PROJECT-A Automation of Medical Benefits Schemes For Air-India Ltd.
By N K Bharadwaja
102CP05
Rajesh Gurumoorthy
102CP38
Rohan Sharma
102CP48
Vipin Valsaraj
203CP66
Guided by Mrs. Aparna Bannore
Submitted to University of Mumbai, Mumbai As partial fulfillment for the Bachelor of Engineering (B.E.) In Computer Engineering
Department of Computer Engineering SIES Graduate School of Technology, Sector V, Nerul, Navi Mumbai. 400706. Academic Year 2005-06
CERTIFICATE This is to certify that project report entitled _______________________________ is a bona-fide record of Project-A carried out by the following students of final year engineering in Computer Engineering.
Sr. No.
Name of Student
Roll Number
1
N Krishna Bharadwaja
102CP05
2
Rajesh Gurumoorthy
102CP38
3
Rohan Sharma
102CP48
4
Vipin Valsaraj
203CP66
This project is carried out for the partial fulfillment of the requirements for the degree of Bachelor of Engineering (B.E.) in Computer Engineering from University of Mumbai, Mumbai.
Guide
Head Department of Computer Engineering
Principal SIES Graduate School of Technology, Nerul, Navi Mumbai.
We have examined this report as per university requirements at SIES Graduate School of Technology, Navi Mumbai on dated_______________
Sign__________________________ Sign___________________________ Name_________________________ Name__________________________ Examiner 1
Examiner II
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CONTENTS
Acknowledgement
4
Abstract
5
1.
Introduction
6
2.
Overview of the Project
8
3.
Detail Design of the Project
10
4.
Conclusions
18
5.
Further Work
19
References / Bibliography
20
3
Acknowledgement
We express our deep sense of gratitude to Dr. M. K. Rao, Principal, SIES GST for his kind assistance in facilitating our project and Mrs. Aparna Bannore, our internal guide, for her invaluable advice and guidance.
We are greatly indebted to Mr. Manish Gupta, our external guide, for his keen interest and guidance. Thanks are also in order to Mr. Mathew and his staff members of Medical Benefit Scheme (MBS) department at Air-India, Kalina, for patiently explaining the nuances of the system.
We also thank all the staff members of Department of Computer Engineering for their valuable help.
Team Members
4
Abstract
We seek to automate the Medical Benefits Schemes of Air-India Ltd. Under these schemes, the beneficiary can claim Medical Benefits by filling the claim form including necessary documents. The claim form submitted by the claimant is processed by the staff of Medical Services Department and is forwarded to the Finance and Accounts Department of the company with recommendation to reimburse the amount claimed. The objective of the project is to automate the process of verification and subsequent processing of the claim thus speeding up the entire process and making the system more reliable.
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1. Introduction Air India is the flagship airline of the country. Employees of the company enjoy premier medical benefits and prime health care. Air India has implemented two types of medical schemes Employee Medical Benefit Scheme Contributory Medical Benefit Scheme
Employee Medical Benefit Scheme is offered only to the working full-time employees of Air India working at various stations distributed across the country. This scheme does not cover the kith and kin of the employee.
The Contributory Medical Benefit Scheme is implemented by the funds collected by taking a monthly contribution from the salary of each employee. This scheme covers the dependents of the employee also.
Problem Definition: -
Air-India wants to automate the Medical Benefit Scheme. Under this scheme, the benefactor files a claim for reimbursement of Bill. The claim should be supported with proper receipts for the fees paid for various procedures, bills, reports, prescriptions, cash memos and details of treatment from the doctor, hospital / nursing home. In the case of domiciliary treatment, the details in the form should be filled in by the attending doctor supported with proper bill and receipt or, alternatively, he should give the information on his letterhead. In the case of consultation, the consultant’s receipt together with his report should accompany the claim. Receipts together with reports must be submitted in support of pathology radiology investigation. Receipts for Rs. 500/- and above must bear a revenue stamp in the denomination of Re.1.00/-. The claim-form is checked for completeness, authenticity, correctness and compliance with the MBS rules. Claim amount may include the cost of consultation, drug and hospitalization, as applicable. Cost of proprietary drugs, if
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dispensed by the attending physician is reimbursed for the first 3 days only. Incomplete forms are liable to be rejected. Further details of the Scheme are outlined in the MBS rulebook.
The system is expected to speed up the overall processing time required to clear one claim. The system must be implemented in the LAN infrastructure present in the Organization.
Existing System:
The Claimant submits the duly completed form with supporting documents (as mentioned in the rule book) to the person manning the form collection counter. At the counter, the form and the supporting documents are checked for completeness and an acknowledgement is given. The acknowledgement number of the receipt serves as primary reference to the claim.
The claim form then goes through multiple levels of scrutiny. Initially, the claim form and the supporting documents scrutinized based on amount claimed. Then the form is re-verified for completeness and correctness. If no errors are found the claim is submitted for further processing, otherwise a clarification is asked from the benefactor. At this stage, the various reasons for rejection may include unregistered (with MBS) person, if the practitioner is not registered, medicines prescribed are not covered under MBS, or wrong receipts are produced, and many more. The reason for rejection is clearly stated and the claimant is accordingly informed. If the claim is not rejected then further processing is done. The amount of claim is checked and it is verified that the combined amount of all previous claims from the same benefactor do not exceed the allocated maximum. Depending on the claim amount the claim is approved by Managers (including GM, Asst.GM and Sr. Manager).
The claim is then sent to the accounts department for clearance and the necessary amount is credited to the benefactor.
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2. Overview The software is to be used in highly sensitive and confidential environment. The requirements have to be fully satisfied in order to guarantee the proper use of the software. Adding and modifying records is a very crucial task and all events must be logged accurately to reduce liability issues.
Scope: The software developed will be used by the Employees of MBS. The Employee claiming reimbursement will have to submit Medical reports, valid medical bills issued by Chemists, Prescription (of recommended drugs) etc. as applicable depending on the nature of the treatment (as described in the rules). The software has to process the application, verifying the claim at each step, and if need be, request clarification from the benefactor. The claim is then processed and genuine claims are forwarded to Accounts Department (Air India) with recommendation for further processing. Unauthorized Employee should not be allowed to access Claim information. Thus, confidentiality is indispensable.
The software is expected to speed up the average processing time required to process a claim thus increasing the efficiency of the system.
System Interfaces: The main database will be designed using Oracle server (with triggers written to dynamically check consistency of database). The Business Logic will interface with the Oracle database using SQL queries. The business Logic component will then present the data to the user using the User Interface (UI).
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Software Interfaces: Oracle 8i: The system must use Oracle 8i as its database component. Communication with the DB is through ODBC connections.
The system must provide SQL data table
definitions to be provided to the company DBA for setup
Visual Basic 6.0 This API is used to develop the business logic, which is a collection of VB components that will manipulate the Database.
External Interfaces The system must provide GUI for easy interaction with the database. In addition, report generation and storage facility should be present. Optionally, the UI may provide for importing external documents so that, in future, claims can be submitted online using XML document format.
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3. Detail Design of the Project UML Diagrams:
1. Use Case Diagram
It shows the various actors in the system and the various activities performed by them during processing of forms.
Use Cases: 1. Submits forms: Description
Claimant Submits the duly filled form at the
counter
along
with
supporting
documents. After this, he receives an acknowledgement. Exceptions
Some of the documents are missing or the form is incomplete. In this case the claimant is informed promptly
2. Collect forms: Description
The collecting officer at the desk collects the form and enters the data into the system. The acknowledgement generated by the system is returned to the claimant.
Exceptions
Incomplete form is submitted. In this case, the system informs the officer who in turn informs the claimant.
3. Seek clarification: Description
The approving officer or the checking officer seeks to clarify some doubts regarding the claim. Such queries are forwarded to the claimant. 10
Exceptions
None
4. Scrutinize form: Description
Checking officer scrutinizes the forms based on the amount claimed. He also verifies that the drugs are eligible for reimbursement
and
practitioner
is
registered. Exceptions
None
5. Use Clubbing Schemes: Description
In cases of serious medical and surgical ailments
mostly requiring
hospitalization
and
prolonged
incurring
huge
expenses, the Checking Officer makes use of clubbing schemes as per the rules. Exceptions
None
6. Approves Claim: Description
The approving officer approves the claim and recommends reimbursement.
Exceptions
None
7. Reimburse Amount: Description
The amount claimed is reimbursed by the finance department.
Exceptions
None
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2. Class Diagram The diagram shows the relationships between various classes. Each class contains certain attributes and operations.
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3. Activity Diagram The diagram shows the flow of activities within the system from the submission of form until the amount is reimbursed. Each actor is responsible for some or the other activity.
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4. Sequence Diagram This diagram adds a dimension of time to the object interactions. In the diagram objects of MBS are laid across the top, and time proceeds from top to bottom.
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5. Collaboration Diagram In this diagram, in addition to associations among objects the collaboration diagram shows the messages objects send each other.
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6. State Transition Diagram The forms in the system change their states in response to events and to time. The UML diagram captures these changes.
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4. Conclusion The project is to be reliable and available 24x7. Simultaneous access to the database server should not result in slowing down the system. For this the database server must be capable of handling multiple connections to the database and accordingly must perform all transactions over each connection properly. In addition, the database has to maintain log files for audit purposes. Every database transaction is real time and is expected to finish within a stipulated period. All changes made to the database must be recorded and information as to who made these changes must be recorded which might be useful at any point of time later for investigative purposes. The database must be temporal to indicate the real world situation. Old records must also exist in the system and this may result in rapid growth of database size. Hence, effective backup and retrieval system must also be designed.
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5. Further Work
The project is envisioned to be LAN based. However to keep up with the ever growing technology the project may be designed to be extendible to be web-based in which each Claimant may fill in the form online and submit his claim with electronic copies of all the documents. Such technologies may involve XML for document transfer over the web and might involve digital signature technology for verifying the authenticity of the document. Digital Certificates may be attached to each pharmacist to that the Bills issued can be verified online as well. This requires the architecture of the system to be flexible and the system easily updateable.
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References: Air-India Ltd., Rulebook (2000) for Medical Benefits Scheme (MBS). Air-India Ltd., Schedule of Charges for Medical Benefits Scheme (MBS). Joseph Schmuller (2004), “Teach Yourself UML”, Techmedia Publications. Noel Jerke (2004), “VB 6: The Complete Reference”, Tata McGraw Hill. Peter Norton (2002), “Beginning with Visual Basic”, Techmedia Publications. Roger S. Pressman (2005), “Software Engineering: A Practitioner's Approach”, McGraw Hill. Silberschatz, Korth, Sudarshan (2002), “Database systems Concepts”, McGraw Hill. Raghu Ramakrishnan (2002), “Database Management Systems”, McGraw Hill. Navathe, Elmasri (2000), “Fundamentals of Database Systems”, McGraw Hill Ali Bahrami (1999), ”Object Oriented Systems Development”, Irvin McGraw Hill. Mark Priestley (2001), “Practical Object-Oriented Design with UML”, Tata McGraw Hill.
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