, findings (founded/unfounded), resolutions, action plans, milestones, contacts, translation requirements, history

Question 10

Workflow of Delivering a Benefit

Answer 10

1. Submit Application Form (Client/ Caseworker submits)
2. Check for Eligibility (Application cases checked & authorized)
3. Cases Created if Eligible (creates Integrated & PDC)
4. Submit Additional Evidence
5. Submit PDC for Approval
6. Activate PDC
7. Issue the Payment

Question 11

Case User Roles

Answer 11

• Case Owner = responsible for case info and maintenance, can be any of the following org objects (user, position, org unit or work queue).
• Case Supervisor = responsible for reviewing and approving cases that are submitted for approval.
• Case Reviewer = responsible for periodic review of PDC’s.
• When you create a case, SPM automatically assigns a Case Owner, default is the same user who registered the first participant added to the case, namely the Primary Case Participant. Same for all case types except for Issue Cases.
• An Admin can associate a case type with a case-ownership strategy process. When a case is being created, if a case-ownership strategy workflow process is associated with the case type, the initial case owner is determined by using the workflow process. If not, the sample out-of-the-box algorithm is used.
• A Supervisor Role can be assigned to a case manually or automatically, so they can action approval requests for the case. The reporting hierarchy in the org. structure determines the automatic assignment of a Supervisor, which is set up in the SPM Administration Manager. A supervisor is dynamically assigned only when an action requiring Supervisor intervention on a task/notification is performed on the case.
• The Case Reviewer Role is responsible for performing periodic reviews on a PDC. Case reviews can be set manually as a case event or scheduled at a regular frequency, as determined in Product Administration. By default, the Case Reviewer is the same as the Case Owner.

Question 12

Case Tabs & Sections

Answer 12

• Home-Case Details –display summary details about a case, e.g. creation/start dates, objectives, status of the case. CaseHeader is the name of the data model entity (database table) that stores high-level info about a case.
• Participants–all those who play a role in the case e.g. other household members are a Case Member in an application group.
• Contact–contain details of user-entered notes, attachments, records of meeting minutes, records of communications.
• Events (calendar)–individual milestone of significance to a case, system can automatically create events as a result of case processing or manually created by a user. Case closure event is an example of an event that the system creates. Can manually create these events; meetings, reviews, referrals and activities.
• Tasks–an instruction to carry out an item of work, user manually creates tasks or system can auto create tasks. Tasks that relate to a case can be viewed and maintained from the case task list.
• Issues and Proceedings –can include issue cases with evidence, investigation cases into allegations, appeal cases of cases or determinations, legal actions by courts, and special cautions or warnings about participants.
• Administration–this tab provides links to information on related cases, transaction history, and user roles for the case.

Question 13

Specific Case Tabs & Sections

Integrated Case Specific Elements:

Answer 13

• Evidence –the PDC within the Integrated Case uses evidence associated with the Integrated Case.
• Services –lists all service records on the specified case, provides links to view and edit these records.
• Referrals –List including the clients that were referred, the provider they were referred to, who referred them and the referral date.
• Outcome Plans –Used to manage activities designed to address the client’s circumstances, to achieve a specific goal, e.g. self-sufficiency.

Question 14

Specific Case Tabs & Sections

Product Delivery Case Specific Elements:

Answer 14

•Determinations –contains one or more decisions defining the client’s eligibility and entitlement for one or more components within a product.
•Financials
–Transactions are the payments and bills issued for eligible and active PDCs.
–Certifications are the eligibility periods for products.–Deductions are money subtracted from benefit payments.–Components represent the various categories of payment for a product.
–Delivery Patterns consist of delivery method (cash, EFT) and delivery frequency (weekly, monthly) of payments.
–Nominees are the recipients of benefit payments.–Over and Under Payments if too much or too little is paid out on the case.
–Payment simulations show all payments and deductions due to a participant for a specific date before the payment is issued.

Question 15

Application Case Lifecycle

Answer 15

Each stage has a Case Status, indicating the stage and deciding which stage it moves to next
•Only applications with a status of In Progress or Submit Failed can move into a state of Submitting.
•A case status history is maintained for an Application Case throughout its lifecycle.
stages:
•Creation
•Approval
•Cancellation
•Determination
•Disposal

Question 16

Application case stage statuses

Answer 16

Statuses:
•In Progress
•Submitting
•Submit Failed
•Submitted 
•Cancelled
•Ready  for Determination
•Disposed

Question 17

Product Delivery Case Lifecycle & Statuses

Answer 17

Lifecycle
•Creation
•Approval 
•Activation
•Suspension 
•Closure
•Reactivation

Statuses
•Open
•Submitted
•Approved
•Active 
•Suspended
•Pending  Closure
•Closed
•Delayed  Process Pending

Question 18

Product Delivery Case Lifecycle background

Answer 18

• When you first create a PDC its status is Open.
• If it is between case processes its status is Delayed Process Pending. If this status appears, refresh the screen and the expected status should then appear.
• Case status indicates the current stage in the lifecycle or stage(s) it can progress to next, e.g. you must approve an Open case before you can activate it.
• A case status history is maintained for a Product Delivery Case throughout its lifecycle.

Question 19

Product Delivery Case Nominees

Answer 19

• A nominee is a participant (usually primary client) receives payments or bills from the organization. A case can have multiple nominees.
• Nominee is assigned to a case component, which is usually a financial objective in PDC’s. A case can have multiple components and you can assign more than one component to a nominee.
• Default case nominee for all case components is the primary client.
• Case components for PDCs are units of entitlement (typically financial) which are available with a benefit, e.g. head-of-household component and child dependent are units of financial entitlement with a benefit case.
• Component assignment history is maintained for each case component, tracking the nominees assigned to one component over time.
• Although the primary client is the default nominee, a case participant other than the primary client can be nominated to receive benefits for a case component, e.g. a person’s employer can be nominated to receive a person’s benefit.
• Nominee delivery patterns are used to create financial schedules for each case component. A nominee can have the same or a different delivery pattern for each of the components.

Question 20

Products Delivery Case Closure types

Answer 20

1. system can automatically close a PDC when its certification period expires or if it is found to be ineligible
2. manually at any point in its lifecycle or set it to close on a specific future date

Question 21

What happens when a Product Cases closes?

Answer 21

1. all associated info. and events such as Case Reviews and Case Referrals are closed, and a case communication is generated for the primary client
2. A case communication is a correspondence to or from the organization that is created within a case.
3. You can create more case closure communications for other case participants, such as a service supplier on a case referral

Question 22

Product Delivery Case Reactivation

Answer 22

• Can reactivate cases with a status of Closed or Pending closure, the status of reactivated case is Open.
• To deliver benefits on the case it must go through the Approval and Activation stages again.
• Cases with a status of Closed or Pending Closure can be reactivated, e.g. a person’s benefits might be discontinued once the person is in regular employment.
• If that person is laid off from the new employer and is once again eligible for benefits, the existing PDC can be reactivated.

Question 23

Product Delivery Case Reassessment

Answer 23

• Case reassessment reevaluates payments or bills when there is a change in circumstance (evidence) on a PDC.
• The system compares the existing set of decisions for a specific period with a new set generated by the evidence changes, if the decision sets are unequal, reassessment compares what was paid and calculates an overpayment or underpayment amount.
• The system automatically creates a payment correction case which links it to the PDC that triggered the original overpayment or underpayment.
• Validations prevent a caseworker from activating or initiating manual reassessment, while reassessment is already in progressfor that case. Info. messages provide the caseworker with more reassessment status info. about a case. On the Current Determination page a new message displays to indicate when the case was last reassessed, even if it did not result in the creation of a new determination.
• The system can also display informational messages to notify the caseworker if a reassessment is in progress for the case and when it started, if a reassessment due to changes is queued for processing and when it was queued, or if a reassessment has failed and been deferred to batch processing when this event occurred

Question 24

What events can trigger a PDC reassessment?

Answer 24

1. Change or addition of evidence or certification period, also known as a “change in circumstance” event
2. Closure of the PDC
3. Manual reassessment by the caseworker

Question 25

What are the two types of PDC?

Answer 25

1. benefits(money or services are being distributed from the agency to the client) 2. liabilities(money is being collected from the client).

Question 26

Who performs PDC administration?

Answer 26

A systems administration NOT a caseworker

Question 27

Product Delivery Case Administration

Answer 27

Product administration includes the maintenance of benefit and liability products, as well as the delivery methods for these products. •Certain info. can be maintained for both product types. •Other info is benefit or liability specific.

Question 28

Common info on Benefits & Liabilities: HOME

Answer 28

Details: •general case info, including start dates and status. •Processing: includes info about adjustments, over/under payment processing, and certification. •Participants: details which participant types might receive the product. •Security: lists the security identifiers required to work with the product.

Question 29

Common info on Benefits & Liabilities: Approval Checks

Answer 29

* Case: percentage and financial amount thresholds. | * Evidence:type and percentage thresholds.

Question 30

Common info on Benefits & Liabilities: Evidence Types

Answer 30

•Detailed listing of evidence records that a product uses to determine eligibility.

Question 31

Common info on Benefits & Liabilities: Financial

Answer 31

* Patterns: defines delivery methods (EFT, cash) and delivery frequencies (weekly, monthly) available for use. * Provision: lists the product providers that can provide the benefit.

Question 32

Common info on Benefits & Liabilities: Ongoing Case Management

Answer 32

* Time Constraints: time limits applied to certain aspects of product processing. * Absence Reasons: used to define the acceptable absence reasons applicable to a particular program, such as Food Stamps, e.g. an absence reason of “family bereavement” can be an acceptable reason for a client to be absent from a scheduled on-the-job training activity that they are required to attend for one program, but not for another.

Question 33

Common info on Benefits & Liabilities: Rule Sets

Answer 33

•The rule set the product uses to determine eligibility and entitlement.

Question 34

Creating PDC’s on Administration Side

Answer 34

* Before can create a case in SPM, need to set up categories of case info., for all case types, as part of system administration. E.g. all PDCs are created from a product, which can be benefit or liability. In effect, products are the templates which individual PDC’s are based. * The screen that is displayed contains a wizard that can use to define settings for a benefit product, including name and start date. * Once a caseworker creates individual PDC that is based on this benefit product, inherits the information defined here. This info. Can be customized on a per-case basis, but most settings should be retained. * The data entered on this page has significant impact on the eligibility determination for individual cases that are based on this benefit product, and the successful delivery of it. * In the same way, Administrators must define settings for the other case types before individual cases of these types can be created in the application.