Health Care Insurance

Contents

1. ABSTRACT

2. INTRODUCTION

3. PROJECT DICTIONARY

3.1. DATAFLOW DIAGRAMS

3.2. E-R DIAGRAMS

3.3. DATA DICTIONARY

4. FORMS & REPORTS

4.1. I/O SAMPLES

5. BIBILIOGRAPHY

1. ABSTRACT

Provide a system for an organization that is in primary care.

Organization schedules health checkups for their clients to keep close eye on

their risk levels depending on the diseases/problems incurred in them .It is

responsible for fixing the appointments with the physicians, labs and also taking

care of emergency situations.

Features:

Client Details

Internal/External physician Details

Insurance Company Details

System User Management

Reports:

Client’s Monthly Health Report

Physician’s client’s reports (Detail/Summary)

Client’s list depending on the risk level

List of External physicians attending the clients

2. INTRODUCTION

The Health Care Insurance System is mainly developed to provide an

organization a well-developed system that is in primary care. The organization

schedules health checkups for its clients to keep close eye on their risk levels.

Organization accepts requests from the physicians who make checkups to the

clients and using the reports, documents, processes the claims raised by the

physicians on behalf of the clients.

This system helps in easy fixing of appointments for

clients. This system also processes insurance claims and the related activities

as a part of organization services. Organization serves its clients in a prompt,

reliable manner, and the fee structure is also highly competitive. This system

will assist the organization in quality claim processing.

Drawbacks of Existing System:

This system was already proposed, but the

communication was through the third party. The existing system lacked proper

communication, proper co-ordination and accountability. This leads to

ineffective and inefficient organization and thus leads to lacking of organization

development and clients unsatisfaction. The existing system was dedicated to

paperwork, which leads to time consuming and inefficient utilization of

resources. There may be claims from many citizens and handling each and

every one’s claim takes lot of time. There may also be some errors encountered

while collecting the required documents. It is also a time taking process to

deliver the reports personally or by post to the clients. There may also be some

errors while handling the payments and dues.

Need for Automation:

Now a day it has become a need for every citizen to get

insured on all domains and the health plays a vital role. Hence this system when

automated eases the task of processing the claims and scheduling health

checkups. The application is made online so that any client registered under an

organization can use the system effectively. The clients and other entities

involved can request online and at anytime.

The payments to be collected are calculated efficiently and all

the information regarding any dues etc is carefully handled. The system also

effectively maintains the information of the clients, managers and physicians.

4. PROJECT DICTIONARY

4.1. DATAFLOW DIAGRAMS

Level 1 DFD for Administrator

Managers Report

Health Care Insurance

Physician

Admin

Manager

Admin

Manager

Physician

Client

Emp_profile

User ID

Admin Login

Web Application

Change of Password

User Management

Privileges

Employee Profile

Attendance Report

Logout

Level 1 DFD for Manager

Emp_profile

User ID

Manager Login

Web Application

Change of Password

Claims

Reg of Clients

Physician Assign

Client Reactivation

Alter Physician

Logout

Level 1 DFD for Client

Emp_profile

User ID

Client Login

Web Application

Change of Password

Doctor Profile

Claims

Doctor Says

Payments

Change of Physician

Logout

Level 1 DFD for Physician

Emp_profile

User ID

Level 1 DFD for Employee Login

Login to Web

n to web

Validation

Option

Physician

Login

Web Application

Change of Password

Appointments

Calendar

Client Details

Claims

Suggestions

Logout

Employee

AdminManagerPhysician

Level 2 DFD for Physician Calendar

Type of appointment

4.3. DATA DICTIONARY

TABLE_NAME FIELDNAME DATATYPE

Web Application

Calendar Logout

Monthly

Weekly

Daily

ASSIGN_PHY EMP_NO varchar2 (10)(FOREIGNKEY) STATUS number (3)

ATTEN_DETATTEND_DATE dateEMP_NO varchar2 (10)(FOREIGNKEY)EMO_LOGIN varchar2 (5)EMP_LOGOUT varchar2 (5)

CLAIM_DET CLAIM_NO varchar2 (10)(PRIMARYKEY)CLAIM_DATE dateCLIENT_REGNO varchar2 (8)(FOREIGNKEY)EMP_NO varchar2 (10) (FOREIGNKEY)AMT_CLAIM number (8,2)CLAIM_FACT varchar2 (20)

CLIENT_DAILY CLIENT_REGNO varchar2 (8) (FOREIGNKEY)DAILY_START_TIME varchar2 (8)DAILY_END_TIME varchar2 (8)

CLIENT_DETAILS CLIENT_REGNO varchar2 (8) (PRIMARYKEY)CLIENT_NAME varchar2 (10)CLIENT_ADD varchar2 (30)CLIENT_PHNO number (10)CLIENT_DOB dateMANAGER_NAME varchar2 (15)USER_ID varchar2 (13)

CLIENT_MONTHLYCLIENT_REGNO varchar2 (8) (FOREIGNKEY)VISIT_DATE varchar2 (10)MONTHLY_START_TIME varchar2 (8)MONTHLY_END_TIME varchar2 (8)

CLIENT_WEEKLY CLIENT_REGNO varchar2 (8) (FOREIGNKEY)VISIT_DAY varchar2 (10)WEEKLY_START_TIME varchar2 (8)

WEEKLY_END_TIME varchar2 (8)

EMP_PRO_INF EMP_NO varchar2 (10) (PRIMARYKEY)EMP_NAME varchar2 (8)EMP_DOB dateEMP_ADD varchar2 (30)EMP_JOB varchar2 (10)

EMP_QUA varchar2 (25)

EMP_EXP number (5)EMP_JB_END dateEMP_DATE_JOIN dateEMP_LOC varchar2 (20)USER_ID varchar2 (15) (FOREIGNKEY)

INST_DUE_DET CLIENT_REGNO varchar2 (8) (FOREIGNKEY)PAID_DATE dateDUE_AMT number (10,2)

INST_PAID_DET CLIENT_REGNO varchar2 (8) (FOREIGNKEY)PAID_DARE datePAID_AMT varchar2 (10)

MAIL_DET SENDER varchar2 (40)RECEIVER varchar2 (50)SUB varchar2 (50)RECEIVEDATE dateMESSAGE varchar2 (300)

PROB_SUGG CLIENT_REGNO varchar2 (8) (FOREIGNKEY)EMP_NO varchar2(10) (FOREIGNKEY)VISIT_DATE dateHISTORY varchar2 (50)SUGGESTION varchar2 (50)

REEMBER_DET REEM_NO varchar2 (10) (PRIMARYKEY)CLAIM_NO varchar2 (10) (FOREIGNKEY)AMT_CLAIM number (2)

TYPE_OF_APP CLIENT_REGNO varchar2 (8) (FOREIGNKEY) TYPE_CASE varchar2 (10)

TYPE_APP varchar2 (15)NUM_TIMES number (2)

USER_DET USER_ID varchar2 (15) (PRIMARYKEY)USER_NAME varchar2 (15)USER_PASS varchar2 (10)TYPE_USER varchar2 (10)

USER_PREV USER_ID varchar2 (15) (FOREIGNKEY)RESTRI_DAY varchar2 (15)RESTRI_HRS varchar2 (6)USER_STATUS varchar2 (2)

5. FORMS & REPORTS

5.1. I/O SAMPLES