Question

Benefits Plus is health insurance company that pays medical and hospital claims of the policy holders.

In order to have policyholder’s claims processed, policy holders must submit a claim form. 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 (policyholder) for completion. Details of those incomplete forms which are returned to the policy holder are first entered in a Claim Pending File. Each week this file is checked and any pending claims more than 45 days old are removed and the policyholder is notified by a 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 claim form. The claims clerk then retrieves the policyholder's policy record from the Policy Files and records policy and 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 claim 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.

(A) Draw Context Level Data Flow Diagram

(B) Draw Level 0 Data Flow Diagram for the situations described above.

Please add the diagram file in answer.

Answer 1

ANSWER:

As per the question we have drawn DFD for Benefit Plus Health Insurance System,

Let’s see shortly what DFD is,

Graphical representation of the flow of data from one component to another component in the information system.

We can overview of the system without going in detail of system.

There are some rules for drawing DFD:

Rules:

1. Process must have at least one input and output.

2. Data share must have at least one data flow in and one data flow out.

3. Data must be stored somewhere.

Types of DFD:

1. Context level/0 level

2. Level 1

3. Level 2

4. Level 3

Let’s see the Context level diagram for Benefit Plus Health Insurance System:

A)

B) Level 0 Data Flow Diagram

As per above DFD we can see overview of Benefit Plus Health Insurance System.