Eligibility Engine

Eligibility Engine

Case management is “a collaborative process of assessment, planning, facilitation, care coordination, and evaluation for options and services to meet an individual’s and family’s comprehensive health needs and promote quality, cost-effective outcomes” (CMSA). But with the unique circumstances of each individual and the variety of programs available, this process can get complicated. How can you identify the best options for each person and ensure that people – not programs – are at the center of your interventions?

Identify a Participant’s Eligibility

Eligibility rules are commonly utilized throughout health and human service programs to identify a participant’s eligibility for different types of resources. Eligibility rules use screening criteria to simplify matching the right resources with the right individuals, prioritizes and targets resources, and facilitates coordinating communication with various stakeholders.

Simplify the Process

ClientTrack’s Eligibility Engine is a comprehensive design tool intended to simplify the process of setting up and managing simple or complex eligibility rules. The Eligibility Engine allows for the set-up of eligibility criteria rules that can be associated with programs, grants, services and/or referrals. ClientTrack can then dynamically evaluate a client, based on these rule sets, to determine additional program and service fits for the client. This Eligibility Engine empowers key project staff with:

  • Eligibility Screens – ClientTrack comes with eligibility screens that are designed to pull up program and service eligibility for all programs or services that have eligibility rules applied. This provides a quick snapshot of the client’s eligibility for all agency programs and services. This can also be utilized for outbound referrals to partner agencies.
  • Multiple Eligibility Paths – Users can create simple eligibility rule-sets by including all rules in the prerequisite path. Complex eligibility rule-sets may include one or more paths to achieving eligibility.
  • Eligibility Path Designer – Users can create one or more rules for each path. Rules include a comparison of some data against some criteria. Users can create friendly rule descriptions to describe what the rule is doing (e.g. “Federal Poverty Level Below 80%”).

Contact Us