Module 2: Member Management Business Interactions

Lesson 2: Critical Components Pg 2

Key components vital to understanding Member Management

  • Person Data information: relates to Personally Identifiable Information (PII), and while plan members will certainly have Person Data in the system, the system may house

  • Person Data for parties who are not Members, such as Legal guardians, head of a household, absent parents, or TPL policy holders.

  • Person Data can include information such as Name, Date of Birth, and Gender.Government implementations will not use the Membership Structure or Policy related entities, or functionality.

  • Each Member (also referred to as a recipient in the Medicaid arena) is associated with one Person. Each Person will typically only be associated with one Member (unlike commercial where a Person may be associated with multiple Members).

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