A2 Solutions - ADVANCED SYSTEM ANALYSIS AND DESIGN A2...

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ADVANCED SYSTEM ANALYSIS AND DESIGN A2 Santhosh Sunkara CWID: 11761417 [email protected] 1 Santhosh Sunkara
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Part A 1) The Complex system that I have identified is Trizetto Facets System. Facets is a client server based system developed using java technology which provides best suited solution for the healthcare management. Top health insurance companies like Anthem use Facets as their basic healthcare management system which helps in performing all the activities like subscriber enrollment, provide enrollment, billing, creating delinquency letters claims and accumes processing etc. The data is loaded to Facets and extracted from Facets by running a set of batch and interface jobs. Each and every sub module within the system has its own interface jobs and specific criteria on data extraction. For example the interface IM01 extracts the enrolled subscriber and member information which include their first and last names, SSN ID, provider IDs, basic address information etc. The problem statement that I have identified is the batch and interface job failures at critical business times. 2) The three main subsystems within the Facets System are the Group membership and Subscriber subsystem, Billing Subsystem, Claims and accumes subsystem. Each subsystem is interactive and is dependent on other system. Considering the Group membership and subscriber subsystem, the customers or subscribers who are taking a specific health insurance plan are enrolled through this subsystem. Through this subsystem we can have all the subscriber related data like the group they belong to, the number of dependents, type of plan, class like medical or pharmacy etc. Next the Billing subsystem will have the subscriber’s bill payment details and delinquency related information. The claims and accumes subsystem contains the information of the providers who provided the services to subscribers and the claim related information like claim amount, line amount, procedure code and diagnosis codes etc.
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