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ProClaim Pricing Re-engineering. CONFIDENTIAL August 21, 2014. Proclaim Pricing Reengineering. Background & Scope of Work TCS Approach – Analysis Inputs Methodology Major Findings – multiple slides Application Assessment Recommendations Re-architect Renovate Next Steps. - 1 -.

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Proclaim pricing re engineering

ProClaim Pricing Re-engineering

CONFIDENTIAL

August 21, 2014


Proclaim pricing reengineering
Proclaim Pricing Reengineering

  • Background & Scope of Work

  • TCS Approach – Analysis

    • Inputs

    • Methodology

  • Major Findings – multiple slides

  • Application Assessment

  • Recommendations

    • Re-architect

    • Renovate

  • Next Steps

- 1 -


Background
Background

CIGNA requested TCS to investigate restructuring Proclaim to facilitate Claims Readiness

Through a series of meetings

Clarity on the strategic initiatives improved:

Refined the approach to narrow the scope and make the process more collaborative:

Reverse engineer Proclaim Pricing as a start

Create a review & recommend step (where we are now)

Determine approach for components after the review

- 2 -


Scope of work
Scope of Work

Applications in scope

  • Deliverables

  • Reform (Reverse engineering analysis Tool) Outputs

  • Recommendations for re-engineering Proclaim Pricing applications based on the analysis outputs

- 3 -

3


Tcs analysis artifacts
TCS Analysis Artifacts

Documents generated by the tool

  • Other Inputs

  • Program Analysis

  • System Documentation

  • Inputs from the PPO Claims QA Team

  • Claims Readiness Documentation

Above documents are available at:

http://sharepoint.cigna.com/sites/PPODOC/Documentation/Forms/Webfldr.aspx

- 4 -


Tcs analysis approach methodology
TCS Analysis Approach - Methodology

Application Inventory

Procalc

Alliance Apply Pricing

Provider Schedule Maint

CPF to Proclaim Wrapper

Provider Maintenance

Nightly Batch

PAM

HIAA (U&C)

System

Documentation

Input from PPO QA

Team




Recommendations re architect procalc
Recommendations – Re-Architect ProCalc

  • Re-architect Procalc

  • Externalize the rules to use a Business Rule Engine (BRE)

  • Create a Rules Repository

  • Make Procalc code as a Service Repository that can be common to Batch and Online

Rules Database

Batch

Invocation

Procalc

Today

Code, rules,

data

Service Repository

Rule Engine

Call to Rule Engine

Online

Invocation

Current State

Future State

Rationale



Next steps
Next Steps

Complete analysis and finalize recommendations with CIGNA team

Identify critical dependencies

identify additional impacted systems / subsystems

Create rough-out of end-state

Develop Tier Two estimates to achieve end-state

Develop plan and presentation to move to next phase

- 10 -



Appendix a observations
Appendix A - Observations

Database

- 12 -




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