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Proclaim Benefit Automation Re-engineering

Proclaim Benefit Automation Re-engineering. CONFIDENTIAL October 13, 2014. Proclaim Benefit Automation Reengineering. Background & Scope of Work TCS Approach – Analysis Inputs Methodology Assessment Major Findings Recommendations Re-architect Renovate Retire Next Steps. - 1 -.

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Proclaim Benefit Automation Re-engineering

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  1. Proclaim Benefit Automation Re-engineering CONFIDENTIAL October 13, 2014

  2. Proclaim Benefit Automation Reengineering • Background & Scope of Work • TCS Approach – Analysis • Inputs • Methodology • Assessment • Major Findings • Recommendations • Re-architect • Renovate • Retire • Next Steps - 1 -

  3. Background CIGNA requested TCS to investigate restructuring Proclaim to facilitate Claims Readiness The approach has been refined over time: Part one was Proclaim Pricing Competed on time CIGNA Team found results valuable This is the second tranche of Proclaim Added a review & recommend step (where we are now) All work, going forward, will be self funding Reduced timeframe from 14 weeks to 6 Added additional resources Results are primarily tool outputs with minimal human intervention Recommendations are people & process driven Eliminated Business Rule Extraction and Analysis - 2 -

  4. Scope of Work Applications in scope • Deliverables • Reform (Reverse engineering analysis Tool) Outputs • Recommendations for re-engineering Proclaim Benefit Automation applications based on the analysis outputs - 3 - 3

  5. TCS Analysis Approach - Methodology Application Inventory Auto Adjudication Proclaim Batch CDB Wrapper CED Wrapper EC Load Proclaim Eligibility Inquiry Wrapper Medical Claim Payment Charge & Credit Plan Specs Procalc System Documentation Input from PPO QA Team

  6. Assessment

  7. Assessment

  8. Assessment • Proclaim Provider Maintenance (QZM) - Contention issues arising from Release changes • Proclaim CDB Wrapper (QZL) - CED data issues volume, characteristics), Contention • Proclaim Accumulator Rebuild (QBY) - Large Volume of pharmacy claim calculations, Acct validation errors, by bad restarts or database locking issues • Proclaim Auto-Adjudication System(QBG) - Data and Contention issues

  9. Major Findings - 8 -

  10. Major Findings - 9 -

  11. Recommendations

  12. Next Steps • Jointly create list of most likely candidates to provide acceptable ROI • Most cost / error intensive components • Performance / Scalable concerns or issues • Maintenance concerns / indicative track record • Availability matrix (on-time delivery for batch, on-line availability for other components) • Finish analysis to create Tier Two estimates • Identify critical dependencies so there are no “surprises” • identify additional impacted systems / subsystems • Create rough-out of end-state • Create cost / benefit analysis & establish appropriate threshold • For applications that meet the ROI threshold: • Develop plan and presentation to move to next phase • Expand the limited analysis to include Power MHS • The team is in place - 11 -

  13. Thank You

  14. Appendix A – Details Abend Trends for the last 12 months Major Findings Programs having more than 10K lines of code Top Contributors– DB/IMS/Hardcode Values Segment Ownership - 13 -

  15. 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 - 14 -

  16. Assessment

  17. Assessment

  18. Recommendations – Re-Architect ProCalc, Auto Adjudication • Re-architect Procalc, Auto Adjudication • 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, AA Today Code, rules, data Service Repository Rule Engine Call to Rule Engine Online Invocation Current State Future State Rationale

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