Module 2: Member Management Business Interactions

Lesson 2: Critical Components Pg 3

Key components vital to understanding Member Management

  • Membership Structure Information: includes information relevant to the set up and maintenance of client-defined group plans that are associated to members.

  • Basic Group Information (ID, name, group type) – Includes organizational data such as the group identification number, name, and and coverage data such as type (for example, Medical, Dental, or Vision).

  • Representatives (called Contacts in MTV)- Official points of contact for plan information.

  • Vendor Associations – Lists of vendors that have relationships with the plan and its providers. Policy Information includes: identifiers that tie family members together on a commercial healthcare policy.

  • Tables associated with the policy hold data such as: Policy (called Coverage Contract in MTV), Policy MSA, Policy Contract, Policy Employment Information (called Coverage Employer Information in MTV), and Policy Other IDs.

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