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Business, 13.11.2019 02:31 boo2023

Draw a level zero, logical dataflow diagram of the processing at benefits plus described below. benefits plus is a supplemental health insurance company that pays medical andhospital claims after its policy holders' primary health insurance benefits through medicare have been exhausted. in order to have their claims processed, policy holders must submit a claim form along with evidence that they have received their full medicare benefit. all claims are either mailed or presented in person to benefits plus' claims processing department. claims forms are first checked by claims screening clerks and any incomplete forms are returned to the claimant for completion. details of those incomplete forms which are returned by mail are firsty entered in a claims pending file. each week this file is checked and any pending claims more then 45 days old are removed and the policyholder is notified by a form letter that their case has been closed. all complete forms, including those pending claims which have been resubmitted, are then passed to the claims clerks who sort them according to the type of claim and assign a claim number to each form. the claims clerk then retrieves the policyholder's policy record from the policy files and records policyand claim action details on the claim form. the policy record is also updated with details of the current claim and then refiled. a benefits cheque is then prepared and sent to the claimant along with a tear-off slip from the original calim form. the tear-off slip serves as the claimant's record of their claim. processed claim forms are filed by claim number after first being microfilmed for archival storage purposes. at the end of each day a summary of all claims processed is sent to the claim payments records section.

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