BRD Health Insurance

SAMPLE BUSINESS
REQUIREMENT DOCUMENT
7/30/2013
Blue Cross Blue Shield
Nahush Gupte
SAMPLE BUSINESS REQUIREMENT DOCUMENT
Contents
VERSION HISTORY ............................................................................................................... 2
INTRODUCTION: .................................................................................................................. 2
BUSINESS RULES: ................................................................................................................. 2
BUSINESS REQUIREMENTS: .................................................................................................. 2
DETAILED USE CASE- 1 ......................................................................................................... 3
DETAILED USE CASE -2 ......................................................................................................... 7
ACTIVITY DIAGRAMS ......................................................................................................... 11
AS-IS DIAGRAM ................................................................................................................. 13
TO-BE PROCESS FLOW DIAGRAM ....................................................................................... 14
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VERSION HISTORY
Version Number Date Description Author Reviewed By Approved By
1.0 Business Requirement for Get Nahush Gupte Jin Noh Scott Turner
Health Insurance Quote
1.1 Insert Use case and Activity Nahush Gupte Jin Noh Scott Turner
diagram for the BR
requirement 54
1.2 Inserted Gap Analysis diagram Nahush Gupte Jin Noh Scott Turner
for the BR Requirement 54
INTRODUCTION:
This document will provide the users with a formal written high level description of what the proposed system will do.
This document gives the AS-IS and TO-BE diagram for the proposed system. This is an enhancement project.
BUSINESS RULES:
1. The Office for Civil Rights enforces the HIPAA Privacy Rule, which protects the privacy of individually
identifiable health information; the HIPAA Security Rule, which sets national standards for the security of
electronic protected health information; Blue Cross Blue Shield (BCBS) will uphold these rules.
2. BCBS, or our email messaging, text alerts, or voice messaging alerts programs, you consent to BCBS's collection
and use of your personal information as set forth in this privacy policy. If you do not agree with this policy or any
of its terms, you may choose to opt out of the service.
3. Any private, confidential, patient information will not be sent out via email, text, or voice message unless prior
authorization from the patient/customer has been given via either handwritten or electronic signature.
4. On October 1, 2014, the ICD-9 code sets used to report medical diagnoses and inpatient procedures will be
replaced by ICD-10 code sets.
5. Please note, the change to ICD-10 does not affect CPT coding for outpatient procedures and physician services.
6. All quotes provided online are subject to change under the discretion of BCBS.
BUSINESS REQUIREMENTS:
1. Allow the user to shop for health insurance and receive a free quote.
2. Allow the ability for current members to access their account.
3. Allow users to find a doctor or hospital that Blue Cross Blue Shield covers.
4. Give the user quick information slides about upcoming events, projects, and public health efforts.
5. Provide members with exclusive media about BCBSA, national policy news and press releases.
6. Provide the ability for the user to learn about BCBS health insurance terms and conditions.
7. Provide the ability for the user to search for urgent care locations.
8. Allow the user to register for a career profile.
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DETAILED USE CASE- 1

Name Allow the User to shop for health insurance and receive a free quote:
Req-54 in BRD
Unique ID 0.01
Primary Actor User/Customer
Secondary Actor Database
Brief Description Customer wants to shop on the website for BCBS health insurance and
receive a quote
Glossary
Priority High
Frequency Medium
Trigger Enter button
Pre-condition User must know their zip code of interest.
Post-condition User receives the various plans with their quotes.
Happy Path User Flow System Response
1. User clicks in the text box which 1.

is located under the label
“Request a quote from your local
Blue company.”
2. User enters the zip code of their 2.

interest.
3. User clicks the enter button 3. User is taken to a page which

located directly to the right of the shows them that they can sign up
text box. for “Individual & Family Health
Insurance” This is the only option
for visitors to the site and they
must select it if it is not already
selected for them.
4. User must select “Individual & 4.
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Family Health Insurance” This is

the only option for visitors to the
site and they must select it if it is
not already selected for them.
5. User must then enter their zip 5.

code of interest.
6. User clicks the “Get Quotes” 6. User is taken to a page where

button. they must enter in addition
information such as gender and
date of birth.
7. User must select their gender 7.

from drop down menu.
8. User enters in their date of 8.

birth.
9. If the User has a Spouse that 9.

they want covered under the plan
then they can also enter in their
Spouses information.
10. If User wants to cover Spouse 10.

under the plan then they must
enter in the Spouses gender.
11. If User wants to cover Spouse 11.

under the plan then they must
enter in the Spouses date of birth.
12. If the User has children that 12.

they need/want to cover under
the health insurance plan then
they can enter up to 5 children
and their corresponding gender
and date of birth.
13. User can determine which 13.

month they want their coverage
to start on up to three months in
the future from a dropdown
menu. Each coverage start date is
from the first of the month.
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14. User then makes sure that the 14.

zip code is correct and can select
the County in which they have an
interest in.
15. User then clicks the button 15. User is directed to a page
which says “Get Quotes” which shows a list of coverage
plans and their corresponding
prices.
16. User can select the desired 16. User is directed to a page
plan by clicking the “Apply” which requires them to enter in
button. additional information.
Alternate Path User Flow System Response
1. User enters in zip code. 1.
2. User clicks enter button. 2. Zip code is wrong, so it redirects

User to an Error page which has a
label named “Error” and also has a
label below the first label named
“Error”, “Error! Your search did
not return any results.” Also has a
hyperlink which says “Go back and
retry your search.”
3. User clicks the hyperlink which 3. Takes User to another page

says “Go back and retry your which is titled with a label saying
search.” “Shop for Health Insurance”
4. User then clicks in the text box 4.

which has a label within the text
box which says “Enter Zip Code”
5. User clicks the enter button. 5. User is taken to a page which

shows them that they can sign up
for “Individual & Family Health
Insurance” This is the only option
for visitors to the site and they
must select it if it is not already
selected for them.
6. User does not enter date of 6. User will get an “Important

birth. Message:” notice. Will prompt
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user to “Please enter a valid date

of birth (e.g. 01/25/1980)”
7. User then clicks “Get Quotes”

button.
Exception Path User Flow System Response
1. System error such as website 1. User gets directed to an Error

down or cannot access database. page with apology.
2. No health care plans uploaded 2. User gets directed to an Error

onto the website for User to page with apology.
search.
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DETAILED USE CASE -2

Name Allow the ability for current members to access their account: Req-60 in
BRD
Unique ID 0.01
Primary Actor User/Member of BCBS
Secondary Actor Database
Brief Description Allow the ability for current Members to access their account/s.
Glossary
Priority High
Frequency High
Trigger User clicks the button “Already a Member?”
Pre-condition User must be a Member.
Post-condition User will be able to view a page with their account information.
Happy Path User Flow System Response
1. User clicks on the button called 1. User is directed to a page where

“Already a Member?” they can enter in their first three
letters of the Identification
Number on their
member ID card.
2. User then enters in the first 2.

three letters of the Identification
Number on their member ID card.
3. User clicks the enter button. 3. User is then connected to their

local BCBS company’s website to
gain access to your member
benefits. In my case I typed in
random letters and came to the
following (Michigan) website:
http://www.bcbsm.com/
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4. User then clicks the login 4. A dropdown menu is presented

button. with the ability for the user to
enter their username and
password.
5. User clicks in the text box under 5.

the label which says “Username:”
6. User can then enter their 6.

username.
7. User clicks in the text box 7.

under the label which says
“Password:”
8. User can then enter their 8.

password.
9. User clicks the Log In button. 9. User is directed to their

member account page.
Alternate Path User Flow System Response
1. User enters incorrect first three 1. User is directed to an Error page

letters of the Identification which has a label named “Error”
Number on their member ID card. and also has a label below the first
label named “Error”, “Error! Your
search did not return any results.”
Also has a hyperlink which says
“Go back and retry your search.”
2. User enters incorrect username 2. User is directed to a Login Help

or password. page and gets an error message
which says “Your User Name
and/or Password is invalid.” Error
message is in the color red.
3. User doesn’t enter any 3. User gets an immediate error

characters in username. message on the dropdown menu
where they are attempting the
Login which says “Please enter a
username.” Error message is in the
color red.
4. User doesn’t enter any 4. User gets an immediate error

message on the dropdown menu
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characters in password. where they are attempting the

Login which says “Please enter a
password.” Error message is in the
color red.
Exception Path User Flow System Response
1. System error such as website 1. User gets directed to an Error

down or cannot access database. page with apology.
2. No health care plans uploaded 2. User gets directed to an Error

onto the website for User to page with apology.
search.
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USE CASE DIAGRAM
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ACTIVITY DIAGRAMS
Register for Career Profile
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Shop For Health Insurance Quotes
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GAP ANALYSIS
AS-IS DIAGRAM
User Searches For Doctors or Hospitals (AS IS)
Selects Doctors or
User goes to User selects
User
Searches for Hospitals of

www.bcbs.com Doctor or Hospital
Doctors/Hospital interest for
website of their choice
comparison
Database
BCBS
Access providers
Database
(Google)
External
Access Google
Maps based on
Zip Code provided
by the user
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TO-BE PROCESS FLOW DIAGRAM

User Searches For Doctors or Hospitals (TO BE)
User selects
User goes to Doctors or User selects
User
User Searches for

www.bcbs.com Hospitals of Doctor or Hospital
Doctors/Hospital
website interest for of their choice
comparison
Database
Access providers
BCBS
based on Zip Code

provided by the
user
Database
(Google)
External
Access Google
Maps based on
Zip Code provided
by the user
(Doctors or
Access individual
Database
Hospital)
External
Doctor or Hospital
calendar for
convenient
scheduling of
appointments
Provides customers the ability to quickly

and easily schedule appointments. Idea is
to decrease schedule conflicts and
provide hassle free scheduling.
14 | P a g e

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SAMPLE BUSINESS

VERSION HISTORY ............................................................................................................... 2

BUSINESS RULES: ................................................................................................................. 2

BUSINESS REQUIREMENTS: .................................................................................................. 2

DETAILED USE CASE- 1 ......................................................................................................... 3

DETAILED USE CASE -2 ......................................................................................................... 7

ACTIVITY DIAGRAMS ......................................................................................................... 11

AS-IS DIAGRAM ................................................................................................................. 13

TO-BE PROCESS FLOW DIAGRAM ....................................................................................... 14

DETAILED USE CASE- 1

Primary Actor User/Customer

Secondary Actor Database

Trigger Enter button

Pre-condition User must know their zip code of interest.

Post-condition User receives the various plans with their quotes.

Happy Path User Flow System Response

1. User clicks in the text box which 1.

2. User enters the zip code of their 2.

3. User clicks the enter button 3. User is taken to a page which

4. User must select “Individual & 4.

Family Health Insurance” This is

5. User must then enter their zip 5.

6. User clicks the “Get Quotes” 6. User is taken to a page where

7. User must select their gender 7.

8. User enters in their date of 8.

9. If the User has a Spouse that 9.

10. If User wants to cover Spouse 10.

11. If User wants to cover Spouse 11.

12. If the User has children that 12.

13. User can determine which 13.

14. User then makes sure that the 14.

Alternate Path User Flow System Response

1. User enters in zip code. 1.

2. User clicks enter button. 2. Zip code is wrong, so it redirects

3. User clicks the hyperlink which 3. Takes User to another page

4. User then clicks in the text box 4.

5. User clicks the enter button. 5. User is taken to a page which

6. User does not enter date of 6. User will get an “Important

user to “Please enter a valid date

7. User then clicks “Get Quotes”

Exception Path User Flow System Response

1. System error such as website 1. User gets directed to an Error

2. No health care plans uploaded 2. User gets directed to an Error

DETAILED USE CASE -2

Primary Actor User/Member of BCBS

Secondary Actor Database

Trigger User clicks the button “Already a Member?”

Pre-condition User must be a Member.

Happy Path User Flow System Response

1. User clicks on the button called 1. User is directed to a page where

2. User then enters in the first 2.

3. User clicks the enter button. 3. User is then connected to their

4. User then clicks the login 4. A dropdown menu is presented

5. User clicks in the text box under 5.

6. User can then enter their 6.

7. User clicks in the text box 7.

8. User can then enter their 8.

9. User clicks the Log In button. 9. User is directed to their

Alternate Path User Flow System Response