BRD - NGL Claims Release 4

NGL CLAIMS Release 4.
0
Business Requirements Document
Version: 1.0
SDLC Workspace Business

NGL CLAIMS Release 4.0 69170
Engagement Name: Case ID:
PTS Project Name: PTS ID:
Application Name: National Guardian Life App ID: 41075

Claims
Sr. Client Manager: Byron Nicas Telephone:

Client Manager: Michael Loe Telephone:
Project Manager: Paul Anderson Telephone:
Document Author: Alok Kumar Telephone:
Date: 6 July 2008 Status: Final
DOCUMENT PURPOSE
The Business Requirement Document represents the customer’s requirement for a project. It does not
anticipate what the solution to these requirements may be – this is the purpose of the Functional
Requirements and Technical Design documents. The Business Requirements document ‘what’ needs to be
done, and the Functional Requirements and the Technical Design documents ‘how’ it will be done. The
other key function of the Business Requirements is to document the current state of affairs in terms of
business processes and existing systems.
BRD Template Version 2.1

Template Release March 19, 2004
Copyright © 2003 – NGL Group
All rights reserved. Information contained herein is for internal use and may only be used for business
purposes authorized by NGL.
Document Control
a. Document history
The following table records information regarding released versions of this document and briefly describes the
changes to them.
Version Date Author Comments
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
b. Document Reviewers/Approvers
List the individuals that must review or approve this document. An “X” indicates whether the individual is a
reviewer only or a reviewer and approver. (Choose One).
Name Position Reviewer Reviewer and

Only Approver
Contents
1 EXECUTIVE SUMMARY………………………………………………………………….…… 4
2 OVERVIEW…………………………………………………………….…………………………4
2.1 The Business Problem/Need……………………………………….………………………….4
2.2 The Business Goals and Benefits………………………………….…………………………..4
2.3 Critical Success Factors…………………………………………….…………………………5
2.4 Assumptions and Restrictions…………………………………………….…………………...5
3 CURRENT PROCESSES……………………………………………………….…………………5
3.1 Current Processes……………………………………………………………………………...6
3.2 Current Limitations……………………………………………………………………………6
4 DESCRIPTION OF REQUIREMENTS………………………………………………..….………7
4.1 Required Business Processes………………………………………………………….………7
4.2 Business Scope……………………………………………………….……………………..…7
4.2.1 Business Groups……………………………………………….………………….……7
4.2.2 Business Product / Business Transaction Types……………….….……………………7
4.2.3 Primary Business Users…………………………………………………………………7
4.2.4 External Impacts / Other Business Groups affected………………………………….…8
4.3 Specific Business Requirements……………………………………………………..……8
4.4 Performance Requirements…………………..…………………………………………..17
4.4.1 Volumes…………………..…………………………………………….…….………..17
4.4.2 Potential Growth…………………..………………………………….………………..17
4.4.3 Performance…………………..…………………………………………………..……17
4.4.4 Exception Handling…………………..………………………………………………..17
4.4.5 Usability…………………..………………………………………………..…………..17
4.4.6 System Availability…………………..……………………….………………………..17
4.4.7 Contingency and Disaster Recovery…………………….……………………………..17
4.4.8 Information Security…………………..………………………………………………..17
4.4.9 Help and Training…………………..…………………………………………………..17
4.5 Regulatory, Audit and Data Retention Requirements………………………………….…18
5 DELIVERY AND TRANSITION STRATEGIES…………………………………………………18

5.1 User Acceptance Testing Groups………………………………………………………………18
5.2 Implemantation Considerations………………………………..………….……………………18
5.3 Project Timimg Considerations………………………………………………...………………18
6 GLOSSARY OF TERMS………………………………………………………………..….………19
1. EXECUTIVE SUMMARY
Handling claims is a key business process—and a significant area of overhead—for any insurance organization.
Recent studies have shown that the processing cost of a claim that adjudicates on the first pass (60–70 percent
of claims) is pennies compared to dollars for a manually processed claim resulting from an exception or "pended"
from the core system (30–40 percent of claims).
When you consider that claims processing applications involve significant volumes and amounts of paper-based
documents, it is clear insurance payers could save significant sums by addressing the issues inherent in manual
claims processing.
2. OVERVIEW
2.1 The Business Problem/Need
The current Claims processing is processed manually and has the following Issues:
a) High errors and exceptions Manual data entry in line-of-business or accounting systems can increase
the number of "pended" claims and raise the time and cost of claims processing.
b) Inefficient workload distribution The inability to distribute work evenly across multiple claims processors,
adjudicators and managers makes it difficult to allocate staff efficiently.
c) Slow turnaround time Manually routing, processing, searching and retrieving physical documents increases
the turnaround time, which impacts customer service and can result in penalties for late claims in some cases.
d) High claims processing costs The supplies and labor associated with paper-based manual document routing,
shipping and storage raise overhead costs, which can lead to higher premiums and lower revenues.
e) Inconsistency Documents received at multiple input points may be routed or classified differently, resulting in
discrepancies and inefficiency.
f) High risk Paper documents are subject to loss or damage and expose organizations to legal and financial risks.
These challenges make claims processing an ideal candidate for automation through workflow, document
management and document delivery technologies. Such technologies accelerate claims processing from beginning
to end and reduce errors—resulting in faster close-out of claims, improved operational efficiency and lower costs.
2.2 The Business Goals and Benefits
Benefits Of Ngl Technology For Claims Processing

This enhancement will address the key stages of claims processing from initial capture in the mail room to
processing, delivery, adjudication and final archiving. By implementing this enhancement the organization can address
the pitfalls of paper-based claims processing and realize considerable financial benefits. The customer examples in the
following table illustrate some of the benefits that Ngl technology provides to real-world claims processing
applications.
BENEFIT CUSTOMER EXAMPLE

Fewer Claims Exceptions One customer reduced misrouted claims packages from
Routed claims packages electronically to the correct 5 percent down to less than 1 percent (or from 5,400
adjudicator thus reducing the number of misrouted claims down to 1,080 claims per year). This represented
claims and saving time in exception handling a $324,000 annual savings using Ngl technology
Improved Workload Allocation One customer with a claims processing group of 500
Distributed the workload across a pool of available staff reclaimed an average of four hours of lost
claims processors and adjudicators to ensure proper productivity per employee per month through the use of
staffing levels Ngl technology. This resulted in a $1.8 million annual
savings.
Faster Turnaround Time One customer with 500 claims processing employees
Reduced the time spent generating and delivering recognized a time savings of two hours per employee
claims correspondence (letters of rejection, requests each month using Ngl Workflow and RightFax
for more information, etc.) technology to automate correspondence generation and
delivery. This equated to an annual savings of $900,000.
Lower Overhead Costs Not only does eliminating the physical routing of
Eliminated shipping, courier and physical paper documents save time, but one customer eliminated
storage costs $52,189 annually in document shipping, mailing and
storage costs by implementing Ngl technology.
Penalty Avoidance One customer which previously averaged $50,000 per
Closed out claims faster and avoided penalties for late month in Performance Standards and Guarantees
claims (PS&G) penalties reduced this by 80 percent after
implementing a Ngl solution using alerts. As a result
they avoided $480,000 in penalties
Faster Discovery One customer saved an average of 30 minutes per
Reduced time for appeals, audits and subpoena information retrieval request related to appeals, audits
responses due to online accessibility of documents and subpoena responses. With an average monthly
volume of 100 such requests, this equated to an annual
savings of $90,000.
2.3 Critical Success Factors

Paper-based, manual claims processes are big cost drivers for insurance payers because they are plagued by errors
as well as time and resource inefficiencies. Solutions are available which bring together workflow, document
management and document delivery technologies to automate claims processing. These efficient solutions enable
insurance payers to greatly reduce costs, limit risks and improve overall performance by helping organizations improve
the accuracy and timeliness of claims processing
2.4 Assumptions and Restrictions

The assumptions are listed below.
 Resource from Business will be available to provide clarifications / feedback during the entire period of Software
Development. They would also validate the system functionality and support the UAT process.
 Resource from Technology will be available for developing the Functional Requirements Document and for the
Design, Construction and Testing of the Application.

BRD - NGL Claims Release 4

Uploaded by

Copyright:

Available Formats

BRD - NGL Claims Release 4

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

BRD - NGL Claims Release 4

Uploaded by

Copyright:

Available Formats

NGL CLAIMS Release 4.

SDLC Workspace Business

PTS Project Name: PTS ID:

Application Name: National Guardian Life App ID: 41075

Sr. Client Manager: Byron Nicas Telephone:

Date: 6 July 2008 Status: Final

BRD Template Version 2.1

Copyright © 2003 – NGL Group

Version Date Author Comments

Name Position Reviewer Reviewer and

5 DELIVERY AND TRANSITION STRATEGIES…………………………………………………18

2.2 The Business Goals and Benefits

Benefits Of Ngl Technology For Claims Processing

BENEFIT CUSTOMER EXAMPLE

2.3 Critical Success Factors

2.4 Assumptions and Restrictions

You might also like