Run FMEA on benefit configuration
Identify benefit-configuration failure modes and select controls based on severity and detection.
A new zero-cost diabetes supply benefit must apply across pharmacy claims and medical DME claims by the first of the month. FMEA: identify failure modes, effects, causes, detection strength, and controls before release. The common trap is testing the happy path only: one pharmacy claim pays correctly, so the team assumes the whole benefit is configured. Name the process step Step: claim applies diabetes supply benefit rule across pharmacy and medical paths. FMEA works best when each failure is attached to a specific process step. List failure modes Mode 1: pharmacy cost share not waived. Mode 2: medical DME path…
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