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"Eligibility Management"

Table of Contents

Introduction: Introduction: Introduction to Eligibility Management
Framework: Using This Artifact as an "Eligibility Management Framework"
Glossary of Related Terms: The "Eligibility Management Glossary"
Capabilities: Eligibility Management as an Enterprise Capability
Ownership: Clearly Defined Eligibility Management Ownership is Critical for Success
Verbs and Actions: Understanding Why Verbs and Actions are Important to Eligibility Management
Roles: Key Verb and Action Driven Roles For Eligibility Management
Taxonomy: Understanding Eligibility Management Classifications or Categorizations
Life Cycle (Lifecycle): Data Lifecycle Phases for Eligibility Management
Metrics: Eligibility Management Metrics
Services: Eligibility Management as a Set of Services (a.k.a. Eligibility Management Services)
Principles & Best Practices: Common Principles and Best Practices for Eligibility Management
Further Reading and Reference Material for Eligibility Management

Introduction: Introduction to Eligibility Management

This document represents an aggregated, ordered and contextualized view of the material we've been able to compile and publish that is related to the topic of "Eligibility Management." The goal is to make this page a landing and launch point for all things related to this topic. As our content becomes more complete and more accurate, this page should become a very useful and powerful knowledge base for this topic and all parties interested in it.

You'll find that the content for this document is consistent with that of other discipline related documents. This is intentional. The consistency is based on a knowledge pattern that helps individuals learn more about different topics, quicker and more efficiently. We hope you find the material useful and easy to learn.

It's important to realize that content in this document and any related sub-documents are constantly evolving. Therefore, we recommend you check for updates, regularly, to keep up with the latest material.

The Foundation always welcomes your feedback and suggestions for improvement, as we're always looking for ways to improve our solutions and offerings to the general community.

All solutions published by the Foundation are subject to the terms and conditions of the Foundation's Master Agreement.

Framework: Using This Artifact as an "Eligibility Management Framework"

This document or artifact, along with everything in it, is intended to act as a "Framework" that addresses various aspects of Eligibility Management.

The readers will notice that most sections in the Table of Contents (TOC) use a format where the TOC entry is prefixed with a topic name, followed by a short descriptive title (i.e. "TOPIC_NAME: TOPIC_RELATED_SECTION_TITLE"). This is intentional and represents a format by which the Foundation may achieve things like the identification of appropriate topic areas, the segregation of distinct topic areas from each other, the appropriate ordering of topic areas, and achieve the maintenance of consistency, both, within and across different IT Disciplines.

To elaborate, this artifact is intended to:

1. Organize different areas of the discipline known as Eligibility Management into clear and compartmentalized areas that allow the Foundation to more effectively and productively collect, document and publish information that pertains to this discipline.
2. Decompose each area of Eligibility Management into smaller and, therefore, more digestible units for more efficient learning and understanding.
3. Document common industry wisdom about each area, piece or subcomponent of Eligibility Management
4. Act as a set of Eligibility Management related best practices and guidelines that have been collected, documented, and published for the benefit of IT Professionals, regardless of their specific industry, line of business, or area of expertise.
5. Act as a consistent and repeatable pattern for documenting, publishing and learning, both, within this Discipline and across "all" Disciplines.

From the Foundation's perspective, if done correctly, all of the above will allow the Foundation to properly decompose, document and publish content related to each sub-area or sub-topic for each IT Discipline, including this specific discipline (i.e. "Eligibility Management").

From the reader's perspective, if done correctly, all of the above will allow him or her to easily find and learn about specific areas of interest associated with this and all other IT Disciplines in a manner where the reader may effectively consume and digest material in small atomic segments that act as repeatable and more effective learning units.

As this artifact evolves and progresses, the reader will see it address key areas of the professional IT Discipline "Eligibility Management" that range from its detailed definition through closely related terms, phrases and their definitions, to its detailed specification of Eligibility Management Capabilities, and all the way through to defining, delivering, operating and supporting Eligibility Management Services.

As mentioned previously, this document will continue to evolve and the Foundation recommends the reader check back, regularly, to stay abreast of modifications and new developments. It is also important to understand that the structure of this artifact may change to meet the needs of such evolution.

Glossary of Related Terms: The "Eligibility Management Glossary"

Language between IT professionals and the businesses we serve is often a significant barrier to success, as we often spend countless hours trying to interpret each other's meanings. This is often also true between IT professionals who are taught to use certain terms and definitions as part of the organizations and industries they serve. It's when you start to jump from organization to organization, from enterprise to enterprise, and from industry to industry that you realize how much time and effort is wasted on just getting language and meanings correct. For these reasons, the Foundation puts a great deal of focus on terms and phrases, as well as their corresponding definitions. We highly recommend you spend time learning and understanding all of the related terms and phrases, along with their meanings, for all areas of "Eligibility Management."

Eligibility Management Glossary

Centralized Eligibility Management	Eligibility Management Program
Decentralized Eligibility Management	Eligibility Management Project
Eligibility	Eligibility Management Reference Architecture
Eligibility Automation	Eligibility Management Release
Eligibility Capacity Management	Eligibility Management Report
Eligibility Catalog	Eligibility Management Reporting
Eligibility Catalogue	Eligibility Management Roadmap
Eligibility Configuration	Eligibility Management Role
Eligibility Configuration Item	Eligibility Management Schedule
Eligibility Configuration Management	Eligibility Management Security
Eligibility Cost	Eligibility Management Service
Eligibility Data Entity	Eligibility Management Service Assurance
Eligibility Database	Eligibility Management Service Contract
Eligibility Decommission	Eligibility Management Service Level Agreement (SLA)
Eligibility Delivery	Eligibility Management Service Level Objective (SLO)
Eligibility Dependency	Eligibility Management Service Level Requirement (SLR)
Eligibility Deployment	Eligibility Management Service Level Target (SLT)
Eligibility Document	Eligibility Management Service Provider
Eligibility Document Management	Eligibility Management Service Request
Eligibility File Plan	Eligibility Management Software
Eligibility Framework	Eligibility Management Solution
Eligibility Governance	Eligibility Management Stakeholder
Eligibility History	Eligibility Management Standard
Eligibility Identifier	Eligibility Management Strategy
Eligibility Inventory	Eligibility Management Supply
Eligibility Item	Eligibility Management Support
Eligibility Lifecycle	Eligibility Management System
Eligibility Lifecycle Management	Eligibility Management Theory
Eligibility Management	Eligibility Management Training
Eligibility Management Application	Eligibility Management Vision
Eligibility Management Best Practice	Eligibility Management Workflow
Eligibility Management Capability	Eligibility Metadata
Eligibility Management Center of Excellence	Eligibility Migration
Eligibility Management Certification	Eligibility Plan
Eligibility Management Class	Eligibility Portfolio
Eligibility Management Community of Practice (CoP)	Eligibility Portfolio Management
Eligibility Management Course	Eligibility Processing
Eligibility Management Data	Eligibility Record
Eligibility Management Data Dictionary	Eligibility Records Management
Eligibility Management Database	Eligibility Repository
Eligibility Management Demand	Eligibility Reuse
Eligibility Management Dependency	Eligibility Review
Eligibility Management Document	Eligibility Schedule
Eligibility Management Documentation	Eligibility Schematic (Schema)
Eligibility Management File Plan	Eligibility Security
Eligibility Management Form	Eligibility Software
Eligibility Management Framework	Eligibility Strategy
Eligibility Management Governance	Eligibility Support
Eligibility Management Lessons Learned	Eligibility Taxonomy
Eligibility Management Metric	Eligibility Termination
Eligibility Management Operating Model	Eligibility Tracking
Eligibility Management Organization	Eligibility Tracking Software
Eligibility Management Plan	Eligibility Transaction
Eligibility Management Platform	Eligibility Unique Identifier
Eligibility Management Policy	Eligibility Verification
Eligibility Management Portfolio	Eligibility Version
Eligibility Management Principle	Eligibility Workflow
Eligibility Management Procedure	Enterprise Eligibility Management
Eligibility Management Process	Federated Eligibility Management
Eligibility Management Professional	Regional Eligibility Management
Eligibility Management Program

Please refer to the IT Glossary for other terms and phrases that may be relevant to this professional discipline.

Readers may also refer to the Taxonomy of Glossaries for terms and phrases that are semantically grouped according to IT Disciplines or enterprise domains.

Capabilities: Eligibility Management as an Enterprise Capability

A Capability, as it pertains to Information Technology (IT) or to an enterprise that an IT Organization serves, is defined to be "A manageable feature, faculty, function, process, service or discipline that represents an ability to perform something which yields an expected set of results and is capable of further advancement or development. In other words, a Capability is nothing more than "the ability to do something" or, quite simply, a Feature or Function. Therefore, when applied to an enterprise, a Capability represents a critical Enterprise Feature or Enterprise Function.

When it comes to Capabilities, there are multiple types that an enterprise needs to be aware of. Examples include but are not limited to:

• Business Capabilities: A set of Capabilities needed and/or offered by a Business.
• Information Technology (IT) Capabilities: A set of Capabilities needed and/or offered by an IT Organization.
• System Capabilities: A set of Capabilities needed and/or offered by a System
• Service Capabilities: A set of Capabilities needed and/or offered by a Service
• Organizational Capabilities: A set of Capabilities needed and/or offered by one or more Organizations.
• Enterprise Capabilities: A set of Capabilities needed and/or offered by an Enterprise (i.e. the combined set of all of the above).

As can be seen above, there are Capabilities that are associated with Resources, Organizations, and Assets such as Systems. All are important to an enterprise.

In the case of this IT Discipline (i.e. Eligibility Management), we use the word Capability in the context of an Enterprise Capability or an IT Capability, which are both equivalent to Enterprise Disciplines or IT Disciplines, respectively. In short, the Capability of Eligibility Management represents the ability to deal with any and all Eligibility Items and anything relevant that is related to or associated with any Eligibility Items.

If you think about it, a capability is really nothing more than a "verb" or "action that represents "the ability to do something." Understanding this allows us to derive a consistent and highly repeatable set of sub-capabilities for any Noun we're dealing with. For example:

• The ability to architect a specific Noun.
• The ability to copy a specific Noun.
• The ability to create a specific Noun.
• The ability to delete a specific Noun.
• The ability to design a specific Noun.
• The ability to edit a specific Noun.
• The ability to modify a specific Noun.
• The ability to purge a specific Noun.
• The ability to request a specific Noun.
• Etc. (The list is quite long.)

In summary, the implication is that the Enterprise Capability or Enterprise Discipline known as Eligibility Management is the superset of all the above Sub-Capabilities, as they pertain to or are applied to the discipline-specific Noun: "Eligibility." This now translates more specifically to:

• The ability to architect a specific Eligibility Item.
• The ability to copy a specific Eligibility Item.
• The ability to create a specific Eligibility Item.
• The ability to delete a specific Eligibility Item.
• The ability to design a specific Eligibility Item.
• The ability to edit a specific Eligibility Item.
• The ability to modify a specific Eligibility Item.
• The ability to purge a specific Eligibility Item.
• The ability to request a specific Eligibility Item.
• Etc. (The list is quite long.)

For a more complete list of very specific Capabilities/Disciplines, refer to the Foundation's Master Inventory of IT Disciplines. It is important to note that this inventory is in a flat or non-hierarchical form, specifically because "hierarchy" is almost always a matter of personal preference or context (what hierarchy is important to one Resource or Organization may be unimportant to another's needs or requirements). Therefore, the Foundation has published its inventory of Capabilities in a non-hierarchical, flat form.

This now brings us to a very obvious problem that surrounds Capabilities, which is the fact that there are simply too many "granular" or "specific" Capabilities to document and publish in any single Capability Model. The end result is that a Capability Model may become unwieldy because of trying to incorporate so many different specific Capabilities. Also, Capability Modeling "Purists," who all have their own (and very differing) opinions about how Capability Models should or should not be represented, almost always refuse to get into the details. To address this, we recommend using a generic set of Capabilities that map to and are driven by the Systems Development Life Cycle. For example:

• Identify and Solicit Demand for Eligibilities
• Create and Set Strategy for Eligibilities
• Perform Research on or for Eligibilities
• Plan for the Delivery of Eligibilities
• Identify Requirements for Eligibilities
• Define and Design Eligibilities
• Build or Construct Eligibilities
• Control Quality of or for Eligibilities
• Deliver Eligibilities (to Meet Identified Demand or Desire)
• Operate and Support Eligibilities

As you can see from the above, we now have a very limited, controlled and manageable set of Discipline-specific Capabilities for the Discipline Eligibility Management.

As a reminder, the above Capability representations are "suggestions" for baselining or initializing your own Enterprise Capability Model (ECM). It's recommended that you take the time to work with your enterprise stakeholders to improve upon and/or customize your own ECM so that you can help meet their needs. However, with that being said, it's always a better idea to go in with a baseline that you can modify rather than building your own solution from scratch, especially if your goals are to standardize, not reinvent the wheel, and not deviate too far from what other enterprises are doing to model their own environments. This is especially true if you've never had any experience building ECMs that have gained and maintained full adoption.

Why do enterprises perform Capability Modeling? Enterprises most often build Capability Models that are associated with Eligibility Management for the following reasons...

• To create a common enterprise language for the Discipline known as Eligibility Management.
• To create a common and reusable Eligibility Management Taxonomy (or a Taxonomy for Eligibility Management). Such Taxonomies can be used to help layout or structure an enterprise's Intranet (often for routing and/or traverse-ability) and tag Documents in Document Management Systems.
• To create a "Knowledge Map" or "Knowledge Model" for Eligibility Management. Such Knowledge Maps or Models can then be translated and used for structuring training programs, establishing Communities of Practice (CoPs), and defining and publishing things like policies, processes, procedures, and standards.
• To help categorize and structure Requirements during Requirements collection and analysis.
• To help map things like Applications, Software, and Hardware to the Capability areas of Eligibility Management.
• To help define enterprise Services, along with helping to understand who provides and consumes such services.
• To help understand what activities go on, in an enterprise, and who performs such activities.
• And much more...

Capability Modeling Recommendations: Some things to consider and keep in mind when working on or creating your Eligibility Management and Enterprise Capability Models...

• Try and keep "context" or "contexts" out of your core model. For example, your Eligibility Management Stakeholders may work hard to get what's important to them into the model (e.g. their "organizations" or organizational contexts), as opposed to what might actually be best for the enterprise. It's always a good idea to keep the model as pure as possible and keep such contexts out.
• While it's a good idea to keep contexts out of your core Capability Model, it will eventually become clear that Capability Contexts are, in fact, very important to your enterprise. You will have to find a way to model and represent such contexts, separately. For example, one context might be an organizational view of what organizations provide or consume specific Capabilities, such as Eligibility Management. Such contexts often represent "cross sectional" or "pivoted" views of your model.
• One of the quickest ways to lose the interest of your enterprise is to keep your model secluded or silo-ed in a spreadsheet or database and not publish it or use it for solving other problems in the enterprise. A good Enterprise Capability Model (ECM) helps get to better Service Management Models, better Document Management Taxonomies, and (most importantly) to better Knowledge Models that can be published as traversable content on your Intranet so that stakeholders can, find, learn about, better understand and use such Capabilities.
• Once you embark on building an ECM, you will undoubtedly run into the challenge that your Business doesn't speak in terms of "Capabilities." Remember, Capability Models are things that were designed by Information Technology (IT) Architects that, very often, have never worked in a Business, built a Business, or run a Business. Some times, it's better to build models using terminology your Business understands, such as "Services," "Features," or "Functions," all terms that most Businesses are far more familiar with. However, this should not be interpreted as a deterrent to keep you from embarking on building an ECM, should it be the right thing to do for your enterprise.
• You will be hard pressed to find many, if any, reusable Capability Models that can be used as solid reference material for your own models, which is why the Foundation has taken the time to document different aspects and issues associated with Capability Modeling and Capability Models.
• You will constantly be under pressure to help define and get your Business Stakeholders to understand what a Capability is. It's for this reason that you may want to use terminology that might be more common with Businesses, such as "Services," "Functions," and/or "Features."
• It's better to start with a model you can go into your Business Stakeholder meetings with, with the intent of improving upon what you have, than it is to go in with nothing at all and build your models from scratch.
• Do your best to work with your Eligibility Management Stakeholders to help verify and improve your Eligibility Management Capability Model.
• Don't assume that tools will help solve your Capability Modeling needs. It's always better to start simple and work your way up to tools, after you know what you want to achieve and can realistically achieve.
• Good Capability Models will be many levels or layers "deep." Modelers that think they can represent their entire enterprise or all its key Capabilities in just a few levels of hierarchy are fooling themselves or trying to fool those that they're trying to sell their models to.
• While Capability Models may look like "hierarchical" structures when building your first few layers, good Capability Models will eventually start to share common Capabilities in different areas of the model, forcing the model to take on the structure of a multidimensional "graph."
• Keep your model published and fresh so that the enterprise can see it and use it, immediately. The more eyes you have on your model, the faster it will improve.

Ownership: Clearly Defined Eligibility Management Ownership is Critical for Success

Here's a very simple fact... If an enterprise does not establish and enforce clearly defined Ownership (i.e. a Resources and his or her Organization are assigned as accountable ownership) for Eligibility Management, the enterprise has automatically set itself up for failure in its implementation of that discipline. Therefore, if you and your enterprise want to implement and maintain a successful solution for Eligibility Management, there must be a clearly defined Owner that can and will be held accountable for getting work done, providing transparency, helping with strategy setting, and coordinating implementation of Eligibility Management as a fully functional and mature enterprise Service.

Having clearly defined Ownership should not be confused with having fully dedicated Resources that spend one hundred percent of their time working on Eligibility Management. In fact, smaller enterprises can rarely afford to dedicate full time Resources, like larger enterprises can, to all enterprise IT Disciplines. This being the case, all IT Disciplines, including Eligibility Management, should "always" have clearly defined Owners so that there is always a clear point of accountability and contact for any issues or work that need to be addressed.

In addition to the common best practice of having clearly assigned Ownership for Eligibility Management, it is also considered a best practice to clearly publish and socialize Eligibility Management Ownership details to a centralized location (often referred to as a "Service Catalog" or an "Enterprise Service Catalog"), along with Ownership details for all other IT Disciplines, so that the entire enterprise has constant access to it.

Figure: How Ownership of the Capability Eligibility Management fits into the Canonical Model for IT

The above figure helps us understand how Capability or Discipline Ownership fits into the Canonical Model for Information Technology (IT) (i.e. "Think," "Deliver," and "Operate"). Owners are assigned to individual Disciplines or Capabilities, such as Eligibility Management, and are instantly made accountable to the enterprise for the results of all Eligibility Management Thinking activities (i.e. Strategy, Research, Planning and Design), all Eligibility Management Delivery activities (i.e. Construction, Deployment and Quality Assurance), and all Eligibility Management Operations activities (i.e. Use, Maintenance and Support). Done correctly, Eligibility Management Ownership is constant and ongoing. It's important to understand that such assigned Ownership should "never" end so that there is clear and constant accountability and transparency for all aspects of the Canonical Model to the enterprise.

Not having clear Ownership for Eligibility Management means that there is no clear understanding of who is accountable for it, who can provide understanding of what's going on within it, who can help the enterprise provide short term and long term descriptions of work being performed within the Discipline area to improve it over time for its customers, and who can help with getting work done that's associated with it. It means your or your enterprise's implementation for Eligibility Management will be highly incomplete and erratic because no one is constantly (or even partially) watching over the Discipline and its needs for maintenance and evolution. Not having clear Eligibility Management Ownership is a recipe for confusion and, sometimes, even chaos.

In summary, if you and your enterprise truly want to be successful with your implementation of Eligibility Management, ensure that a clear and highly accountable owner is identified and assigned to the Discipline. Publish those ownership details, preferably in an enterprise's Service Catalog, and socialize it so everyone knows whom to go to for answers and for help with Eligibility Management related work. In other words, if you want to implement Eligibility Management as an enterprise Service, then you absolutely must start with clearly defined, published and socialized Ownership.

Verbs and Actions: Understanding Why Verbs and Actions are Important to Eligibility Management

Throughout the Foundation's documentation, you will continuously run into the references of "Nouns and Verbs." These concepts are key to consistency and standardization, throughout the IT Industry, down to each and every IT Discipline. Given that we've discussed the impact of "Nouns" on the discipline of "Eligibility Management," this section will start to discuss the importance of "Verbs" or "Actions" that can be performed with or against the key Noun or Nouns associated with this Discipline. To reiterate, Verbs or Actions allow us to clearly understand what can be performed on or with the Noun in question. As will be discussed in the next section, Verbs or Actions will also help us clearly identify whom it is (i.e. the "who" or more specifically the Roles) that performs or executes such Verbs or Actions against a Discipline and its associated Noun or Nouns. As will be discussed later, Verbs or Actions will also help identify key Attributes (i.e. Field Names) that are necessary for the very data definition of the Noun or Nouns for this Discipline and will even help identify which Verbs or Actions can be automated for this Discipline.

As a reminder, the base Noun for the discipline known as Eligibility Management is: "Eligibility," which is sometimes referred to as a the Noun: "Eligibility Item."

By now, it should be becoming apparent that verbs represent a baseline for defining solid functional requirements and sub-capabilities for what would be a part of any good Eligibility Management System or Service. What this means is that if you and/or your Organization is looking for a solution in this space (e.g. the purchasing or building of a software solution or the implementation of a Service to address the needs of Eligibility Management), you could use discipline-related verbs to drive the foundation of what the solution should or shouldn't do, as mapped to specific stakeholders that will use or provide the solution.

Examples of the types of Verbs or Actions that are important to this Discipline include but are not limited to:

• Architect
• Create
• Edit/Modify
• Delete
• Design
• Copy
• Own
• Manage
• Etc.

The above list represents a very small subset of all Verbs or Actions that are relevant for this Discipline. The more complete set can be found in the Roles section of this document, where readers can see the direct correlation of Verb to Noun and to, both, Generic Role and Discipline Specific Role.

Roles: Key Verb and Action Driven Roles For Eligibility Management

An "action" or a "verb" is something that can be performed on or with a specific "noun." The reason it is important to itemize all relevant verbs is because we can now start to determine what we can or cannot do with the noun in question, where in this case the noun is "Eligibility."

Actions/Verbs	Example as Applied to "Eligibility"	Generic Roles	Discipline-Specific Roles
Administrate	Administrate Eligibility	Administrator	Eligibility Administrator
Approve	Approve Eligibility	Approver	Eligibility Approver
Architect	Architect Eligibility	Architector	Eligibility Architector
Archive	Archive Eligibility	Archiver	Eligibility Archiver
Audit	Audit Eligibility	Auditor	Eligibility Auditor
Bundle	Bundle Eligibility	Bundler	Eligibility Bundler
Clone	Clone Eligibility	Cloner	Eligibility Cloner
Code	Code Eligibility	Coder	Eligibility Coder
Configure	Configure Eligibility	Configurer	Eligibility Configurer
Copy	Copy Eligibility	Copier	Eligibility Copier
Create	Create Eligibility	Creator	Eligibility Creator
Decommission	Decommission Eligibility	Decommissioner	Eligibility Decommissioner
Delete	Delete Eligibility	Deletor	Eligibility Deletor
Deploy	Deploy Eligibility	Deployer	Eligibility Deployer
Deprecate	Deprecate Eligibility	Deprecator	Eligibility Deprecator
Design	Design Eligibility	Designer	Eligibility Designer
Destroy	Destroy Eligibility	Destroyer	Eligibility Destroyer
Develop	Develop Eligibility	Developer	Eligibility Developer
Distribute	Distribute Eligibility	Distributor	Eligibility Distributor
Download	Download Eligibility	Downloader	Eligibility Downloader
Edit	Edit Eligibility	Editor	Eligibility Editor
Educate	Educate Eligibility	Educator	Eligibility Educator
Export	Export Eligibility	Exporter	Eligibility Exporter
Govern	Govern Eligibility	Governor	Eligibility Governor
Import	Import Eligibility	Importer	Eligibility Importer
Initialize	Initialize Eligibility	Initializer	Eligibility Initializer
Install	Install Eligibility	Installer	Eligibility Installer
Instantiate	Instantiate Eligibility	Instantiator	Eligibility Instantiator
Integrate	Integrate Eligibility	Integrator	Eligibility Integrator
Manage	Manage Eligibility	Manager	Eligibility Manager
Merge	Merge Eligibility	Merger	Eligibility Merger
Modify	Modify Eligibility	Modifier	Eligibility Modifier
Move	Move Eligibility	Mover	Eligibility Mover
Own	Own Eligibility	Owner	Eligibility Owner
Package	Package Eligibility	Packager	Eligibility Packager
Persist	Persist Eligibility	Persister	Eligibility Persister
Plan	Plan Eligibility	Planner	Eligibility Planner
Purge	Purge Eligibility	Purger	Eligibility Purger
Receive	Receive Eligibility	Receiver	Eligibility Receiver
Record	Record Eligibility	Recorder	Eligibility Recorder
Recover	Recover Eligibility	Recoverer	Eligibility Recoverer
Register	Register Eligibility	Registrar	Eligibility Registrar
Relocate	Relocate Eligibility	Relocator	Eligibility Relocator
Reject	Reject Eligibility	Rejecter	Eligibility Rejecter
Remove	Remove Eligibility	Remover	Eligibility Remover
Replicate	Replicate Eligibility	Replicator	Eligibility Replicator
Report	Report Eligibility	Reporter	Eligibility Reporter
Request	Request Eligibility	Requestor	Eligibility Requestor
Restore	Restore Eligibility	Restorer	Eligibility Restorer
Review	Review Eligibility	Reviewer	Eligibility Reviewer
Save	Save Eligibility	Saver	Eligibility Saver
Search	Search Eligibility	Searcher	Eligibility Searcher
Split	Split Eligibility	Splitter	Eligibility Splitter
Sponsor	Sponsor Eligibility	Sponsor	Eligibility Sponsor
Store	Store Eligibility	Storer	Eligibility Storer
Strategize	Strategize Eligibility	Strategizer (or Strategy Setter)	Eligibility Strategizer (or Eligibility Strategy Setter)
Support	Support Eligibility	Supporter	Eligibility Supporter
Train	Train Eligibility	Trainer	Eligibility Trainer
Upgrade	Upgrade Eligibility	Upgrader	Eligibility Upgrader
Upload	Upload Eligibility	Uploader	Eligibility Uploader
Version	Version Eligibility	Versioner	Eligibility Versioner
View	View Eligibility	Viewer	Eligibility Viewer

At a minimum, the above list of Verbs can be used to help identify, track, and manage the basic "Features" required by and associated with Eligibility Management, even if your enterprise doesn't maintain a Capability Model that lists specific Eligibility Management Capabilities. Application designers, developers, and architects often find such Verb Lists or Feature Inventories to be invaluable.

Taxonomy: Understanding Eligibility Management Classifications or Categorizations

A Taxonomy, in its noun form, is defined as:

...a documented and orderly set of types, classifications, categorizations and/or principles that are often achieved through mechanisms including but not limited to naming, defining and/or the grouping of attributes, and which ultimately help to describe, differentiate, identify, arrange and provide contextual relationships between the entities for which the Taxonomy exists.

From this general definition, we can derive that the definition for an Eligibility Management Taxonomy is:

...a documented and orderly set of types, classifications, categorizations and/or principles that are often achieved through mechanisms including but not limited to naming, defining and/or the grouping of attributes, and which ultimately help to describe, differentiate, identify, arrange and provide contextual relationships between Eligibility Items, Entities or Types.

In short, what this means all means is that a Taxonomy is nothing more than a classification or typing mechanism and that an Eligibility Taxonomy is nothing more than a classification or typing mechanism that helps people and systems distinguish between different Eligibility Items, Entities, Types, Records or any other Eligibility Management element you can think of.

It's important to understand that Taxonomies can be as simple as a list of relevant terms or phrases with respective meanings or definitions or they can take on more complex forms, such as hierarchical and graphical model structures that can be homogeneous and heterogeneous in nature. More complex Taxonomies include examples such as "Visual Taxonomies" and "Audible Taxonomies" but, expect in the case of very special technologies, are typically out of scope for general Information Technology (IT) Operations.

The Foundation directs readers to its ever-evolving Inventory of Taxonomies for Standard Taxonomy suggestions. Specifically, readers may want to start with the Taxonomy of Taxonomies, which helps make it clear that the IT Industry is composed of many hundreds if not thousands of Taxonomies, Classifications, Categorizations or Types.

Life Cycle (Lifecycle): Data Lifecycle Phases for Eligibility Management

Data Lifecycle (or Life Cycle) for any and all data is the period from the "inception" of data through to its ultimately being "purged" from existence. This is no different for Eligibility Management related data.

Like the data associated with any other professional IT Discipline, Eligibility Management related data adheres to the following common Data Lifecycle Phases:

Figure: Eligibility Management Lifecycle Phases

1. Inception: Data is in it's raw idea-like form and is not ready for consumption by the general population because it has not been documented or registered, anywhere, in a formal manner.
2. Creation and Registration: Data is formally put into existence for day-to-day use by appropriate stakeholders.
3. Iterative Maintenance: Data is in a mode of constant use and is updated and modified, as needed, to meet the needs of daily use by various stakeholders.
4. Decommission and Deletion: Data is prepared for deletion and eventually deleted from daily operational use but still exists for administrative or organizational purposes, such as historical auditing. It can be restored to any one of its relevant last states and, therefore, can be brought back into existence for day-to-day use.
5. Purged From Existence: Data is completely removed from an environment with no means to restore or reconstruct it, without recreating it from scratch and with no guarantees that it will match it's previous state.

The above Life Cycle Phases represent the high level transitions that occur from the inception of Eligibility Items or Entities all the way through to their complete elimination from existence. A more detailed breakdown of these transitions or phases represents what are referred to as "Eligibility Management States."

Metrics: Eligibility Management Metrics

As with any professional Discipline, the place to start with when dealing with Eligibility Management specific metrics is with standard metrics categorizations. Standard Metrics Categorizations, or what are commonly referred to as "SMCs," include but are not limited to...

• Quantitative Metrics or, in this case, Eligibility Management Quantitative Metrics
• Qualitative Metrics or, in this case, Eligibility Management Qualitative Metrics
• Time Metrics or, in this case, Eligibility Management Time Metrics
• Utilization Metrics or, in this case, Eligibility Management Utilization Metrics
• Financial Metrics or, in this case, Eligibility Management Financial Metrics

Eligibility Management Quantitative Metrics: Quantitative metrics for Eligibility Management often revolve around the "counting" of key constructs that are associated with the Discipline. For example, the number of Eligibility Items or Entities that have been Created, Edited or Modified, Copied or Cloned, Destroyed, Archived, Restored, etc. (Note the correlations to key Eligibility Management Verbs!). Also, the counts for things like the number of Eligibility Management Stakeholders, such as but not limited to Paying Customers, End Users, Employees, Consultants, etc. are also very useful.

Eligibility Management Qualitative Metrics: Qualitative metrics for Eligibility Management often revolve around concepts such as Eligibility Management Defects, Failures, Problems, Incidents, and/or Issues. So, for example, if we were to capture the number of Eligibility Management Defects (i.e. their counts) over time, we could do things like see if Defect quantities are going up or down, over time, allowing us to explore that area for things like correlating Causes and Effects.

Eligibility Management Time Metrics: When dealing with Eligibility Management Time Metrics, there are usually two forms. The first was introduced in the previous paragraph, which has to do with capturing and measuring things like Quantitative or Qualitative Metrics, over time. In this case, we capture other metric categories, over time, with the intent to see how they change and perform, based on modifications to the Eligibility Management Operating Environment. The second form of Time related metrics has to do with system or operational performance, such as in the case of how long it takes to process a Eligibility Management Request, from the time it is created to the time the Requester gets a satisfactory deliverable that allows him or her to move on with his or her work.

Eligibility Management Utilization Metrics: Utilization Metrics specifically have to do with the consumption of Eligibility Management specific solutions or deliverables. For example, tracking the number of Eligibility Management Service Requests, over periods of time, along with their corresponding Eligibility Management Deliverables, allows one to measure how active Eligibility Management Services are against other Services that may exist within the Enterprise.

Eligibility Management Financial Metrics: As is always the case for any single Discipline, Financial Metrics for Eligibility Management always revolve around things like revenue, expenses, and profits, both, for operators of the Service or Services and for consumers of the Service or Services. For example, if an Eligibility Management Request is invoked by an Eligibility Management Customer (acting as the "Requester"), it becomes important to be able to identify and understand what the cost is to that Customer who is invoking the Request, and it also becomes important to understand why that cost is what it is. In the case of Services that do not yield revenue or profits, measuring costs is a strong way to, at very least, help understand the costs associated with each Service being performed by, within, external to, and for the Enterprise and its Customers.

Note: It's important to understand that, when it comes to metrics, enterprises should take a "Crawl," "Walk," "Run" approach to collecting, working with, and understanding them. That is, you cannot get to complex metrics collection, dissection, analysis, and understanding until you start with basic metrics and slowly work your way to more complex metrics representations.

Services: Eligibility Management as a Set of Services (a.k.a. Eligibility Management Services)

One of the most important concepts you will learn about Eligibility Management (or any Discipline, for that matter) is the notion of implementing the Discipline as an accountable, planned, controlled, transparent, and managed "Service."

In short, Services represent a logically "bounded" and repeatable sets of work types, activities or tasks that are performed by humans and/or machines, with the specific intent to provide outputs or deliverables, in the form of solutions for the requesting Stakeholders who are commonly considered the customers of such Services. In other words, we perform and/or provide a Service to deliver very specific solutions to very specific Stakeholders who are looking for a means to solve a certain problem they have.

Services can be performed manually (i.e. by people), automatically (i.e. by machines such as Computers), or by a combination of the two (i.e. a hybrid that is both manually and automated).

Eligibility Management Service Components: The successful implementation of Eligibility Management as a set of Services for your enterprise usually implies that a number of key components have been established to support it. These components are:

1. A clearly documented and socialized Eligibility Management Service Owner
2. A clearly documented and socialized Eligibility Management Service Provider, Organization or Group who is performing the Service or work
3. A clearly documented and socialized inventory of all Eligibility Management Service Inputs, including Eligibility Management Service Requests and any artifacts necessary to support such Requests
4. For every Eligibility Management Service Input, a clearly documented and socialized inventory of Eligibility Management Service Outputs, making it clear to consumers what they can expect to receive as a result of a successful Service Request
5. For every Eligibility Management Service Input, a clearly documented and socialized inventory of the work being performed by the Service Provider to achieve such Outputs or Deliverables
6. For every Eligibility Management Service Input, a clearly documented and socialized inventory Service Levels that can be used to set expectations and measure actuals against for said Service Outputs

Eligibility Management Ownership: The most important thing to understand about an Eligibility Management Service is that, in order for such a Service to be successful, there must be a clear and accountable Owner for it. That is, there needs to be a very clear and accountable named person or organization that owns and is fully responsible for the Service, all of its sub-Services and, most importantly, all of the Service's "Outcomes." Without clear ownership, Services are almost never successful. And, for those few occasions where Services are successful without clear ownership, you can assume that they're successful because the people working in those Service areas are acting as heroes, or... the those Services are just plain lucky (that kind of luck doesn't last for long).

Eligibility Management Service Inputs: There are typically two types of inputs to any Eligibility Management Service. The first is what is known as an "Eligibility Management Service Request" and the second really represents any and all supporting artifacts that are necessary to support such requests, including but not limited to Data and Information in the form of Documents, either electronic or paper in form. Many would argue that the "money" to pay for the Service execution of the Request would be the third but, for now, we will assume that payment is controlled through the Data and Information provided to the Service Operators, in support of the Request.

Eligibility Management Service Outputs: The outputs of any Service are often referred to as the Service's Deliverables. Therefore, the readers should be aware that the terms "Eligibility Management Outputs" and "Eligibility Management Deliverables" are synonymous and interchangeable. All work performed in any enterprise is, by default, a Service that is being performed for someone else and, therefore, all work or Services yield results. These results are the Service's Outputs or Deliverables and a good Service ensures that such Outputs are appropriately documented to the consumers of said Service. This means that for any given Eligibility Management Service Request Type or Category there will be one or more clearly defined and documented Outputs or Deliverables, making it clear to the consumer what he, she, or they will get in response to their Request. This can be as simple as an answer to a question or as complex as the Merger of two enterprises.

Eligibility Management Service Levels: Service Levels represent "performance agreements," contractual or otherwise, that dictate how well an Eligibility Management Service should perform, most often keeping the Customers, Consumers, Clients or End Users of the Service in mind. Eligibility Management Service Levels can come in many forms and are often worked out by the Customers paying for the Services and the Service Providers who sell or provide the Services. In many cases, Service Levels are also self-imposed by the Service Providers performing the Services as a means to set expectations for Service Customers. In short, Eligibility Management Service Levels are constraints, limitations, and/or expectations that are tied directly to Eligibility Management Service Deliverables. They represent measures for things like quality, efficiency, and cost against said Deliverables or Outputs that allow the consumer of such Services to measure what they actually get against what they expected to get.

Principles & Best Practices: Common Principles and Best Practices for Eligibility Management

A "Principle" is defined as being: "A professed assumption, basis, tenet, doctrine, plan of action or code of conduct for activities, work or behavior." Therefore, we can deduce the definition of "an Eligibility Management Principle" to be:

Eligibility Management Principle: "1. A professed assumption, basis, tenet, doctrine, plan of action or code of conduct for any activities, work or behavior associated with the Discipline known as Eligibility Management."

A "Best Practice" is defined as being: "One or more Activities, Actions, Tasks or Functions that often do not conform with strict Standards and that have evolved, over time, to be considered as conventional wisdom for consistently and repeated achieving Outcomes or Results that can be measured as being equal to or above acceptable norms." Therefore, we can deduce the definition of "an Eligibility Management Best Practice" to be:

Eligibility Management Best Practice: "1. One or more Eligibility Management related Activities, Actions, Tasks or Functions that often do not conform with strict standards and that have evolved, over time, to be considered as conventional wisdom for consistently and repeatedly achieving Outcomes or Results that can be measured as being equal to or above acceptable norms."

The plural form of this term would be "Eligibility Management Best Practices."

Common Eligibility Management related principles and best practices exist to help achieve higher than average expectations of quality and to ease in the implementation, support, operations, and future change associated with the solutions industry professionals put in place to address the needs of this Discipline and all its related stakeholders.

While this entire document is meant to represent and serve as a set of common principles and best practices for Eligibility Management, the following list represents a summary of some very basic examples of what implementers, supporters, and operators of Eligibility Management should constantly be working toward:

Principle or Best Practice	Description
Establish and always have very clear Ownership for Eligibility Management.	Establishing, publishing and socializing clear Ownership for Eligibility Management allows an enterprise and all its Resources, regardless of their geographic location, to assign accountability for all aspects of the Discipline. It also ensures that there's always at least one person that everyone can go to for transparency into the Discipline as well as for handling work that is associated with the Discipline.
Always use standard terminology for Eligibility Management, in order to standardize communications between stakeholders.	It is often argued that the biggest mistake you can make is to create your own words and/or your own definitions, when communicating with others. There is no place where this is more accurate than in the field of Information Technology. IT Stakeholders make up their own words and definitions far too often, or let their business constituents do so. When you make up words or definitions, or you let others do so, you're creating a grave injustice for your organization. Self invented terminology and grammar often leads to poor communications, which in turn leads to redundancy of solutions, higher complexity of environments, slower delivery times, and much higher costs. Therefore, the IF4IT always recommends that you leverage standard terminology for Eligibility Management, whenever possible.
Centralization of Eligibility related data.	While often impossible to centralize and collocate all Eligibility related data and information, especially in a geographically dispersed environment, Eligibility Management related stakeholders should always strive to centralize all data and information. The goals are to eliminate data fragmentation, improve source of truth for data, reduce the number of systems needed to support stakeholders, reduce the complexity of solutions, improve usability, and to ultimately reduce the costs associated with Eligibility Management.
Transparency of Eligibility related data.	Stakeholders should always strive to make any and all Eligibility Management data transparent to all other appropriate stakeholders, at a minimum, and often to the entire enterprises. The exception when private user data must be protected. Many stakeholders often make the mistake of treating internal operational data as private or protected. This often creates a data silo and will often lead to internally silo-ed organizations that revolve around such data silos.
Do not let "perfection" of Eligibility Management solutions stand in the way of "good enough solutions".	Often, Eligibility Management stakeholders "overthink" solutions, leading to the impression that best-of-breed or perfect solutions are more effective than "good enough" solutions. Experience tells us that "good enough" is, almost always, the better path to follow. We live in an age where technologies grow old in the blink of an eye. Even the implementation of something that looks perfect, today, will look antiquated, tomorrow. This is especially true if your enterprise doesn't have a long term funding plan and commitment to improvements and upgrades of the solution(s) put in place.
Follow industry Standards, Best Practices, and Guiding Principles for Eligibility Management, whenever possible".	One of the most common errors many enterprises make is to create solutions from scratch or without the guidance, assistance and/or experience of others who have created such solutions, before them. Whenever possible, the IF4IT recommends that you research existing Standards, Best Practices, and Guiding Principles to avoid the mistakes of others, while also gaining from their successes. Remember, we live in a vast world. Chances are very high that someone else has already experienced the pain you're about to create for yourself. Wise people will always look to learn from such people's experiences before they go down the road of implementing their own solutions.
Work toward and maintain a Single Source of Truth (SSoT), whenever possible.	While it may be impossible to truly maintain a Single Source of Truth (SSoT) for all data items at all times, especially in the case where the same data entity or instance enters an enterprise through unique data channels, it is an accepted, industry-wide best practice to always work toward such a goal.

Further Reading and Reference Material for Eligibility Management

The Information Technology (IT) Learning Framework. A tutorial that helps understand Information Technology and how disciplines, such as this one, fits into the bigger picture of IT Operations.