Health Insurance Project
Health Insurance Project
Health Insurance Project
Organisation Name-Alere
Developer
Admin
CSR
Pharmacist
MD
Provider search
Member search
Drug search
Questionnaire
Pharmacist Approval
Medical director Approval
Resolve
Alternate Stages:
Rejected
Provider search:
Under provider search stage configure view with below fields
Provider ID
Provider name
Provider address
Provider email
Provider Phno
Member Search:
Member ID
Member name
Member email
Member address
Member Phoneno
Drug search:
Drug name
Dosage
Taken through
NO of days to be taken
Formulary alternatives
Go to data explorer->Click on Add new data type and create a new data class as Members
Add another new data type and create a new data class as Drugs
Fields as Below
Gpc(Primary Key)
Ndc
Drug name
Dosage
Formulary alternative
Follow the above instructions and create another data class for providers
Providerid(Primary Key)
ProviderName
Provideremail
Providerphonenumber
Provider address
Create a section and flow action named PharmacistApproval with read only fields to display selected
provider, member, drug details in read only mode. Hint (In section drag controls and map existing
properties and in cell settings under presentation make them read only)
Create a section and flow action named PharmacistRejected to capture Reject reason. Create property
“Reason for rejection” and map in section.
Create flow as Pharmacist approval and on assignment shape add 2 connectors and on each connector
map above 2 flow actions and give livelihood as 80 for approve and 20 for Reject so that by default
approval screen appears 1st and Reject appears under actions tab of work object as optional screen.
Create a section and flow action named MDApproval with read only fields to display selected provider,
member, drug details in read only mode. Hint (In section drag controls and map existing properties and
in cell settings under presentation make them read only)
Create a section and flow action named MDRejected to capture Reject reason. Create property “Reason
for rejection” and map in section.
Create flow as MD approval and on assignment shape add 2 connectors and on each connector map
above 2 flow actions and give livelihood as 80 for approve and 20 for Reject so that by default approval
screen appears 1st and Reject appears under actions tab of work object as optional screen.
Validation:
Provider Id : It should start with “P-“ example “P-12345678“ . Hint :Use starts with function in validate
rule.
Note:Make sure in Providers data table you have data as shown in example.
It should contain only integers after “P-“ Hint : use substr and is integer functions
combination.
Member Id: It should start with “M-“ example “M-12345678“ . Hint :Use starts with function in validate
rule.
Note:Make sure in Members data table you have data as shown in example.
It should contain only integers after “M-“ Hint : use substr and is integer functions
combination.
Provider PhoneNo: Should be integers and length =10 or length = 13 characters. Example : 8019256326
(length 10 chars) or +9180192564326(length 13 chars).
Can have special character + in it. Hint: Look for allowed spl character functions
Member PhoneNo: Should be integers and length =10 or length = 13 characters. Example : 8019256326
(length 10 chars) or +9180192564326(length 13 chars). Can have special character + in it.
User should enter provider id and hit on search button, then provider details like provider
name , address, email , phone number should display in repeating grid or table layout
Code Configuration:
In provider search section add a text box for entering provider id and a search button.
Create a datapage of type list and source as activity which can hit the database and get the
provider details based on provider id.
Add “on click” Refresh action on Search button. On click of search the table layout should
refresh and display provider details.
In the repeating grid add a select button and name it as “Select Provider”.
pyWorkPage.ProviderID = Primary.ProviderID
Trigger the data transform from the “select Provider” button using onclick event.
2. Member search:
3. Drug search:
Create paragraph rules for each question (Right click on class 🡪 Create 🡪 User Interface 🡪
Paragraph (write your question here and save it))
Once the paragraph rules are created, open questionnaire question and drag paragraph control
and map paragraph rule in it , then the question will display.
A1. Create a property and give local list values, Yes NO (Refer network property in banking
project)
A2. Create a property with local list values with Mouth or Intraveinal
Map the above created answer properties to the questionnaire section below the corresponding
Question
If the drug Mg is less than or equal to 50 Mg and if taken by Mouth 🡪 Approve the case
If the drug Mg is greater than 50 Mg and taken either by mouth or Intraveinal 🡪 Pend the case
7. Add a decision shape in the questionnaire flow and trigger the above created decision table
8. The outgoing connector from the decision table with the result as approve should be connected
to end shape and the other connector with result pend should be connected to “ChangetoStage
“ Smart shape to route to Pharmacist approval stage
10. Upon case approval end the flow by connecting it to end shape.
11. If case is rejected add change to a stage smart shape and route to Medical director approval
stage.
12. Upon approve or reject in Medical director approval flow connect to end shape.
13. Add status as Resolved approved on approve connector and status as resolved rejected on
reject connector.
Configuring Routing:
Reporting:
Create a report definition rule in work class to display Resolved –Rejected cases and plug it in
manager portal under Reports category using category and shortcut rules.
SLA
Create a SLA rule named as “PharmacistApprovalSLA” , with goal as 2 days and deadline as 4 days.
When deadline time expires resume flow on approve flow action, which means it should auto
approve.
Create a SLA rule named as MDApprovalSLA with goal as 1 day and deadline 2 days when goal
expires send reminder email, when deadline expires auto approve case.
Agents
Create a advanced agent which triggers an activity which identified the cases whose pystatuswork is
“Resolved Approved” sends email to all the approved cases with subject holding case id approved and
body of mail holding all details.