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.   

Answer 1

Level 1 for Benefit Plus Health Insurance System:-

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