Business Function



Download 9.59 Kb.
Date09.06.2018
Size9.59 Kb.
#54068

EEDT Project Design Document – HP Daily Maintenance Process

Created: June 20, 2007
Author: Clay Rehm
Business Users: Michelle Baxter, Brian Schroeder

Business Function

Health Plan Daily Maintenance Reconciliation Process



Function Description (Current Environment)




  1. Load 997

This process will run each weekday (Monday through Friday) after the 834 file has been sent to the health plan. This process will retrieve the 997 file from the ETF sFTP server, validate it and then load the contents of it into the ETF reconciliation database.


  1. System Load Report (SLR)

After the 997 file is processed above, a report is generated that displays the results of the daily maintenance process. This report is emailed to specific individuals within ETF and can be viewed on the next page.
Business Requirements (Proposed)

Load 997 Process

This is required to map the accumulator fields in the 997 file into the reconciliation database. Copy an existing 997 Data Junction map and modify it to load into the new health plan reconciliation database.

SLR Process

This is required to automate the map created in the step above. Copy an existing batch process and modify it to create a new SLR process.

Create batch file

This is required to automate the process created in the step above. Copy an existing batch file process used to process the 997 and modify it to process a new 997 file.

Create Windows scheduler

Schedules the batch file to run each weekday (Monday through Friday) at 11 PM CST including holidays. Create a schedule file to call the batch file above.
Business Rules

  • The 997 file name provided by the health plan will be HIE997_xx_ETF_YYYYMMDD.txt where xx is the carrier code.



Business Processing Considerations

Example of the daily report sent via email to specific ETF resources:


Daily Health Insurance Eligibility Extract Report
Daily Update Date: 04/18/2007 Health Carrier: HP
ETF Counts
Contracts Sent: 25
Subscribers Sent: 22
Dependents Sent: 16

Total Records Sent: 38


HP Acknowledgement Counts (997)
Contracts Received: 25

Contracts Accepted: 25


Contracts Accepted with Errors: 0
Contracts Rejected: 0


Implementation Schedule/Dependencies

  • None.



System Processing Considerations
New Data Elements

None.

Data Conversion

None.
Program Changes

See the proposed Business Requirements section.
Programming Tips

None.



Page of 06/07/18


Download 9.59 Kb.

Share with your friends:




The database is protected by copyright ©ininet.org 2023
send message

    Main page