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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 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 -
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 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 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 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
Major Findings - 6 -
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 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 Database - 12 -
Appendix A - Observations (continued) Code Structure - 13 -
