Free Essay

Testing

In: Science

Submitted By myankabatra
Words 9695
Pages 39
(FIS)
SPRF#400019173

Reversal Correction - HLD

[pic]

Version 1.7

Version Created on 6/01/2009

Table of Contents

1. Revision History 4

2. Overview 5

2.1 Purpose 5 2.2 Scope 5 2.2.1 In Scope 5 2.2.2 Out of Scope 5 2.3 Assumptions 6 2.4 Reference 7 2.5 Functional Description – Reversal-Correction Process 8 2.5.1 Functional Overview 8 2.5.1.1 Current State Data Flow Diagrams 8 2.5.1.2 Future State Data Flow Diagrams 12 2.6 Related Application Requirements 19 2.7 Key Considerations 20 2.8 Source System Inputs 21 2.9 FDS/ODS Inputs 21 2.10 FDS/ODS Outputs 22 2.11 Logical Data Model Diagram – N/A 22 2.11.1 Table Definitions 22 2.12 Technical Description 25 2.13 Processing Logic 25 2.13.1 Functional Process Flow 25 2.13.2 Process 01 – Identification 29 2.13.2.1 Inputs 29 2.13.2.2 Outputs 29 2.13.2.3 Potential temporary/staging table definition 30 2.13.2.4 Processing Steps 31 2.13.2.5 Mapping document 31 2.13.3 Process 02 – Reversal 32 2.13.3.1 Inputs 32 2.13.3.2 Outputs 32 2.13.3.3 Potential temporary/staging table definition 34 2.13.3.4 Processing Steps 34 2.13.3.5 Mapping document 35 2.13.4 Process 03 – Delete 35 2.13.4.1 Inputs 35 2.13.4.2 Outputs 36 2.13.4.3 Potential temporary/staging table definition 37 2.13.4.4 Processing Steps 37 2.13.4.5 Mapping document 37 2.13.5 Process 04 – Correction 38 2.13.5.1 Inputs 38 2.13.5.2 Outputs 39 2.13.5.3 Potential temporary/staging table definition 40 2.13.5.4 Processing Steps 40 2.13.5.5 Mapping document 42 2.13.6 Enhancements 42 2.13.6.1 FSDB Reversal Extract: 44 2.13.6.2 FSDB Reversal Extract with no impact to FDS/ODS 44 2.13.6.3 FSDB Reversal Extract with impact to FDS/ODS 45 2.14 Commit/Restart Processing 46 2.15 Error Processing 46 2.16 Architectural Mechanisms 46 2.17 Security 46

3. Run Control Execution 46

4. Issues 47

5. Glossary 47

6. APPENDIX – A 47

Revision History

|Date |Version |Description |Author |
|03/18/2009 |1.0 |Creation of initial version based on RX Claims |Krishna Mudhiganti / Phil Stevens|
|04/13/2009 |1.1 |Made revisions per initial review, added couple of |Krishna Mudhiganti |
| | |assumptions, added more process details, process flows | |
| | |one per each scenario, added details on enhancements to| |
| | |existing process, table definitions. | |
|04/14/2009 |1.2 |Modified Table Definitions section to list the table |Krishna Mudhiganti |
| | |names and provide a summary on them | |
|04/17/2009 |1.3 |Made changes as suggested by Phil from the review e.g.,|Krishna Mudhiganti |
| | |add new process status ‘P’ to state that the process is| |
| | |in progress, added more details on interface between | |
| | |the Reversal-Correction process and FSDB extract | |
| | |process. | |
|04/21/2009 |1.4 |Added details on Common utilities that will be used by |Krishna Mudhiganti |
| | |the process, file retention policy, made correction as | |
| | |suggested by the review. Added detail on table | |
| | |maintenance. | |
|06/01/2009 |1.5 |Added FSDB Reversal extract process |Bala Sandi |
|08/21/2009 |1.6 |Added process flows and Input output tables for Medical|Bala Sandi |
| | |claims, Capitation & Premium | |
|08/24/2009 |1.7 |Made corrections as per the QA review to match column |Krishna Mudhiganti |
| | |names with the actual names from the database and also | |
| | |added couple of assumptions and details related to | |
| | |medical claims (Rejournal claims). Added details on the| |
| | |logic to derive original schedule book date and | |
| | |schedule book date when the GL_PERIOD is closed. | |

Overview

1 Purpose

This project is to create a new process that will enable the current environment (FDS/ODS) to meet regulatory and financial reporting requirements of being able to support historically reports even when data in production is overlaid with changing/corrected information. Key purpose of this project is to build a process to correct a financial database’s information without losing audit trail of information getting changed over the course of period.

The benefit of establishing a new process to fix data in FDS/ODS is that we will maintain the integrity of the financial data allowing us to meet various regulatory requirements. This new process will save original records, reversal records, and correction records in the data store with sufficient detail and audit trail allowing UHG to recreate a snapshot of the detail at any given time.

This document will define the Reversal Correction processes, transformation/mapping rules, source and target extract layouts and table structures.

2 Scope

Enhanced capabilities of FDS/ODS to identify original records and process the same to create reversal and later perform correction of a transaction batch based on the scenario type. All records type codes (Original, Reversal, and Correction) will be stored to the data store.

Possible scenarios for reversal correction are: 1. Tagging error 2. Transformation error/Duplicate error 3. Source extract error

1 In Scope

• Medical Claims and RX Claims for corrections for all three scenarios listed above • Only PSI carrier for RX Claims is in scope • Revenue and Billed Membership for corrections only for PS tagging errors and transformation errors. • Correction of Capitation is again for errors due to wrong PS tagging rules or transformation errors. The source system corrects the data the following month and sends to FDS as the following month extract if there was any data issues (e.g. wrong cap rate for a provider resulting in wrong cap amount) in the prior month • FSDB – modify the existing extract process to interface with the new process • FDS – enhance existing load processes to support the new process • ODS – enhance existing load processes to support the new process • IFS – corrections related to FQA tagging and amounts • PRDS – based on the correction appropriate action needs to be taken on PRDS side to replicate the changes

2 Out of Scope

• Billed Membership and Revenue correction due to Source Error • Correction of Capitation due to Source Error • PRDS Eligibility • Galaxy • Cap Deducts from Settlements Plus are out of scope for this project since they are not PeopleSoft tagged • Pended and Payable Medical Claims are out of scope since they are not booked to the journals • Correction of IBNP only tables is out of scope since the process is scheduled for retirement by end of Q2 2009

The following table lists the scope and impact on the existing systems listed per subject area due to the listed correction types:
| |Medical Claims |RX Claims |Capitation |Premium/Billed Membership |
| |

3 Assumptions

|# |Assumption |Source |
|2.3.1 |P&P limitation of only one correction to any feed on any give day. |BRD |
|2.3.2 |Required information to be passed as parameters to identify detail records to be |HLD |
| |corrected will be provided before starting the process. | |
|2.3.3 |In case of correction due to Tagging error only PS Tagging data will be copied to the |HLD |
| |audit table and not the detail records. Audit table in this case will have the | |
| |original, reversed and corrected PS Tagging data only. | |
|2.3.4 |In case of correction due to Source Error data will be corrected for the entire |HLD |
| |transaction batch (extract cycle) assuming that the source system will send a file with| |
| |data for the entire period. | |
|2.3.5 |In case of RX Claims when correction is performed on the source side by sending a new |HLD |
| |feed then the extract that is sent to Galaxy will be suppressed. | |
|2.3.6 |In case of correction due to Transformation error data in the original detail tables |HLD |
| |will be corrected via an RDO. | |
|2.3.7 |In case of correcting duplicate issue there will be no reload of the data assuming that|HLD |
| |required information will be provided to identify duplicates. | |
|2.3.8 |Corrected data may not always match to the reversal data. |HLD |
|2.3.9 |Data Correction will use supplemental values based on the date of the correction not on|HLD |
| |the date of the original transactions. These include | |
| |Data extracted from PRDS to support PeopleSoft tagging. | |
| |Data extracted from NICE and Settlements Plus to support assignment of risk for Rx | |
| |Claims. | |
| |PeopleSoft and Oracle FQA tagging rules. | |
|2.3.10 |Data correction due to duplicate issue will be treated as Data Transformation Error. |HLD |
|2.3.11 |In case of Source Data Correction for Medical Claims subject area, extracts for all the|HLD |
| |companies from that source system are to be sent for the given period. | |
|2.3.12 |Correction due to tagging errors will not be initiated until a confirmation is received|HLD |
| |from the business group stating that the rules were updated. | |
|2.3.13 |In case of correction on top of correction or if the GL_PERIOD is closed in PeopleSoft |HLD |
| |then values for schedule book date and original schedule book date to be used in the | |
| |FSDB reversal and correction extracts will be provided. | |
|2.3.14 |In case of medical claims if a paid claim has a Rejournal claim in the following months|HLD |
| |then the risk that will be assigned to the paid claim as part of the correction file | |
| |will be as of latest | |
|2.3.15 |In case of medical claims whenever a paid claim is corrected using the reversal |HLD |
| |correction process for SDC scenario all the corresponding rejournal claims for that | |
| |paid claim will also be included in the reversal file and the same will be audited | |
| |along with the paid data. | |

4 Reference

This document will use references from the following artifacts.

Reversal-Correction BRD (Link)

Common ETL Framework (Link)

RX Claim Reversal-Correction Mapping (Link)

Medical Claim Reversal-Correction Mapping (Link)

Revenue Reversal-Correction Mapping (Link)

Capitation Reversal-Correction Mapping (Link)

Reversal-Correction FSDB Extract Mapping (Link)

Reversal-Correction Status Table Mapping (Link)

5 Functional Description – Reversal-Correction Process

1 Functional Overview

1 Current State Data Flow Diagrams

1 RX Claims

[pic]

2 Medical Claims

[pic]

3 Revenue

[pic]

4 Capitation

[pic]

2 Future State Data Flow Diagrams

1 RX Claims

[pic]

[pic]

2 Medical Claims

[pic]

[pic]

3 Revenue

[pic]

[pic]

4 Capitation

[pic]
[pic]

6 Related Application Requirements

Reference Requirement Traceability Matrix (RTM) - Functional & Non Functional Req tab at:

RTM for Reversal-Correction (Link)

Physical document name is:

7 Key Considerations

Listed below are some key considerations to be made as part of the Reversal-Correction process:

|In case correction was performed on the source side a new extract will be sent and will be processed using the existing load processes |
|on FDS/ODS. In this scenario: |
|Feeds that are sent to Galaxy for RX Claims must be suppressed |
|Feed to PRDS that is created in this scenario will be named differently from the regular extracts so that it’s not treated as a normal |
|file and required action will be taken on PRDS to fix the data using this corrected extract. |
|Required code changes need to be made to the ongoing FSDB extract process so that it does not send a feed to FSDB as it would normally |
|instead the new process that is getting build must do the FSDB extract process. |
|In case where a detail records is populated with a Correction Key then such records should not be picked by the existing FSDB extract |
|process. |
|Source will send a feed with the entire data for that period instead of sending selective records. |
|In case the correction was performed due to PS Tagging error following considerations need to be made: |
|Original, Reversal and Corrected records with just the PS tagging data will be save to the audit tables, details data will not be copied|
|since it’s correct. |
|Required code changes need to be made to the ongoing FSDB extract process so that it does not send a feed to FSDB as it would normally |
|instead the new process that is getting build must do the FSDB extract process. |
|In case correction was performed due to duplicate data issue then the Reversal-Correction process will follow Data Transformation |
|Correction (DTE) scenario. |

Impacted Objects/Modules/Programs/Files (if these will require modifications)

|Impact |Object/Module/Program/File Type |Object/Module/Program/File Name |
|(New, Enhancement) | | |
|Enhancements |DataStage |FSDB extract processes for each subject area |
|Enhancements |DataStage |RX Claims - GL15 process |
|Enhancements |DataStage |Medical Claims - GL16 process |
|New |Datastage |Reversal-Correction - Identification process for each |
| | |subject area |
|New |Datastage |Reversal-Correction – Reversal process for each subject |
| | |area |
|New |Datastage |Reversal-Correction – Delete process for each subject area|
|New |Datastage |Reversal-Correction – Correction process for each subject |
| | |area |

8 Source System Inputs

If the correction is performed on source a new corrected feed will be sent from source, listed below are sources by subject area that will be send a file in this scenario:

Medical Claims:

NICE RIMS ILIAD P5

RX Claim: CHF 6.0

Revenue: NICE RIMS ILIAD AR

Capitation: NICE ILIAD

File Specifications

Corrected files that are sent from the source side will be in the same layout that is used by the ongoing feeds that are currently being sent to Medical Claims/RX Claims processes (FDS/ODS).

9 FDS/ODS Inputs

Scenarios where correction is due to PS Tagging error or Transformation error Tables listed below will be used as input for the Reversal-Correction process:

Medical Claims:

• CLAIM_HEADER • CLAIM_DETAIL • CLAIM_PAYMENT • CLAIM_PAYMENT_DETAIL • CLAIM_PROVIDER • CLAIM_PS

RX Claims:

• RX_CLAIM • RX_CLAIM_PS

Capitation:

• IFS_FDS_CAP_PAY_DETLS • IFS_FDS_CAPITATION_FQA • CAPITATION_CHECK_DETAILS • CAPITATION_PS • ILIAD_CAP_PAY_DETLS

Revenue and Billed Membership:

• PREMIUM • PREMIUM_PS • PREMIUM_FQA

10 FDS/ODS Outputs

For all three correction scenarios Original, Reversal and Correction records will be saved to the corresponding audit tables by subject area:

Medical Claims:

• AUDIT_CLAIM_HEADER • AUDIT_CLAIM_DETAIL • AUDIT_CLAIM_PAYMENT • AUDIT_CLAIM_PAYMENT_DETAIL • AUDIT_CLAIM_PROVIDER • AUDIT_CLAIM_PS

RX Claims:

• AUDIT_RX_CLAIM • AUDIT_RX_CLAIM_PS

Capitation:

• AUDIT_IFS_FDS_CAP_PAY_DETLS • AUDIT_IFS_FDS_CAPITATION_FQA • AUDIT_CAPITATION_PS • AUDIT_ILIAD_CAP_PAY_DETLS

Revenue and Billed Membership:

• AUDIT_PREMIUM • AUDIT_PREMIUM_PS • AUDIT_PREMIUM_FQA

Common:

• REVERSAL_CORRECTION_STATUS

11 Logical Data Model Diagram – N/A

1 Table Definitions

Listed below are subject area specific tables that are used during the Reversal-Correction process:

RX Claims:
RX_CLAIM – a new column called CORRECTION_KEY is added to the existing table in ODS.

AUDIT_RX_CLAIM – new table will be created in ODS to maintain original, reversal and corrected detail level RX Claim data, this table is an exact copy of RX_CLAIM table with two additional fields (CORRECTION_KEY, RECORD_TYPE_CD) that are used by the Reversal-Correction Process.

AUDIT_RX_CLAIM_PS – new table will be created in ODS to maintain original, reversal and corrected detail level RX Claim PS Tagging data, this table is an exact copy of RX_CLAIM_PS table with two additional fields (CORRECTION_KEY, RECORD_TYPE_CD) that are used by the Reversal-Correction Process.

Refer to RX Claim Reversal-Correction Mapping (Link) for details on the above listed RX Claim specific tables.

Medical Claims:
CLAIM_HEADER - a new column called CORRECTION_KEY is added to the existing table in FDS.

AUDIT_CLAIM_HEADER - new table will be created in FDS to maintain original, reversal and corrected detail level Medical Claim Header data, this table is an exact copy of CLAIM_HEADER table with two additional fields (CORRECTION_KEY, RECORD_TYPE_CD) that are used by the Reversal-Correction Process.

AUDIT_CLAIM_DETAIL - new table will be created in FDS to maintain original, reversal and corrected detail level Medical Claim Detail data, this table is an exact copy of CLAIM_DETAIL table with two additional fields (CORRECTION_KEY, RECORD_TYPE_CD) that are used by the Reversal-Correction Process.

AUDIT_CLAIM_PAYMENT - new table will be created in FDS to maintain original, reversal and corrected detail level Medical Claim Payment data, this table is an exact copy of CLAIM_PAYMENT table with two additional fields (CORRECTION_KEY, RECORD_TYPE_CD) that are used by the Reversal-Correction Process.

AUDIT_CLAIM_PAYMENT_DETAIL - new table will be created in FDS to maintain original, reversal and corrected detail level Medical Claim Payment Detail data, this table is an exact copy of CLAIM_PAYMENT_DETAIL table with two additional fields (CORRECTION_KEY, RECORD_TYPE_CD) that are used by the Reversal-Correction Process.

AUDIT_CLAIM_PROVIDER - new table will be created in FDS to maintain original, reversal and corrected detail level Medical Claim Provider data, this table is an exact copy of CLAIM_PROVIDER table with two additional fields (CORRECTION_KEY, RECORD_TYPE_CD) that are used by the Reversal-Correction Process.

AUDIT_CLAIM_PS - new table will be created in FDS to maintain original, reversal and corrected detail level Medical Claim PeopleSoft data, this table is an exact copy of CLAIM_PS table with two additional fields (CORRECTION_KEY, RECORD_TYPE_CD) that are used by the Reversal-Correction Process.

Refer to Medical Claim Reversal-Correction Mapping (Link) for details on the above listed Medical Claim specific tables.

Revenue:
PREMIUM – a new column called CORRECTION_KEY is added to the existing table in ODS.

AUDIT_PREMIUM - new table will be created in ODS to maintain original, reversal and corrected detail level Premium data, this table is an exact copy of PREMIUM table with two additional fields (CORRECTION_KEY, RECORD_TYPE_CD) that are used by the Reversal-Correction Process.

AUDIT_PREMIUM_PS – new table will be created in ODS to maintain original, reversal and corrected detail level Premium PS Tagging data, this table is an exact copy of PREMIUM_PS table with two additional fields (CORRECTION_KEY, RECORD_TYPE_CD) that are used by the Reversal-Correction Process.

AUDIT_PREMIUM_FQA – new table will be created in ODS to maintain original, reversal and corrected detail level Premium FQA Tagging data, this table is an exact copy of PREMIUM_FQA table with two additional fields (CORRECTION_KEY, RECORD_TYPE_CD) that are used by the Reversal-Correction Process.

Refer to Revenue Reversal-Correction Mapping (Link) for details on the above listed Revenue specific tables.

Capitation:
IFS_FDS_CAP_PAY_DETLS - a new column called CORRECTION_KEY is added to the existing table in FDS.

ILIAD_CAP_PAY_DETLS - a new column called CORRECTION_KEY is added to the existing table in FDS.

AUDIT_IFS_FDS_CAP_PAY_DETLS - new table will be created in FDS to maintain original, reversal and corrected detail level Capitation Payment Details data, this table is an exact copy of IFS_FDS_CAP_PAY_DETLS table with two additional fields (CORRECTION_KEY, RECORD_TYPE_CD) that are used by the Reversal-Correction Process.

AUDIT_IFS_FDS_CAPIATION_FQA - new table will be created in FDS to maintain original, reversal and corrected detail level CAPITATION FQA Tagging data, this table is an exact copy of IFS_FDS_CAPIATION_FQA table with two additional fields (CORRECTION_KEY, RECORD_TYPE_CD) that are used by the Reversal-Correction Process.

AUDIT_CAPITATION_PS - new table will be created in FDS to maintain original, reversal and corrected detail level Capitation PS Tagging data, this table is an exact copy of CAPITATION_PS table with two additional fields (CORRECTION_KEY, RECORD_TYPE_CD) that are used by the Reversal-Correction Process.

AUDIT_ILIAD_CAP_PAY_DETLS - new table will be created in FDS to maintain original, reversal and corrected detail level Capitation Payment Details data, this table is an exact copy of ILIAD_CAP_PAY_DETLS table with two additional fields (CORRECTION_KEY, RECORD_TYPE_CD) that are used by the Reversal-Correction Process.

Refer to Capitation Reversal-Correction Mapping (Link) for details on the above listed Capitation specific tables.

Common:
REVERSAL_CORRECTION_STATUS – new status table will be created in FDS and ODS that is used by the Reversal-Correction process, this table is used for audit purposes. Each time the process is invoked entries are made to this table listing out individual processing steps along with required audit information e.g., records counts, dollar totals, process status codes, current and next processing steps, identification parameters.

Refer to Reversal-Correction Status Table Mapping (Link) for details on REVERSAL_CORRECTION_STATUS table.

12 Technical Description

Main purpose of this new process is to perform Reversal-Correction to the erroneous extract that was sent to FSDB, listed below are some key steps that will incorporated to the new process:

1. Based on the reason behind incorrect FSDB extract a correction scenario is identified and required information will be passed to this new process, this will include information required to identify what needs to be corrected e.g., batch number, extract period, and date ranges. 2. Based on the correction scenario and provided information first process to be invoked is the Identification process. In this step all the detail records in FDS/ODS that need to be corrected will be marked with an identifier. These original detail records will be copied to the corresponding audit table. 3. Once the records to be corrected are identified the same are used to create detail level reversal records that are saved to the audit tables, reversed detail records are used to create a reversal extract to FSDB. 4. Next step in the process is to cleanup original FDS/ODS tables based on the correction scenario. 5. Final step in the process is to perform correction. Correction process again depend on the scenario, if the correction was due to source extract error a corrected feed for that period will be sent to FDS/ODS and will be processed using existing subject area specific load programs with some additional enhancements. Once the data is loaded corrected details will then we copied over to the audit table. In case the correction was due to PeopleSoft Tagging error then data will be retagged and the corrected tags will be saved to the audit table. Once the correction is performed a correction file is extracted to be sent to FSDB. 6. During each step of the Reversal-Correction process an audit trail is maintained in a separate status table.

NOTE: Above listed processing steps are explained in detail in the following sections.

13 Processing Logic

1 Functional Process Flow

Source Data Correction (SDC) Scenario:
[pic]
Data Transformation Correction (DTC) / Duplicate (DUP) Correction Scenarios: [pic]

Tagging Correction (TAG) Scenario:
[pic]

2 Process 01 – Identification

This is the first step in the Reversal-Correction process as shown in the process flow diagram. Given the correction scenario and required parameters this process identifies all the detail records in FDS/ODS that need to be corrected and marks them for correction with an identifier (CORRECTION_KEY). New field called CORRECTION_KEY will be added to the detail table of each subject area. This field is normally left empty and will only be populated if there was a correction performed. Detail processing steps are listed in the section 3.1.2.4 below.

1 Inputs

|Subject Area Name |File/Table Name |Description |File/Table Layout |
|RX Claims |RX CLAIM |ODS RX Claim table with detail level data |RX Claim Reversal-Correction Mapping |
| | | |(Link) |
|RX Claims |RX_CLAIM_PS |ODS RX Claim PeopleSoft Tagging table |RX Claim Reversal-Correction Mapping |
| | | |(Link) |
|Medical Claims |CLAIM_HEADER |Claim header level data |Medical Claim Reversal-Correction |
| | | |Mapping (Link |
|Medical Claims |CLAIM_STAGE |Table to store the key fields ONLY which are | |
| | |common to ALL the CLAIM tables | |
|Medical Claims |CLAIM_DETAIL |Claim Detail lines | |
|Medical Claims |CLAIM_PS |Claim PeopleSoft Tagging table at line level | |
|Medical Claims |CLAIM_PAYMENT |Claim payment at Header level | |
|Medical Claims |CLAIM_PAYMENT_DETAIL |Claim payment with details on check payment | |
|Medical Claims |CLAIM_PROVIDER |Claim Provider demographic | |
|Revenue |PREMIUM |Revenue & Billed Membership details |Revenue Reversal-Correction Mapping |
| | | |(Link) |
|Revenue |PREMIUM_PS |Revenue & Billed Membership PeopleSoft tagged | |
|Capitation |IFS_FDS_CAP_PAY_DETLS |NICE Capitation Detail table |Capitation Reversal-Correction |
| | | |Mapping (Link) |
|Capitation |ILIAD_CAP_PAY_DETLS |ILIAD Capitation Detail table | |
|Capitation |CAPITATION_PS |CAP PS tagged for both NICE & ILIAD | |
|Capitation |CAPITATION_CHECK_DETAILS |Capitation Check Details for NICE CAP payment | |
|Capitation |IFS_FDS_CAPITATION_FQA |Capitation FQA tagged data for NICE | |
|Common |REVERSAL_CORRECTION_STATUS |Reversal-Correction audit trail table, this table |Reversal-Correction Status Table |
| | |hold process status, audit trial information |Mapping (Link) |
| | |during the process. | |

2 Outputs

|Subject Area Name|File/Table Name |Description |File/Table Layout |
|RX Claims |AUDIT_RX_CLAIM |Reversal correction audit table for RX Claim detail |RX Claim |
| | |data. Original, Reversal and Corrected detail level data|Reversal-Correction Mapping|
| | |for RX Claim is saved to this table during |(Link) |
| | |Reversal-Correction process. | |
|RX Claims |AUDIT_RX_CLAIM_PS |Reversal correction audit table for RX Claim PS detail |RX Claim |
| | |data. Original, Reversal and Corrected detail level PS |Reversal-Correction Mapping|
| | |tagging data for RX Claim is saved to this table during |(Link) |
| | |Reversal-Correction process. | |
|Medical Claims |AUDIT_CLAIM_HEADER |Audits reversal correction for Claim header level data |Medical Claim |
| | | |Reversal-Correction Mapping|
| | | |(Link) |
|Medical Claims |AUDIT_CLAIM_DETAIL |Audits reversal correction for Claim Detail lines | |
|Medical Claims |AUDIT_CLAIM_PS |Audits reversal correction for Claim PeopleSoft Tagging| |
| | |table at line level | |
|Medical Claims |AUDIT_CLAIM_PAYMENT |Audits reversal correction for Claim payment at Header | |
| | |level | |
|Medical Claims |AUDIT_CLAIM_PAYMENT_DETAIL |Audits reversal correction for Claim payment with | |
| | |details on check payment | |
|Medical Claims |AUDIT_CLAIM_PROVIDER |Audits reversal correction for Claim Provider | |
| | |demographic | |
|Revenue |AUDIT_APREMIUM |Audits reversal correction for Revenue & Billed |Revenue Reversal-Correction|
| | |Membership details |Mapping (Link) |
|Revenue |AUDIT_PREMIUM_PS |Audits reversal correction for Revenue & Billed | |
| | |Membership PeopleSoft tagged | |
|Capitation |AUDIT_IFS_FDS_CAP_PAY_DETLS |Audits reversal correction for NICE Capitation Detail |Capitation |
| | |table |Reversal-Correction Mapping|
| | | |(Link) |
|Capitation |AUDIT_ILIAD_CAP_PAY_DETLS |Audits reversal correction for ILIAD Capitation Detail | |
| | |table | |
|Capitation |AUDIT_CAPITATION_PS |Audits reversal correction for CAP PS tagged for both | |
| | |NICE & ILIAD | |
|Capitation |AUDIT_IFS_FDS_CAPITATION_FQA |Audits reversal correction for Capitation FQA tagged | |
| | |data for NICE | |
|Common |AUDIT_REVERSAL_CORRECTION_STATUS|Reversal-Correction audit trail table, this table hold |Reversal-Correction Status |
| | |process status, audit trial information during the |Table Mapping (Link) |
| | |process. | |

3 Potential temporary/staging table definition

|Subject Area Name|File/Table Name |Description |File/Table Layout |
| | | | |
| | | | |

4 Processing Steps

|Step # |Action |
|1a |Add a new line to the REVERSAL_CORRECTION_STATUS table with a new Correction Key, CURR_CORRECTION_STEP as IDENTIFICATION, |
| |STATUS_CD as ‘I’, PROCESS_SEQ_NBR as 1, CORRECTION_DATE as system date, CORRECTION_TYPE_CD populated with the appropriate |
| |correction scenario and SELECTION_PARAMETER as concatenated Name-Value pairs of parameters used for identification along |
| |with Subject Area. |
|1b |Update STATUS_CD to ‘P’ in REVERSAL_CORRECTION_STATUS table for the derived Correction Key where CURR_CORRECTION_STEP as |
| |IDENTIFICATION for the subject area to indicate that the process is in progress |
|2a |Identify detail records that need to be corrected based on the passed parameters |
|2b |Identified detail records are assigned the Correction Key in FDS/ODS original detail tables |
|3 |Copy the identified original records from FDS/ODS to the corresponding subject area specific audit tables and assign |
| |RECORD_TYPE_CD as ‘O’ along with Correction Key. |
| | |
| |What original data is copied to the audit tables is decided by the Correction Scenario: |
| |If correction is due to source error or Transformation Error then both detail and PS tagging data will be copied. |
| |If correction is due to PS Tagging error only the PS data corresponding to the marked detail records must be copied. |
|4 |Update the REVERSAL_CORRECTION_STATUS table with TOTAL_RECORDS_CNT, TOTAL_AMT, STATUS_CD is updated to ‘C’ and set |
| |NEXT_CORRECTION_STEP as ‘REVERSAL’ for the Correction Key, Subject Area where Process Id is IDENTIFICATION |
|5 |Insert a new row in the REVERSAL_CORRECTION_STATUS table using the same Correction Key, CURR_CORRECTION_STEP as REVERSAL |
| |and STATUS_CD as ‘I’, PROCESS_SEQ_NBR as 2, CORRECTION_DATE as system date, CORRECTION_TYPE_CD populated with the |
| |appropriate correction scenario and SELECTION_PARAMETER as concatenated Name-Value pairs of parameters used for |
| |identification along with Subject Area. |

5 Mapping document

Listed below are links to mapping document by subject area:

RX Claims:

RX Claim Reversal-Correction Mapping (Link)

Medical Claims:

Medical Claim Reversal-Correction Mapping (Link)

Revenue:

Revenue Reversal-Correction Mapping (Link)

Capitation:

Capitation Reversal-Correction Mapping (Link)

Reversal-Correction common mapping documents:

Reversal-Correction FSDB Extract Mapping (Link)

Reversal-Correction Status Table Mapping (Link)

Subject Area Specific FSDB Extract Layout (Link)

3 Process 02 – Reversal

Once the detail records to be corrected are identified the next step in the process is to perform a reversal. Again give the scenario and the correction key this process reads in the identified detail records to create reversals that will be copied to corresponding source specific audit tables. Once the details are reversed they will be used to create a reversal extract to FSDB. Detail processing steps are listed in the section 3.1.3.4 below.

1 Inputs

|Subject Area Name |File/Table Name |Description |File/Table Layout |
|RX Claims |RX CLAIM |ODS RX Claim table with detail level data |RX Claim Reversal-Correction Mapping |
| | | |(Link) |
|RX Claims |RX_CLAIM_PS |ODS RX Claim PeopleSoft Tagging table |RX Claim Reversal-Correction Mapping |
| | | |(Link) |
|Medical Claims |CLAIM_HEADER |Claim header level data |Medical Claim Reversal-Correction |
| | | |Mapping (Link) |
|Medical Claims |CLAIM_STAGE |Table to store the key fields ONLY which are | |
| | |common to ALL the CLAIM tables | |
|Medical Claims |CLAIM_DETAIL |Claim Detail lines | |
|Medical Claims |CLAIM_PS |Claim PeopleSoft Tagging table at line level | |
|Medical Claims |CLAIM_PAYMENT |Claim payment at Header level | |
|Medical Claims |CLAIM_PAYMENT_DETAIL |Claim payment with details on check payment | |
|Medical Claims |CLAIM_PROVIDER |Claim Provider demographic | |
|Revenue |PREMIUM |Revenue & Billed Membership details |Revenue Reversal-Correction Mapping |
| | | |(Link) |
|Revenue |PREMIUM_PS |Revenue & Billed Membership PeopleSoft tagged | |
|Capitation |IFS_FDS_CAP_PAY_DETLS |NICE Capitation Detail table |Capitation Reversal-Correction |
| | | |Mapping (Link) |
|Capitation |ILIAD_CAP_PAY_DETLS |ILIAD Capitation Detail table | |
|Capitation |CAPITATION_PS |CAP PS tagged for both NICE & ILIAD | |
|Capitation |CAPITATION_CHECK_DETAILS |Capitation Check Details for NICE CAP payment | |
|Capitation |IFS_FDS_CAPITATION_FQA |Capitation FQA tagged data for NICE | |
|Common |REVERSAL_CORRECTION_STATUS |Reversal-Correction audit trail table, this table |Reversal-Correction Status Table |
| | |hold process status, audit trial information |Mapping (Link) |
| | |during the process. | |

2 Outputs

|Subject Area Name |File/Table Name |Description |File/Table Layout |
|RX Claims |AUDIT_RX_CLAIM |Reversal correction audit table for RX |RX Claim Reversal-Correction |
| | |Claim detail data. Original, Reversal |Mapping (Link) |
| | |and Corrected detail level data for RX | |
| | |Claim is saved to this table during | |
| | |Reversal-Correction process. | |
|RX Claims |AUDIT_RX_CLAIM_PS |Reversal correction audit table for RX |RX Claim Reversal-Correction |
| | |Claim PS detail data. Original, |Mapping (Link) |
| | |Reversal and Corrected detail level PS | |
| | |tagging data for RX Claim is saved to | |
| | |this table during Reversal-Correction | |
| | |process. | |
|RX Claims |FSDB Extract |Layout of extract file to be sent to |RX Claims FSDB Extract Layout |
| | |FSDB |(Link) |
|Medical Claims |AUDIT_CLAIM_HEADER |Audits reversal correction for Claim |Medical Claim |
| | |header level data |Reversal-Correction Mapping |
| | | |(Link) |
|Medical Claims |AUDIT_CLAIM_DETAIL |Audits reversal correction for Claim | |
| | |Detail lines | |
|Medical Claims |AUDIT_CLAIM_PS |Audits reversal correction for Claim | |
| | |PeopleSoft Tagging table at line level | |
|Medical Claims |AUDIT_CLAIM_PAYMENT |Audits reversal correction for Claim | |
| | |payment at Header level | |
|Medical Claims |AUDIT_CLAIM_PAYMENT_DETAIL |Audits reversal correction for Claim | |
| | |payment with details on check payment | |
|Medical Claims |AUDIT_CLAIM_PROVIDER |Audits reversal correction for Claim | |
| | |Provider demographic | |
|Medical Claims |FSDB Extract |Layout of extract file to be sent to |Claims FSDB Extract Layout |
| | |FSDB |(Link) |
|Revenue |AUDIT_PREMIUM |Audits reversal correction for Revenue|Revenue Reversal-Correction |
| | |& Billed Membership details |Mapping (Link) |
|Revenue |AUDIT_PREMIUM_PS |Audits reversal correction for Revenue| |
| | |& Billed Membership Peoplesoft tagged | |
|Revenue |FSDB Extract |Layout of extract file to be sent to |Revenue FSDB Extract Layout |
| | |FSDB |(Link) |
|Capitation |AUDIT_IFS_FDS_CAP_PAY_DETLS |Audits reversal correction for NICE |Capitation Reversal-Correction |
| | |Capitation Detail table |Mapping (Link) |
|Capitation |AUDIT_ILIAD_CAP_PAY_DETLS |Audits reversal correction for ILIAD | |
| | |Capitation Detail table | |
|Capitation |AUDIT_CAPITATION_PS |Audits reversal correction for CAP PS | |
| | |tagged for both NICE & ILIAD | |
|Capitation |AUDIT_IFS_FDS_CAPITATION_FQA |Audits reversal correction for | |
| | |Capitation FQA tagged data for NICE | |
|Capitation |FSDB Extract |Layout of extract file to be sent to |Cap FSDB Extract Layout (Link) |
| | |FSDB | |
|Common |REVERSAL_CORRECTION_STATUS |Reversal-Correction audit trail table, |Reversal-Correction Status |
| | |this table hold process status, audit |Table Mapping (Link) |
| | |trial information during the process. | |
|FSDB Reversal |Rx Claims, Medical Claims, Revenue and Billed|Summarized file that hold all the |Subject Area Specific FSDB |
|Extract |Membership, Capitation |reversal records that need to be sent |Extract Layout (Link) |
| | |to FSDB | |

3 Potential temporary/staging table definition

|Subject Area Name|File/Table Name |Description |File/Table Layout |
|MEDICAL claims |CLAIM_STAGE |Table to store the key fields ONLY which are |Medical Claim Reversal-Correction |
| | |common to ALL the CLAIM tables |Mapping |

4 Processing Steps

|Step # |Action |
|1a |Get the Correction Key from REVERSAL_CORRECTION_STATUS table where CURR_CORRECTION_STEP is REVERSAL and STATUS_CD is ‘I’ |
| |for the Subject Area |
|1b |Update STATUS_CD to ‘P’ in REVERSAL_CORRECTION_STATUS table for the derived Correction Key where CURR_CORRECTION_STEP as |
| |REVERSAL for the subject area to indicate that the process is in progress |
|2 |Read records from FDS/ODS detail and PS Tagging tables that are marked with the Correction Key to create reversal records |
| |by negating the amounts. |
|3 |Reversed detail level records must be copied to the source specific audit tables while assigning RECORD_TYPE_CD as ‘R’ |
| |along with Correction Key. |
| | |
| |What reversal data is copied to the audit tables is decided by the Correction Scenario: |
| |If correction is due to source error or Transformation Error then both detail and PS tagging data will be copied. |
| |If correction is due to PS Tagging error only the PS data corresponding to the marked detail records must be copied. |
|4 |Using the detail level reversal records create Reversal extract to be sent to FSDB at a summarized level. |
| | |
| |All the detail level reversal records are saved to a file and must be passed to the FSDB extract process along with a |
| |Reversal-Correction Indicator, if this indicator is set to ‘REV’ then the FSDB extract process treats the file that’s |
| |being sent to it as a reversal file and will perform the required mapping and summarizes it as per the FSDB requirement. |
| | |
| |Use the following mapping rules/FSDB interface file requirements while creating reversal FSDB extract: |
| |Reversal-Correction FSDB Extract Mapping (Link) |
| |Extract File Requirements (Link) |
| |Subject Area Specific FSDB Extract Layout (Link) |
|5 |Update the REVERSAL_CORRECTION_STATUS table with TOTAL_RECORDS_CNT, TOTAL_AMT, STATUS_CD is updated to ‘C’ and set |
| |NEXT_CORRECTION_STEP as ‘DELETE’ for the Correction Key, Subject Area where CURR_CORRECTION_STEP is REVERSAL |
|6 |Insert a new row in the REVERSAL_CORRECTION_STATUS table using the same Correction Key, CURR_CORRECTION_STEP as DELETE and|
| |STATUS_CD as ‘I’, PROCESS_SEQ_NBR as 3, CORRECTION_DATE as system date, CORRECTION_TYPE_CD populated with the appropriate |
| |correction scenario and SELECTION_PARAMETER as concatenated Name-Value pairs of parameters used for identification along |
| |with Subject Area. |

5 Mapping document

Listed below are links to mapping document by subject area:

RX Claims:

RX Claim Reversal-Correction Mapping (Link)

Medical Claims:

Medical Claim Reversal-Correction Mapping (Link)

Revenue:

Revenue Reversal-Correction Mapping (Link)

Capitation:

Capitation Reversal-Correction Mapping (Link)

Reversal-Correction common mapping documents:

Reversal-Correction FSDB Extract Mapping (Link)

Reversal-Correction Status Table Mapping (Link)

Subject Area Specific FSDB Extract Layout (Link)

4 Process 03 – Delete

Next step in the Reversal-Correction process is to delete data from original subject area specific tables on FDS/ODS that were marked for correction based on the correction scenario. Detail processing steps are listed in section 3.1.4.4 below.

1 Inputs

|Subject Area Name |File/Table Name |Description |File/Table Layout |
|RX Claims |RX CLAIM |ODS RX Claim table with detail level data |RX Claim Reversal-Correction Mapping |
| | | |(Link) |
|RX Claims |RX_CLAIM_PS |ODS RX Claim PeopleSoft Tagging table |RX Claim Reversal-Correction Mapping |
| | | |(Link) |
|Medical Claims |CLAIM_HEADER |Claim header level data |Medical Claim Reversal-Correction |
| | | |Mapping (Link) |
|Medical Claims |CLAIM_STAGE |Table to store the key fields ONLY which are | |
| | |common to ALL the CLAIM tables | |
|Medical Claims |CLAIM_DETAIL |Claim Detail lines | |
|Medical Claims |CLAIM_PS |Claim PeopleSoft Tagging table at line level | |
|Medical Claims |CLAIM_PAYMENT |Claim payment at Header level | |
|Medical Claims |CLAIM_PAYMENT_DETAIL |Claim payment with details on check payment | |
|Medical Claims |CLAIM_PROVIDER |Claim Provider demographic | |
|Revenue |PREMIUM |Revenue & Billed Membership details |Revenue Reversal-Correction Mapping |
| | | |(Link) |
|Revenue |PREMIUM_PS |Revenue & Billed Membership PeopleSoft tagged | |
|Capitation |IFS_FDS_CAP_PAY_DETLS |NICE Capitation Detail table |Capitation Reversal-Correction |
| | | |Mapping (Link) |
|Capitation |ILIAD_CAP_PAY_DETLS |ILIAD Capitation Detail table | |
|Capitation |CAPITATION_PS |CAP PS tagged for both NICE & ILIAD | |
|Capitation |CAPITATION_CHECK_DETAILS |Capitation Check Details for NICE CAP payment | |
|Capitation |IFS_FDS_CAPITATION_FQA |Capitation FQA tagged data for NICE | |
|Common |REVERSAL_CORRECTION_STATUS |Reversal-Correction audit trail table, this table |Reversal-Correction Status Table |
| | |hold process status, audit trial information |Mapping (Link) |
| | |during the process. | |

2 Outputs

|Subject Area Name |File/Table Name |Description |File/Table Layout |
|RX Claims |AUDIT_RX CLAIM |Audits reversal correction for ODS RX Claim table |RX Claim Reversal-Correction Mapping |
| | |with detail level data |(Link) |
|RX Claims |AUDIT_RX_CLAIM_PS |Audits reversal correction for ODS RX Claim |RX Claim Reversal-Correction Mapping |
| | |PeopleSoft Tagging table |(Link) |
|Medical Claims |AUDIT_CLAIM_HEADER |Audits reversal correction for Claim header level|Medical Claim Reversal-Correction |
| | |data |Mapping (Link) |
|Medical Claims |AUDIT_CLAIM_DETAIL |Audits reversal correction for Claim Detail lines| |
|Medical Claims |AUDIT_CLAIM_PS |Audits reversal correction for Claim PeopleSoft | |
| | |Tagging table at line level | |
|Medical Claims |AUDIT_CLAIM_PAYMENT |Audits reversal correction for Claim payment at | |
| | |Header level | |
|Medical Claims |AUDIT_CLAIM_PAYMENT_DETAIL |Audits reversal correction for Claim payment with| |
| | |details on check payment | |
|Medical Claims |AUDIT_CLAIM_PROVIDER |Audits reversal correction for Claim Provider | |
| | |demographic | |
|Revenue |AUDIT_APREMIUM |Audits reversal correction for Revenue & Billed |Revenue Reversal-Correction Mapping |
| | |Membership details |(Link) |
|Revenue |AUDIT_PREMIUM_PS |Audits reversal correction for Revenue & Billed | |
| | |Membership PeopleSoft tagged | |
|Capitation |AUDIT_IFS_FDS_CAP_PAY_DETLS |Audits reversal correction for NICE Capitation |Capitation Reversal-Correction |
| | |Detail table |Mapping (Link) |
|Capitation |AUDIT_ILIAD_CAP_PAY_DETLS |Audits reversal correction for ILIAD Capitation | |
| | |Detail table | |
|Capitation |AUDIT_CAPITATION_PS |Audits reversal correction for CAP PS tagged for | |
| | |both NICE & ILIAD | |
|Capitation |AUDIT_IFS_FDS_CAPITATION_FQA |Audits reversal correction for Capitation FQA | |
| | |tagged data for NICE | |
|Common |AUDIT_REVERSAL_CORRECTION_STA|Reversal-Correction audit trail table, this table |Reversal-Correction Status Table |
| |TUS |hold process status, audit trial information |Mapping (Link) |
| | |during the process. | |

3 Potential temporary/staging table definition

|Subject Area Name |File/Table Name |Description |File/Table Layout |
|MEDICAL claims |CLAIM_STAGE |Table to store the key fields ONLY which are |Medical Claim Reversal-Correction |
| | |common to ALL the CLAIM tables |Mapping |
| | | | |

4 Processing Steps

|Step # |Action |
|1a |Get the Correction Key from REVERSAL_CORRECTION_STATUS table where CURR_CORRECTION_STEP is DELETE and STATUS_CD is ‘I’ for|
| |the Subject Area. |
|1b |Update STATUS_CD to ‘P’ in REVERSAL_CORRECTION_STATUS table for the derived Correction Key where CURR_CORRECTION_STEP as |
| |DELETE for the subject area to indicate that the process is in progress |
|2 |Based on the Correction Key and the correction scenario that is passed as a parameter data is deleted from subject area |
| |specific tables in FDS/ODS. |
| | |
| |Data to be deleted and what tables is decided by the Correction Scenario: |
| |If correction is due to source error then both detail and PS tagging data will be deleted based on the correction key. |
| |If correction is due to Transformation error only PS data corresponding to the marked detail records will be deleted based|
| |on the correction key. |
| |If correction is due to PS Tagging error only PS data corresponding to the marked detail records will be deleted based on |
| |the correction key. |
|3 |Update the REVERSAL_CORRECTION_STATUS table with TOTAL_RECORDS_CNT, STATUS_CD is updated to ‘C’ and set |
| |NEXT_CORRECTION_STEP as ‘CORRECTION’ for the Correction Key, Subject Area where CURR_CORRECTION_STEP is DELETE |
|4 |Insert a new row in the REVERSAL_CORRECTION_STATUS table using the same Correction Key, CURR_CORRECTION_STEP as CORRECTION|
| |and STATUS_CD as ‘W’, PROCESS_SEQ_NBR as 4, CORRECTION_DATE as system date, CORRECTION_TYPE_CD populated with the |
| |appropriate correction scenario and SELECTION_PARAMETER as concatenated Name-Value pairs of parameters used for |
| |identification along with Subject Area. |
| | |
| |STATUS_CD is set to ‘W’ so that the correction process is put on hold until an appropriate action is taken to correct data|
| |in the original tables in FDS/ODS. As soon the data in original tables is complete a manual RDO is performed to reset the |
| |STATUS_CD to ‘I’ so that the Correction process can be initiated. In case of SDC scenario correction process will be |
| |initiated once the corrected source file is processed to FDS/ODS, in case of DTC/DUP scenarios the correction process will|
| |be initiated once the data in FDS/ODS is fixed via an RDO and in case of TAG scenario correction process will be initiated|
| |only after the identified data is retagged on FDS/ODS. |

5 Mapping document

Listed below are links to mapping document by subject area:

RX Claims:

RX Claim Reversal-Correction Mapping (Link)

Medical Claims:

Medical Claim Reversal-Correction Mapping (Link)

Revenue:

Revenue Reversal-Correction Mapping (Link)

Capitation:

Capitation Reversal-Correction Mapping (Link)

Reversal-Correction common mapping documents:

Reversal-Correction FSDB Extract Mapping (Link)

Reversal-Correction Status Table Mapping (Link)

Subject Area Specific FSDB Extract Layout (Link)

5 Process 04 – Correction

This is the final step in the Reversal-Correction process, in this step based on the correction scenario data is corrected and a corrected FSDB extract is created. Detail level corrected data is copied from original tables from FDS/ODS to the corresponding audit tables. Detail processing steps are listed in section 3.1.5.4 below.

1 Inputs

|Subject Area Name |File/Table Name |Description |File/Table Layout |
|RX Claims |RX CLAIM |ODS RX Claim table with detail level data |RX Claim Reversal-Correction Mapping (Link) |
|RX Claims |RX_CLAIM_PS |ODS RX Claim PeopleSoft Tagging table |RX Claim Reversal-Correction Mapping (Link) |
|Medical Claims |CLAIM_HEADER |Claim header level data |Medical Claim Reversal-Correction Mapping |
| | | |(Link) |
|Medical Claims |CLAIM_STAGE |Table to store the key fields ONLY which | |
| | |are common to ALL the CLAIM tables | |
|Medical Claims |CLAIM_DETAIL |Claim Detail lines | |
|Medical Claims |CLAIM_PS |Claim PeopleSoft Tagging table at line | |
| | |level | |
|Medical Claims |CLAIM_PAYMENT |Claim payment at Header level | |
|Medical Claims |CLAIM_PAYMENT_DETAIL |Claim payment with details on check | |
| | |payment | |
|Medical Claims |CLAIM_PROVIDER |Claim Provider demographic | |
|Revenue |PREMIUM |Revenue & Billed Membership details |Revenue Reversal-Correction Mapping (Link) |
|Revenue |PREMIUM_PS |Revenue & Billed Membership PeopleSoft | |
| | |tagged | |
|Capitation |IFS_FDS_CAP_PAY_DETLS |NICE Capitation Detail table |Capitation Reversal-Correction Mapping (Link)|
|Capitation |ILIAD_CAP_PAY_DETLS |ILIAD Capitation Detail table | |
|Capitation |CAPITATION_PS |CAP PS tagged for both NICE & ILIAD | |
|Capitation |CAPITATION_CHECK_DETAILS |Capitation Check Details for NICE CAP | |
| | |payment | |
|Capitation |IFS_FDS_CAPITATION_FQA |Capitation FQA tagged data for NICE | |
|Common |REVERSAL_CORRECTION_STATUS |Reversal-Correction audit trail table, |Reversal-Correction Status Table Mapping |
| | |this table hold process status, audit |(Link) |
| | |trial information during the process. | |

2 Outputs

|Subject Area Name |File/Table Name |Description |File/Table Layout |
|RX Claims |AUDIT_RX_CLAIM |Reversal correction audit table for|RX Claim Reversal-Correction Mapping |
| | |RX Claim detail data. Original, |(Link) |
| | |Reversal and Corrected detail level| |
| | |data for RX Claim is saved to this | |
| | |table during Reversal-Correction | |
| | |process. | |
|RX Claims |AUDIT_RX_CLAIM_PS |Reversal correction audit table for|RX Claim Reversal-Correction Mapping |
| | |RX Claim PS detail data. Original, |(Link) |
| | |Reversal and Corrected detail level| |
| | |PS tagging data for RX Claim is | |
| | |saved to this table during | |
| | |Reversal-Correction process. | |
|RX Claims |FSDB Extract |Layout of extract file to be sent |RX Claims FSDB Extract Layout (Link) |
| | |to FSDB | |
|Medical Claims |AUDIT_CLAIM_HEADER |Audits reversal correction for Claim|Medical Claim Reversal-Correction |
| | |header level data |Mapping (Link) |
|Medical Claims |AUDIT_CLAIM_DETAIL |Audits reversal correction for Claim| |
| | |Detail lines | |
|Medical Claims |AUDIT_CLAIM_PS |Audits reversal correction for Claim| |
| | |PeopleSoft Tagging table at line | |
| | |level | |
|Medical Claims |AUDIT_CLAIM_PAYMENT |Audits reversal correction for Claim| |
| | |payment at Header level | |
|Medical Claims |AUDIT_CLAIM_PAYMENT_DETAIL |Audits reversal correction for Claim| |
| | |payment with details on check payment| |
|Medical Claims |AUDIT_CLAIM_PROVIDER |Audits reversal correction for Claim| |
| | |Provider demographic | |
|Medical Claims |FSDB Extract |Layout of extract file to be sent to |Claims FSDB Extract Layout (Link) |
| | |FSDB | |
|Revenue |AUDIT_APREMIUM |Audits reversal correction for |Revenue Reversal-Correction Mapping |
| | |Revenue & Billed Membership details |(Link) |
|Revenue |AUDIT_PREMIUM_PS |Audits reversal correction for | |
| | |Revenue & Billed Membership | |
| | |Peoplesoft tagged | |
|Revenue |FSDB Extract |Layout of extract file to be sent to |Revenue FSDB Extract Layout (Link) |
| | |FSDB | |
|Capitation |AUDIT_IFS_FDS_CAP_PAY_DETLS |Audits reversal correction for NICE |Capitation Reversal-Correction |
| | |Capitation Detail table |Mapping (Link) |
|Capitation |AUDIT_ILIAD_CAP_PAY_DETLS |Audits reversal correction for ILIAD| |
| | |Capitation Detail table | |
|Capitation |AUDIT_CAPITATION_PS |Audits reversal correction for CAP | |
| | |PS tagged for both NICE & ILIAD | |
|Capitation |AUDIT_IFS_FDS_CAPITATION_FQA |Audits reversal correction for | |
| | |Capitation FQA tagged data for NICE | |
|Capitation |FSDB Extract |Layout of extract file to be sent to |Cap FSDB Extract Layout (Link) |
| | |FSDB | |
|Common |AUDIT_REVERSAL_CORRECTION_STATUS |Reversal-Correction audit trail |Reversal-Correction Status Table |
| | |table, this table hold process |Mapping (Link) |
| | |status, audit trial information | |
| | |during the process. | |

3 Potential temporary/staging table definition

|Subject Area Name|File/Table Name |Description |File/Table Layout |
| | | | |
| | | | |

4 Processing Steps

|Step # |Action |
|1 |Based on the correction scenario that is passed as a parameter Correction process has to take the following paths: |
| | |
| |1. If correction is due to source error then: |
| |A new extract file for the erroneous period will be resent by the source provided the extract information |
| |A new process needs to be added to the existing Medical Claims/RX Claims load process to check if Accounting Period |
| |Date, Source System ID, Claim Status Code for Medical Claims or Plan Bill Date for RX Claims from the incoming extract |
| |match to a corresponding name value pairs in SELECTION_PARAMETER in the REVERSAL_CORRECTION_STATUS table based on the |
| |subject area where STATUS_CD is ‘W’, CORRECTION_TYPE_CD_CD is ‘SDC’ and CURR_CORRECTION_STEP is CORRECTION, if a match |
| |is found then get the corresponding Correction Key |
| |Once the Correction Key is derived the file is process as any other file, only enhancement would be to pass the |
| |Correction Key along with every detail record in the file and populate it in the original detail tables in FDS/ODS |
| |Once the load of corrected source file is complete then reset the STATUS_CD to ‘I’ in REVERSAL_CORRECTION_STATUS table |
| |based on the subject area where STATUS_CD is ‘W’, CORRECTION_TYPE_CD_CD is ‘SDC’ and CURR_CORRECTION_STEP is CORRECTION |
| |for the Correction Key so that the FSDB Correction Process is initiated |
| |Once the correction process is initiated update STATUS_CD to ‘P’ in REVERSAL_CORRECTION_STATUS table for the derived |
| |Correction Key where CURR_CORRECTION_STEP as CORRECTION for the subject area to indicate that the process is in progress|
| |Correction process then reads in all the detail level records along with the PS Tagging data for the Correction Key from|
| |the original tables from FDS/ODS and copy the data to the corresponding audit detail and PS tables by assigning |
| |RECORD_TYPE_CD as ‘C’ along with Correction Key |
| |Using the corrected detail records and tagged PS data generate a Correction extract to be sent to FSDB in the next step |
| | |
| |2. If correction is due to Transformation error then: |
| |Once the transformation issues on all the source specific detail records are fixed via an RDO then reset the STATUS_CD |
| |to ‘I’ in REVERSAL_CORRECTION_STATUS table based on the subject area where STATUS_CD is ‘W’, CORRECTION_TYPE_CD_CD is |
| |‘DTC’ and CURR_CORRECTION_STEP is CORRECTION for the Correction Key and the appropriate period in the name value pair in|
| |SELECTION_PARAMETER so that the FSDB Correction Process is initiated |
| |Once the correction process is initiated update STATUS_CD to ‘P’ in REVERSAL_CORRECTION_STATUS table for the derived |
| |Correction Key where CURR_CORRECTION_STEP as CORRECTION for the subject area to indicate that the process is in progress|
| |Correction process then reads in all the detail level data from FDS/ODS original tables that were marked for correction |
| |with the passed Correction Key and copies the same to corresponding audit detail tables by assigning RECORD_TYPE_CD as |
| |‘C’ along with Correction Key |
| |Using the detail records perform retagging (Refer to next scenario on details about retagging process) and insert the PS|
| |tagging information to source specific PS table in FDS/ODS |
| |Copy the newly tagged PS data to the corresponding audit PS tables by assigning RECORD_TYPE_CD as ‘C’ along with |
| |Correction Key |
| |Using the corrected detail records and retagged PS data generate a Correction extract to be sent to FSDB in the next |
| |step |
| | |
| |3. If correction is due to PS Tagging error then: |
| |Once the identified data in FDS/ODS is retagged the reset the STATUS_CD to ‘I’ in REVERSAL_CORRECTION_STATUS table |
| |based on the subject area where STATUS_CD is ‘W’, CORRECTION_TYPE_CD_CD is ‘TAG’ and CURR_CORRECTION_STEP is CORRECTION |
| |for the Correction Key and the appropriate period in the name value pair in SELECTION_PARAMETER so that the FSDB |
| |Correction Process is initiated |
| |Once the correction process is initiated update STATUS_CD to ‘P’ in REVERSAL_CORRECTION_STATUS table for the derived |
| |Correction Key where CURR_CORRECTION_STEP as CORRECTION for the subject area to indicate that the process is in progress|
| |Read all the source specific detail records from FDS/ODS original tables that were marked for correction with the passed|
| |Correction Key |
| |Using the detail records perform retagging and insert the PS tagging information to source specific PS table in FDS/ODS |
| |Copy the newly tagged PS data to the corresponding audit PS table by assigning RECORD_TYPE_CD as ‘C’ along with |
| |Correction Key |
| |Using the original detail records and retagged PS data generate a Correction extract to be sent to FSDB in the next step|
|2 |Using the detail level corrected records create a Correction extract to be sent to FSDB at a summarized level. |
| | |
| |All the detail level correction records are saved to a file and must be passed to the FSDB extract process along with a |
| |Reversal-Correction Indicator, if this indicator is set to ‘COR’ then the FSDB extract process treats the file that’s |
| |being sent to it as a correction file and will perform the required mapping and summarizes it as per the FSDB |
| |requirement. |
| | |
| |Use the following mapping rules/FSDB interface file requirements while creating Correction FSDB extract: |
| |Reversal-Correction FSDB Extract Mapping (Link) |
| |Extract File Requirements (Link) |
| |Subject Area Specific FSDB Extract Layout (Link) |
|3 |Update the REVERSAL_CORRECTION_STATUS table with TOTAL_RECORDS_CNT, TOTAL_AMT, STATUS_CD is updated to ‘C’ and set NULL |
| |to NEXT_CORRECTION_STEP for the Correction Key, Subject Area where CURR_CORRECTION_STEP is CORRECTION |

5 Mapping document

Listed below are links to mapping document by subject area:

RX Claims:

RX Claim Reversal-Correction Mapping (Link)

Medical Claims:

Medical Claim Reversal-Correction Mapping (Link)

Revenue:

Revenue Reversal-Correction Mapping (Link)

Capitation:

Capitation Reversal-Correction Mapping (Link)

Reversal-Correction common mapping documents:

Reversal-Correction FSDB Extract Mapping (Link)

Reversal-Correction Status Table Mapping (Link)

Subject Area Specific FSDB Extract Layout (Link)

6 Enhancements

Listed below are details on enhancements that need to be made to existing processes so that the new Reversal-Correction process can interface well:

Subject Area Specific:

RX Claims – GL15 process: A new pre-process is to be added to the existing RX Claims load process, in case of correction due to source data error a new extract file will be sent and will be processed using existing GL15 process. To treat this file as a correction file a new pre-process has to be put in place to perform the following steps:

• Capture the Plan Bill Date from the incoming extract and see if it matches to a corresponding name value pair in SELECTION_PARAMETER in the REVERSAL_CORRECTION_STATUS table based on the subject area where STATUS_CD is ‘W’, CORRECTION_TYPE_CD_CD is ‘SDC’ and CURR_CORRECTION_STEP is CORRECTION, if a match is found then get the corresponding Correction Key • Pass this derived Correction Key as a parameter to be used later to populate RX_CLAIM table for all the detail claims that get inserted as part of this load so that the Reversal-Correction process can later copy them to the corresponding subject area specific audit tables based on the Correction Key • PRDS extract that is create once the load of RX Claims data is complete must be sent to a different landing zone so that the same can be used later to fix data on the PRDS side • Once the load is complete then reset the STATUS_CD to ‘I’ via an RDO in REVERSAL_CORRECTION_STATUS table based on the subject area where STATUS_CD is ‘W’, CORRECTION_TYPE_CD_CD is ‘SDC’ and CURR_CORRECTION_STEP is CORRECTION for the Correction Key so that the FSDB Correction Process is initiated

Please refer to RX Claim HLD for more details on existing process.

Medical Claims – GL16 process: A new pre-process is to be added to the existing Medical Claims load process, in case of correction due to source data error a new extract file will be sent and will be processed using existing GL16 process. To treat this file as a correction file a new pre-process has to be put in place to perform the following steps:

• Capture the Accounting Period Date, Source System ID, Claim Status Code from the incoming extract and see if it matches to a corresponding name value pair in SELECTION_PARAMETER in the REVERSAL_CORRECTION_STATUS table based on the subject area where STATUS_CD is ‘W’, CORRECTION_TYPE_CD_CD is ‘SDC’ and CURR_CORRECTION_STEP is CORRECTION, if a match is found then get the corresponding Correction Key • Pass this derived Correction Key as a parameter to be used later to populate CLAIM_HEADER/CLAIM_DETAIL tables for all the header/detail claims that get inserted as part of this load so that the Reversal-Correction process can later copy them to the corresponding subject area specific audit tables based on the Correction Key • PRDS extract that is create once the load of Medical Claims data is complete is named different from that of the regular files so that the same can be used later to fix data on the PRDS side • Once the load is complete then reset the STATUS_CD to ‘I’ via an RDO in REVERSAL_CORRECTION_STATUS table based on the subject area where STATUS_CD is ‘W’, CORRECTION_TYPE_CD_CD is ‘SDC’ and CURR_CORRECTION_STEP is CORRECTION for the Correction Key so that the FSDB Correction Process is initiated • All updated reports due to correction must be sent to finance team

Please refer to Medical Claim HLD for more details on existing process.

All Subject Areas: A stand alone retagging process will be created for each subject area to read the identified detail records based on the CORRECTION_KEY to perform PS tagging and then load the PS tagged data to the corresponding subject area specific PS table.

FSDB Extract: Existing FSDB extract process must be modified so that it is called only for incremental files. Following modifications need to be made: • The FTP process that transfers a zero byte trigger file to start the FSDB process must not be called in case a file was reprocessed due to Source Data Correction • Reversal and correction must be done by the new process and the parameter (REVERSAL_CORRECTION_IND) that is used by existing process will always be set to ‘NO’ • Existing FSDB extract process that will be used for ongoing incremental extracts must only extract data from RX_CLAIM where CORRECTION_KEY is NULL, any detail level data that is marked for correction by a Correction Key will be reversed and corrected by the new process

1 FSDB Reversal Extract:

One of the following two processes will be followed to create FSDB Reversal process: • FSDB Reversal extract having no impact to FDS/ODS • FSDB Reversal extract having impact to FDS/ODS

2 FSDB Reversal Extract with no impact to FDS/ODS

If no impact to FDS/ODS then the FSDB Reversal extract will follow the current Reversal process. [pic] FTS will GET from FSG/FSDB the fully-tagged file that has been identified by the business (UHG Finance) for the Reversal. FTS then performs the step to reverse the G/L Amounts – those that are positive become negative, and those that are negative become positive. (GL_A_AMT is highlighted as an example below.) FTS updates the GL Journal ID field in each record adding “R” to the end of the field, and then creates and sends the appropriate file(s) to FSDB. FTS will also need to update the ORIG-SCHED-BK-DT and RVRS-CORR-CD fields. If the GL period is closed, then SCHED-BK-DT field may also need to be updated to create unique records. The date for the SCHED_BK_DT will be passed from business and have to be forced in through the CFW parameter.

Record in Tagged File sent from FSDB to FTS for Reversal:

|GL Journal Identification |PHSNI0301 |
|DISTRB_STAT_CD |B |
|GL_A_AMT |+432.65 |
|Underwriter Code |4 |
|TPA Identifier |DFLX |
|Key Date |2008-03-07 |
|PS Business Unit |Tagged |30000 |

Record in Reversal File sent from FTS to FSDB:

|GL Journal Identification |PHSNI0301R |
|DISTRB_STAT_CD |B |
|GL_A_AMT |-432.65 |
|Underwriter Code |4 |
|TPA Identifier |DFLX |
|Key Date |2008-03-07 |
|ORIG-SCHED-BK-DT |2008-02-27 |
|RVRS-CORR-CD |Y |
|SCHED-BK-DT |2008-02-27 |
|PS Business Unit |Tagged |30000 |

3 FSDB Reversal Extract with impact to FDS/ODS

[pic]

If FDS/ODS fields are impacted then the FSDB Reversal extract will follow the new Reversal process. FDS/ODS Reversal process will create the extract for Reversal from FDS/ODS. FSDB Reversal extract job will be run on those source file created from FDS/ODS.

FTS then performs the step to reverse the G/L Amounts – those that are positive become negative, and those that are negative become positive. (GL_A_AMT is highlighted as an example below.) FTS updates the GL Journal ID field in each record adding “R” to the end of the field, and then creates and sends the appropriate file(s) to FSDB. FTS will also need to update the ORIG-SCHED-BK-DT and RVRS-CORR-CD fields. If the GL period is closed, then SCHED-BK-DT field may also need to be updated to create unique records. The date for the SCHED_BK_DT will be passed from business and have to be forced in through the CFW parameter.

In case the GL PERIOD is closed in PeopleSoft then we will use the following logic to assign scheduled book date and original schedule book date for the reversal correction process:

Logic for the reversal extract: ORIG-SCHED-BK-DT = SCHED-BK-DT from the original file SCHED-BK-DT = new date from business provided via an OM ticket

Logic for the correction extract: ORIG-SCHED-BK-DT = SCHED-BK-DT from the original file SCHED-BK-DT = the new date from business provided in the OM ticket

Refer to following links for existing subject area specific designs:

RX Claims: RX Claims FSDB Extract HLD

Medical Claims: Medical Claims FSDB Extract HLD

Revenue: Revenue FSDB Extract HLD Billed Membership FSDB Extract HLD

Capitation: Capitation FSDB Extract HLD

NOTE: Refer to Subject Area Specific FSDB Extract Layout for extract layouts.

14 Commit/Restart Processing

• During the DataStage processing the job can restart from the failure point and/or from the beginning of the process

15 Error Processing

• DataStage error processing and management will be done using the common error management frame work

16 Architectural Mechanisms

N/A

17 Security

• N/A—This is a batch process and all the relevant data security will be managed via Managed Services Guidelines and Processes

Run Control Execution

• Autosys will be utilized for execution and managing job dependencies

Issues

Glossary

|Term |Definition |
|Autosys |Enterprise scheduling tool |
|Batch status |A batch run status |
|CFW |Common Frame Work |
|Inbound audit |Incoming file verification process |
|Outbound audit |Outgoing file verification process |
|BRD |Business Requirements Document |
|PRDS |Pacific Region Data Store |
|FDS |Financial Data Store-Pulls together and stores all medical and capitation claim |
| |activity from the multiple systems (NICE, RIMS). FDS reaches out to get the |
| |Financial Tags |
|ODS |Operational Data Store- Stores billed membership, revenue and pharmacy claims |
| |and communizes those data structures together |
|FSDB |Financial Summary Database. Houses not only structure attributes but also GL |
| |string. Feeder to People Soft GL and other downstream applications. |
|FTS |Financial Tagging Service |
|GL |General Ledger |
|RPS |Reserve Production System- Claim reserving engine |
|UP |United Platform. A single platform that will serve as a common platform for |
| |business administered on |
|HLD |High Level Design |
|PS |PeopleSoft |

DI&A Terms and Acronyms

APPENDIX – A

Utilities:

ResetCorrectionStatus: A Common process to reset STATUS_CD in REVERSAL_CORRECTION_STATUS table will be created, given the CORRECTION_KEY, CURR_CORRECTION_STEP and Subject Area this process will reset value of STATUS_CD with the newly passed value. This process can be called on ad-hoc basis as required.

File retention policy:

At any given time a file that’s saved to the server will be retained for 15 days from the creation date before it is backed up to a local tape for the next 90 days, turn around time to retrieve the file from tape can take up to 3 days. Same policy will be applied for any file that’s created out of this process and required arrangements need to be made to retrieve any file.

[pic]

Similar Documents

Premium Essay

Testing

...Non-Functional Testing and Security Testing in Mobile Application Development Abstract Smart-phones have become part of human life. As smartphones become more powerful and usage rises, Smartphone makers have a much wider range of innovation possibilities than their PC counterparts. The personal nature and pocket size of mobile phones and their potential offer a wide scope for developing distinctive handset models targeted at a specific segment of the smart-phone market. The mobile application market’s growth is driven by the widespread push of advanced handset capabilities by the mobile industry and the increasingly-connected global consumer base. Progress of network technologies, restructuring of revenue-sharing pattern, lowering of mobile data usage cost, growing adoption of smart phones, and increase in application usability have contributed to the growth of mobile application adoption globally. This trend has led to substantial surge in the dependence and usage of the mobile Internet, specifically mobile applications. Mobile Application Development is the method by which application software is produced for low power handling devices, mobile devices, and other small digital equipment. As this technological development continues to gain momentum, it's quickly turning into one of the most powerful industries in the world. Majority of the mobile application testers tend to focus more on testing the product against client requirements – Functional testing and pay......

Words: 10078 - Pages: 41

Premium Essay

Testing

...Impact of Inspection and Testing on Quality of Software; a Comparison Naila Bashir Awan, Tooba Ahmad and Mehreen Ahmed KEYWORDS: Quality Assurance, Software testing, Inspection, testing. comparison. The methodology being used is empirical research. This research paper will answer the following questions. • • Are both testing and inspection necessary for software quality assurance? Which Technique (testing or inspection) is better for checking the quality of code? Abstract---Developing software systems involves a series of activities where there are many possibilities to make errors. Thus, software development should always be accompanied by quality assurance (QA) activities. Inspection and testing are two common QA activities, which are often used in different phases of the software development life cycle (SDLC). This research addresses the basic question that which technique is better and are both necessary. But we come to know that both testing and inspection are important defect removal activities and equally effective. 1. INTRODUCTION Quality means the degree to which a system, component, or process meets customer or user needs or expectations. [1] Quality Assurance is set of activities designed to evaluate the process by which products are developed or manufactured. [3]All major software developers stress software quality assurance and try to remove bugs before release. It’s easy to review code but fail to notice significant errors. Thus, software development......

Words: 3074 - Pages: 13

Premium Essay

Testing

...test testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest testtest......

Words: 1101 - Pages: 5

Free Essay

Testing

...your reference in testing services Test Coördinatie Introductie 1 Gent, 4 april 2011 Wat denken jullie? Inleiding Kick off Teststrategie Testaanpak Testbegroting Organisatie Beheren Rapporteren Evaluatie Ondersteuning Wat verstaan jullie onder testen? En testcoördinatie? Hoe zien jullie het? 2 Wat is testen? Inleiding Testen bestaat uit activiteiten die uitgevoerd worden om één of meerdere kenmerken van een product, proces of dienst vast te stellen volgens een gespecifieerde methode Testen is een proces dat inzicht geeft in- en adviseert over de kwaliteit en de daaraan gerelateerde risico‟s Kick off Teststrategie Testaanpak Testbegroting Organisatie Beheren Rapporteren Evaluatie Ondersteuning 3 Definities volgens TMAP Next® Wat is een test level? Inleiding Kick off Teststrategie Testaanpak Testbegroting Organisatie Beheren Rapporteren Evaluatie Ondersteuning Een test level is een groep van testactiviteiten die gezamenlijk worden uitgevoerd en aangestuurd 4 Definities volgens TMAP Next® Wat is coördinatie? Johan Symons, “Introductie tot de psychomotoriek” coördinatie = het harmonisch en economisch samenwerken van spieren, zenuwen en zintuigen om doelgerichte, stabiele bewegingsakties en snelle situatie - aangepaste reacties (reflex) tot stand te brengen. Voor een optimale samenwerking dienen volgende aspecten in acht te worden genomen : ‣ ‣ ‣ een juiste krachtmaat (bewegingsomvang en snelheid) een juiste......

Words: 3788 - Pages: 16

Premium Essay

Software Testing

...Software Testing Techniques Manpreet Kaur1 and Rupinder Singh2 1 Department of CSE CGC, Gharuan Mohali, India 2 CSE CGC, Gharuan Mohali, India Abstract Software testing is important to reduce errors, maintenance and overall software costs. One of the major problems in software testing area is how to get a suitable set of test cases to test a software system. We identify a number of concepts that every software engineering student and faculty should have learned. There are now many testing techniques available for generating test cases. This set should ensure maximum effectiveness with the least possible number of test cases. The main goal of this paper is to analysed and compare the testing technique to find out the best one to find out the error from the software. Keywords: Software testing; process model; testing techniques; 1. Introduction Software testing is a process or a series of processes designed to verify computer code does what it was designed to do. According to ANSI/IEEE 1059 standard [1, 2], Testing can be defined as ―A process of analyzing a software item to detect the differences between existing and required conditions (that is defects/errors/bugs) and to evaluate the features of the software item. Another more appropriate definition is this: [3] Testing is the process of executing a program with the intent of finding errors. The concept of testing is as old as coding and is change along with time. Gelperin and Hetzel [4] proposed the concept of the......

Words: 4928 - Pages: 20

Premium Essay

Animal Testing

...Humans have used animals for different uses. They have been used for food, clothing farm work and a variety of other uses. So using them to test new medical advances is different. Animal testing for medical purpose help saves lives and future generations. Animal testing should be continued for the use within the medical field. The ancient Greeks believed that animals were created by the gods to be used however people wish. The Bible says God gave man dominions “over the fish of the sea, over the birds of the air, and over the cattle, over all the earth and over every creeping things that creeps on the earth” (Genesis 9:1-3). The ancient Greeks and Romans influenced the laws of western civilization. The western civilization had no laws saying what you could not do to an animal no matter how cruel or unnecessary the act was (Thorburn). To some people animals have no rights at all while to others animals have rights and should not fell unnecessary pain and suffering. The people who believe animals have no rights; and use them just for their benefits but there is a line that should not be crossed animals do have feelings and some rights. The new movement of animal right groups has some good points like human like primates should not be used in testing like chimpanzees. The first law put in place by western civilizations was in the Massachusetts Bay colony. The law states that it is illegal to exercise any tyranny or cruelty towards any animal which are kept for use by......

Words: 1491 - Pages: 6

Premium Essay

Testing Plan

...3.0 TESTING There are many types of testing such as inspection, walkthrough, desk checking, unit test, integration test, stub test and system test. Inspection, walkthrough and desk checking was implemented by development team. Each module of system is test alone in attempt to discover errors in code. By using several of test, the potential error is revealed and action being taken to improve the performance of the system. The objectives of test planning are: • Record, organize, and guide testing activities • Schedule testing activities according to the test strategy and project deadlines • Provide a basis for re-testing during system maintenance • Provide a basis for evaluating and improving testing process The testing process required in implementation phase being began from planning phase which are determining part of system needs to be tested and also collecting test data. After that, come to analysis phase, testing requirements are list out by relating it with system requirements. HL Northern Enterprise development team used several types of testing toward system that consists of manual and computer conduct. Inspection being executed by team and subtle errors are being examined with the checklist. The information of errors occurred is investigated and documented to avoid making same types errors in future work. In addition, the automated inspection software is being implemented for detecting the routine error and content mistake. HL Northern Enterprise cooperates......

Words: 625 - Pages: 3

Premium Essay

Animal Testing

...¬¬¬Animal testing is always on the debate through the past century with the rapid development of technology and medication industry. Animals are used in generally three purposes Biomedical and behavior research, Education, and Drug and product testing. With the development of these industries, animal testing becomes a hot topic. On one side, people tries to protect animals since they think all the organisms are equal. On the other side however, scientist and some anthropologists who stand on human’s perspective point out that all the efforts we have paid to try to be nice to animals are just because we are humans and we are the dominant force on this earth. The better position should be --- we as humans should protect animals since they live on the same planet as we do, but the first priority of all the creatures are to survive which is very cruel but very true. Therefore, humans have the right to make their lives better by conducting a certain level of animal testing. Animal testing is essential for human beings to cure their diseases. The record of animal would be traced back to at least 2000 years ago with the first record made in the third century B.C. In Egypt, philosopher and scientist Erisistratus used animals to study body functions. About five centuries later, the roman physician Galen proved that theory by conducting an animal test and finally uncovered the mask of body function (Research Animals, History, n.d). According to the FBR, (Foundation for Biomedical......

Words: 1088 - Pages: 5

Free Essay

Animal Testing

...Animal testing is use of animals in experimental ways for the benefit of biomedical research, and it has been a topic long argued about. To every argument, there are two sides: The American Medical Association (AMA) and the People for the Ethical Treatment of Humans (PETA). AMA’s opinion on the topic states that animal testing is necessary, while PETA highly discriminates it. These two major groups of people have been “at war” with each other on this topic of animal testing in biomedical research for decades. The AMA has recently published an article on this topic titled “Use of Animals in Biomedical Research.” AMA’s argument in this article is effective, they use persuasive techniques to support their claim, and their evidence is clear; however, the author fails to make some of his counterarguments convincing. AMA’s claim convinces you that animal testing is needed for biomedical research in many different, but persuasive ways. For example, they express that without all of the information gathered from animal testing, either man kind will be tested on, or we wouldn’t have the health benefits and treatments for diseases that we have today. In this statement, the author uses appeal to fear, by stating that humans everywhere will pay the price in terms of human pain and suffering, thus increasing fear and prejudice towards the audience. Another way the author uses persuasive techniques to support the claim, is by saying that there are limitations to the use of human subjects......

Words: 670 - Pages: 3

Free Essay

Load Testing

...Indonesia, Hong Kong, Taiwan, and Japan. PVS Testing Services offers end to end management, execution and analysis of performance tests to identify performance defects and to identify performance tuning opportunities. PVS Testing enables proactive actions to be taken to minimize and to eliminate performance defects from entering production. PVS Testing enables proactive actions to be taken to minimize, and to eliminate performance defects from entering production. Performance testing enables Large US Payer to deliver applications that satisfy customer expectations, hence ROI is obtained is satisfactory. PVS objectives are as follows: OBJECTIVES BENEFITS Interoperability Ensure that multiple applications can share both physical and logical resources without contention within a shared infrastructure environment. Proof of Concept Validate that a change in software design or infrastructure component performs as expected. Scalability Repetitive execution of a test cycle with progressively increasing volumes to verify system thresholds. Iterative Repetitive execution of a test cycle with a fixed volume during software/infrastructure configuration tuning Project Overview VOLUME TESTING - It applies to large amount of data to determine if the system meets specified objectives. NETWORK ANALYSIS - It captures system network characteristics for inefficiencies to identify potential performance and network risks. ENDURANCE TESTING - It executes an extended test......

Words: 304 - Pages: 2

Free Essay

Stress Testing

...commercial banking literature, refer to assessing the impact of a rare but plausible shock to the financial system. Stress testing is a simulation technique, which are used to determine the reactions of different financial institutions under a set of exceptional, but plausible assumptions through a series of battery of tests. At institutional level, stress testing techniques provide a way to quantify the impact of changes in a number of risk factors on the assets and liabilities portfolio of the institution. For instance, a portfolio stress test makes a rough estimate of the value of portfolio using a set of exceptional but plausible events in abnormal markets. At institutional level, stress testing techniques provide a way to quantify the impact of changes in a number of risk factors on the assets and liabilities portfolio of the institution. For instance, a portfolio stress test makes a rough estimate of the value of portfolio using a set of exceptional but plausible events in abnormal markets. These tests help in managing risk within a financial institution to ensure optimum allocation of capital across its risk profile. At the system level, stress tests are primarily designed to quantify the impact of possible changes in economic environment on the financial system. The system level stress tests also complement the institutional level stress testing by providing information about the sensitivity of the overall financial system to a number of risk factors. These tests......

Words: 656 - Pages: 3

Premium Essay

Software Testings

...Software Testing Types: Black box testing – Internal system design is not considered in this type of testing. Tests are based on requirements and functionality. White box testing – This testing is based on knowledge of the internal logic of an application’s code. Also known as Glass box Testing. Internal software and code working should be known for this type of testing. Tests are based on coverage of code statements, branches, paths, conditions. Unit testing – Testing of individual software components or modules. Typically done by the programmer and not by testers, as it requires detailed knowledge of the internal program design and code. may require developing test driver modules or test harnesses. Incremental integration testing – Bottom up approach for testing i.e continuous testing of an application as new functionality is added; Application functionality and modules should be independent enough to test separately. done by programmers or by testers. Integration testing – Testing of integrated modules to verify combined functionality after integration. Modules are typically code modules, individual applications, client and server applications on a network, etc. This type of testing is especially relevant to client/server and distributed systems. Functional testing – This type of testing ignores the internal parts and focus on the output is as per requirement or not. Black-box type testing geared to functional requirements of an application. System testing – Entire system......

Words: 6035 - Pages: 25

Premium Essay

Animal Testing

...Imagine this situation: a new company is testing an eye care product on a subject. In the test, a substance is placed in one eye of the subject, with the other eye serving as a control. The subjects are restrained, preventing them from responding naturally to the irritation, and their eyes are evaluated after one hour and then at 24-hour intervals for up to 14 days. Some continue to be evaluated up to three weeks later. The level of irritation to the eyes is scored numerically by observation of the three major tissues of the eye (cornea, conjunctiva, and iris). The subjects suffer from redness, bleeding, ulcers, and even blindness, and are likely killed upon completion of the experiment. The subjects were in fact rabbits in tests called “animal testing.” Animal testing has raised huge debates worldwide that has raised many questions. How important is animal testing for us humans? Are the results going to be the same? Most importantly, should we ban animal testing for the sake of the animals? Animal testing is a phrase that most people have heard but are perhaps still unsure of exactly what is involved. Whether it is called animal testing, animal experimentation or animal research, it refers to the experimentation carried out on animals. It is used to assess the safety and effectiveness of everything from medication to cosmetics, as well as understanding how the human body works. Animal testing, also known as animal research, plays a crucial role in scientists' understanding......

Words: 1467 - Pages: 6

Premium Essay

Introduction to Testing

...IBM, Bangalore A White Paper Challenges of Managing a Testing Project: (A White Paper) A White Paper Page 1 of 20 Vinod Kumar Suvarna IBM, Bangalore A White Paper Introduction Testing is expected to consume 30 – 50 % of the Project Effort, Still properly managing testing project is not considered seriously. Project Managers always undermine the impact the testing activity has on the Project Cost and Schedule. Hence the testing activity is usually unplanned and uncontrollable. As the project manager assumes that the main focus of the testing activity in the project is not to meet the project schedule. But Its is a reality that a thorough and close monitoring of the Testing project is required to increase productivity, reduce cycle -time and improve quality. Below pie chart depicts the Project effort distribution by phase for a development project, where independent testing team performs the testing activity. Project Effort Distribution by Phase 21 35 Requirement Design Code & Unit testing Testing 25 19 A White Paper Page 2 of 20 Vinod Kumar Suvarna IBM, Bangalore A White Paper The Problem / Issues / Improvement Opportunity in Hand: Ask a Tester ‘Why he/she needs to burn midnight oil to churn a Quality Product?’ Answer is obvious ‘Needs to put extra time and effort to overcome the Project schedule slippage ‘ Ask a Project Manager ‘Why the Project is in trouble during the last phase?’ Answer is obvious ‘Not Sure, Did not......

Words: 2954 - Pages: 12

Premium Essay

Animal Testing

...Animal Testing Over 70 million animals die each year from animal testing. Although many animals have died during the course of animal testing, many things have been improved or have benefitted from animal testing including medicine. Animal testing also affects everyone in more than one way. Animals are not just used for testing in the United States; they are used all over the world for animal testing. Animal testing is a social justice issue that has improved medical research, but has resulted in the killing of many animals. Animal testing is the testing of cosmetic products, cleaning products, agricultural research, dog and cat food trials, weapons tests, aerospace studies, and car crash simulations (PETA). One might feel animal testing is cruel, but almost the whole world has benefitted from vaccines. It has also led to the treatment of some diseases. Animal testing can sometimes end with mixed outcomes. Many people have died because drugs or treatments that have successfully passed tests conducted on animals have failed on humans. Many alternatives to animal testing exist. Some alternatives include using computer models and using tissue cultures in research. During some of the experiments, some animals are given medicine so the animals do not feel pain or distress. However, thousands are not. The experiments preformed can be painful, damaging, and deadly to the animals used (B 5-9). Animal testing is an issue all around the world. In Great Britain, more than 2.5......

Words: 913 - Pages: 4