ࡱ> [ bjbj 4ΐΐ11111EEEELtE&&j  %%%%%%%$'2*R%1%11%zzzR11%z%zz#|$絆HEp #%%0&&#*z*$$$P*1$z%%z&&* : BR #URFRRequirement NameRequirement DetailBusiness Owner1.CareFirst wants to establish new trading partner relationships thatare called full, partial, and futuretrading partners, sothat broker relationships can be improved, ongoing transactional costs can be reduced and capacity risks can be reduced or mitigated Broker Proposal ValidationCd workflow system would call Broker Proposal validation Service to ensure that the proposal sent by a broker is in the expected format and has valid and appropriate data BPVA Service RequestShall expect a Proposal XML validationXML schema will validated to check the integrity of the incoming file with the set standard XML schemas.Duplicate checkSystem shall check if a duplicate application exists in the system.Multiple validationsDCN availability is checked Contact information availability is checkedProduct category checkSystem shall check if the application is on or off exchange product.FR001.5BPVA Service ResponseComponent to generate unique ID and have it available as an output for any Service calling BPVA for validationsUR 002Broker Proposal VerificationBroker Proposal Validation service would call Broker Proposal Verification service in-order to run it through multiple business rules to check business logic integrity.FR002.1BPVE Service RequestSystem shall receive a validated proposal, from the BPVA serviceFR002.2On exchange and Off exchange classificationSystem shall check if the application is on or off exchange product. Based on the classification the appropriate business rules would be fired.FR002.3Set primary applicantSystem shall set the primary applicant for the policy for both the on and off exchangeFR002.4Spouse existing policy holder checkSystem shall check if the spouse of the primary applicant a current individual policy holder. IF so Spouse should now be treated as the primary policy holderFR002.5Create Contact recordSystem shall create a contact record for the policy for both the on and off exchange processes.FR002.6Duplicate and multiple application checksSystem shall check if there are duplicate applications for the same subscriber with same plan, if not are there any multiple for the same subscribers with different plan and/or dependents.FR002.7Work Order update (Pending PotentialDuplicate/Potential Multiple) System shall update the WO based on the responses on the checks made in FR 2.6FR002.8Duplicate resolutionSystem shall attempt to resolve the duplicate application, in the event of resolution additional check for SMARTS error code 54 is made; which if not required application move to App Processing (UR x.x); if there is a SMARTS error code 54 a SMARTS registration should be initiatedFR002.9Multiple app resolutionIn the event of resolution the one of the multiple applications would be closed or withdrawn.FR002.10Existing policyholder checkSystem shall check for all on exchange customers to validate if they are an existing customer.FR002.10Underwriting checkSystem shall check if underwriting (in case of existing policy holders) is required and update the WO status accordinglyFR002.11Coverage area checkSystem shall check if the customer is within the coverage area.(in case of non-existing policy holders)FR002.12KFI checkSystem shall check the integrity of the data filled on the paper app via KFI checks and inbuilt UI validations for the electronic applicationsFR002.13SID checkSystem shall check if a SID is provided to the subscriber of the applicationFR002.14Data availability for SMART registrationSystem shall check if enough data is available to complete a SMARTS registration( in case if no SID is available)FR002.15Application completeness checkSystem shall check if the application is complete; if not subscriber would be contacted via Phone or correspondence mailed to him/her.FR002.16Over 65 checkSystem shall check if the application is for Over 65 Need clarity on yes and no paths, I think diagram is wrongFR002.17BPVE Service ResponseSystem shall have the application validated and verified for the processing to utilize the same as inputsUR 003Broker Proposal ProcessingBroker Proposal Verificationservice would call Broker Proposal Processing service in-order to run it through light underwriting and advance it to Medical underwriting where required.FR003.1BPP Service RequestSystem shall get the validated and verified application for the processing and underwriting needs.FR003.2Light underwriting checkFollowing are the 3 options available as possible outcomes Approval : Prepare 834 transaction and communicate the same Partial approval : uw Rejected : correspondance FR003.3BPVE Service RequestUR 004Broker Proposal UnderwritingFR004.1Additional Documents Required checkFR004.2Data sufficiency checkFR004.3UW decision checkApproval : 834 Partial approval : uw Rejected : correspondance UR 005EnrollmentUR 006Payments >?@CI L M N P j k      J K L M O ] ^ i  ! 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