Decide what will be the business rules for digital development and artificial intelligence.
- Limit benefits or insurance coverage for primary, secondary, tertiary healthcare, rehabilitation, and palliative care for each family.
- A time limit of benefits or insurance coverage and its renewal.
- Pre-authorization.
- Wage Loss.
- Funeral Charges.
- Entry Fee i.e. community participation in UHC Fund and its collection mechanism.
- Newborn baby in hospital and auto inclusion of his membership in the family tree.
- Incentives/gift packs for newborn baby and his mother to encourage delivery in hospital under UHC.
- System intelligence to auto-update the insurance coverage balance of each family without human interference.
- Data entry should depend upon maximum mouse selection instead of using a keyboard to maintain uniformity.
- The system should intelligently generate auto alerts and notifications for users regarding beneficiaries or households and complainants.
- Claim adjudication, claim contest and claim repudiation or payment.
- Administration charges, duration, and calculation of profit commission.
- Empanelment, de-empanelment, temporary empanelment, scoring points against maximum score, their description, lookups like rating, abbreviations, and self-assessment mechanism.
- Complaint Management.
Incorporating the above and other business rules in the digital system will require the following two global database tables.
- Lookups
All lookup values will be incorporated globally in the system by using the following two tables of the database.
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