BCBSMA - Claims Ops - Global Claim Reset SDD 1.0

Blue Cross Blue Shield of
Massachusetts
Solution Design Document

(SDD)
Global Claim Reset

Business Unit Claims
Function (group in Business unit) Claims Operations
Process Name Global Claim Reset
Sponsor (BCBS) Kathryn Cohane
Developer (BCBS) Lateetud
BCBSMA: Global Claim Reset - Solution Design Document
(SDD)
Document History and Approvals
Date Version Name Role Function Comment

04/03/2023 0.1 Deep Shah Team Lead Global Claim Initial Draft
Reset
04/04/2023 0.2 Rohan Goswami Software Global Claim Updated Object List Post COE
Engineer Reset Walkthrough
05/04/2023 1.0 Rohan Goswami Software Global Claim Alex Lam approved the SDD
Engineer Reset pending comments. In this revision
we have addressed Alex comments
as well.
BLUE CROSS BLUE SHIELD OF MASSACHUSETTS | CONFIDENTIAL – NOT FOR DISTRIBUTION Page 2 of 24
(SDD)
Table of Contents
Document History and Approvals..................................................................................2
2 Introduction.............................................................................................. 5
2.1 Purpose of Document.......................................................................................... 5
2.2 Document Contributors and Key Contacts...........................................................5
2.3 Document References......................................................................................... 5
2.4 Robotic Resource Requirement...........................................................................5
3 Master Project Details...............................................................................6
4 Input Data................................................................................................. 6
5 Output Data.............................................................................................. 7
6 Solution Design......................................................................................... 7
6.1 Applications & Accesses......................................................................................7
6.2 Design Considerations and Justification..............................................................7
6.2.1 Reusable code........................................................................................................................7
6.2.2 Performance and Scalability...................................................................................................9
6.2.3 Security..................................................................................................................................9
6.2.4 Reporting...............................................................................................................................9
6.2.5 Potential or future enhancements.........................................................................................9
6.3 Process Maps...................................................................................................... 9
6.3.1 AS-IS Flow..............................................................................................................................9
6.3.2 To-Be Flow.............................................................................................................................9
6.3.3 High Level Solution Architecture............................................................................................9
6.4 Process Steps – To Be Process.........................................................................10
6.5 Out Of Scope List:..............................................................................................17
6.6 IA Technology.................................................................................................... 17
6.7 Work Queues..................................................................................................... 17
6.8 Directory Structure for Files................................................................................18
6.9 Process Variables..............................................................................................18
6.10 Tables and Queries.........................................................................................18
6.11 Process Model................................................................................................ 18
6.11.1 Processes and Objects......................................................................................................18
(SDD)
6.12 Object Model...................................................................................................19
6.13 Exception Handling.........................................................................................19
6.14 E-Mail Templates............................................................................................20
6.15 Development Specification Details..................................................................21
7 Service Level Agreement (SLA).................................................................21
8 Scheduling & BOT Run Time....................................................................22
9 Applications Uptime................................................................................22
10 Password Policy.......................................................................................22
11 Security................................................................................................... 22
11.1 Credentials......................................................................................................22
11.2 Data Privacy....................................................................................................22
11.3 Data Storage...................................................................................................23
12 Testing Validation....................................................................................23
13 Reusable Assets to be Created.................................................................23
14 Assumptions............................................................................................23
14.1 Technical.........................................................................................................23
14.2 Business..........................................................................................................23
15 Risks........................................................................................................ 24
16 Code Change Log..................................................................................... 24
17 Appendix.................................................................................................24
(SDD)
2 Introduction
2.1 Purpose of Document

The purpose of this document is to provide a description of the changes required to meet the
high-level requirements of the process to be automated.
This is classified as a “living document”, and all changes in process or solution must be appended
and signed off prior to implementation.
This document is intended for the core automation team and IT support and enables a snapshot
of the automated process details and components. It also serves to enable handovers and aid
developers in understanding the current state before troubleshooting in code.
2.2 Document Contributors and Key Contacts

Role Name Contact Details (E-Mail, Phone, ID) Notes
Senthilkumar
Technical Lead senthil.sethurambabu@bcbsma.com
Sethurambabu
Team Lead Deep Shah Deep.shah@bcbsma.com
Software
Rohan Goswami rohan.goswami@bcbsma.com
Engineer
2.3 Document References

Solution has been created basis on the attached signed off PDD.
2.4 Robotic Resource Requirement

# Item Details Comment
Should be triggered post initial Global Table
1 Expected Schedule/Trigger
Load (tbl_Global_Claim_Reset_Lines)
2 Current Volume 1100/Month | 50/Day
3 Expected Future volume NA
Manual AHT (Avg. Handle
4 50 Claims/Hour
Time)
An hour of processing time needed in a

day to run this process and process
5 SLA
execution must complete within business
hours.
(SDD)
3 Master Project Details

Master Project Name (Process Name) OC_Global Claim Reset Data

Load_LAT
1
OC_Global Claim Reset
Main_LAT
Environment Prerequisites (OS details, NASCO Mainframe,

2 libraries, required applications) ClaimOps_3 Database
3 QA Bot ID _RPAROBO01
4 QA Server BSSIT04VW
5 Production Bot ID _RPAROBO02
6 Production Server BSSIP04VW
7 Robot Type NA
Control Room Schedule Details, or how Can be scheduled via
8 to the process is started if not using Dynamic Scheduler or RPA
Control Room Supervisor
Can any Reusable Code be leveraged? If Refer to Section, 6.2.1.
9 so, please list. Yes This will be further refined
post development
Can any Reusable Code be created for This will be defined post
10 TBD
future use? development
4 Input Data
Global Table Global table holds claim and its related This table will be updated daily
data for performing Global Claim Reset from Global Scripts
(tbl_Global_Claim_Reset_
process will be updated for Business/BET
Lines)
adjudication as below -
 To Be Scripted (01),
1
 To be Manually Reviewed (10),
 Script Repended (80),
 Script Finalized (11),
 Claim Already Finalized (91)
(SDD)
5 Output Data
Inventory Master Table Inventory Master will be updated with
following status values –
(tbl_SQLScript_InventoryMa
ster)  To Be Scripted (01),
1  Skipped (90),
 Repended (12),
 Approved To Pay (11),
Global Table Global table holds claim and its related
data for performing Global Claim Reset
(tbl_Global_Claim_Reset_Li
process will be updated for Business/BET
nes)
adjudication as below -
2
 To Be Scripted (01),
 To be Manually Reviewed (10),
 Script Repended (80),
 Script Finalized (90),
6 Solution Design
6.1 Applications & Accesses
Application Name Environment Login Login Mode / Access

Comments/ Downtime
& Version Method Interface Required/Model After
Dev <Process Variable.
NASCO HEHK NASCOCredentialsName
>
QA <Process Variable.
>
Prod <Process Variable.

>
6.2 Design Considerations and Justification

6.2.1 Reusable code
One of the key tenants of the design is to ensure that existing objects relevant to this process is reused.
The design also aims to build components that could potentially be reused in future automations
(SDD)
The existing components that are reused are below
Name Description
HEHK – Basic Actions Actions Considered –
Check Terminate / Start Screen
StartClaimProcessing
Maximize NASCO
Exit Claim (F3)
Send Escape
Read Error Message
PPI Read
Write PPI
Send Enter
Submit Claim
Force Submit Claim
Release Claim – (F4)
Press F6
Keyed ICN Not Found
HEHK – Professional Claims EEC Actions Considered –
Read PPI
Write PPI
F6 to Last Claim Line
Read Line Count
HEHK – Facility Claims EEC Actions Considered –
Read PPI
Write PPI
Read Line Count
HEHK – Dental Claims EEC Actions Considered –
Read PPI
Write PPI
Read Line Count
HEHK – Prof Med Related Claims Actions Considered –
EEC Read PPI
Write PPI
Read Line Count
The automation will also create reusable components that could be used in future automations.
Name Description
HEHK – Professional Claims EEC TBD
HEHK – Facility Claims EEC TBD
HEHK – Dental Claims EEC TBD

HEHK – Prof Med-Related EEC TBD
(SDD)
6.2.2 Performance and Scalability
This automation is designed as a multi bot operation. This will allow multiple bots to work
simultaneously to complete the processing of cases.
The design involves two separate high-level processes. One will be a loader which will load the data into
Blue Prism Queue. Other will be a worker, which will take requests loaded to the Queue and start
working on them.
When the automation is kicked off, the loader will start first and place a lock on the environment,
thereby preventing any other bots from loading the queue. The other bots can start reading the Queue
and begin processing cases through NASCO.
6.2.3 Security
This automation will use the Blue Prism credential manager to store all passwords, access keys and
client secrets.
All access to systems will be from within BCBSMA machines.
6.2.4 Reporting
The design will follow the standard BCBSMA reporting formats. All the email templates are as per
definition in this SDD. The error and exception reporting will happen out of the database.
6.2.5 Potential or future enhancements

Not Applicable
6.3 Process Maps

6.3.1 AS-IS Flow
6.3.2 To-Be Flow
This section depicts the future state – Automation Solution process flow based on the Business
Requirements. The Solution is designed to automate end to end process steps using RPA. The
Automation adds value proposition by reducing manual effort, decreasing process time, and improving
customer claim processing TAT.
6.3.3 High Level Solution Architecture

Paste Flow and Architecture diagrams here and provide a copy of the document in the appendix
Solution Process Flow
(SDD)
6.4 Process Steps – To Be Process

Include a detailed description of each step in the process map and the corresponding application.
Step # Step Description/ Screen Shot

1 Fetch Claims from Bot will read Inputs “ICNs and Claim Processing Actions” with Status = ‘To be
Global Table Scripted’ from table – “tbl_Global_Claim_Reset_Lines”
(tbl_Global_Clai
m_Reset_Lines) Procedure Input:
- ICN (required)
- PPI (default to zero – allow user to change)
- Line Number (Optional) and below is the list of formats which is
applicable as an input for “LineNo” field.
ICN LineNo Remarks
38230190034500 5 Specific claim line
38230190024400 All claim Lines
20223623342500 2-5 Range from 2 to 5
26213446061000 1;2;4;7 Specific claim lines
Initial Pull SP – sp_001_ClaimOps_GlobalClaimReset_Load_Fresh_Inventory
Initial Pull Criteria –

 Status Code 01
 RPAUser should be null or empty
Description –
 The tbl_Global_Claim_Reset_Lines will have new import records on
daily basis from Global Scripts/database
 The loader and worker process should run one after another
immediately. Once a new record is pulled per above criteria then
update RPAUser with Bot ID immediately for that pulled record.
(SDD)
 Post pulled records processed in NASCO, the status code and remarks
would be updated back to this table.
 @FetchCount = <Process
Variable.SPLoadQueueInventoryFetchCount> -- 0 will fetch all or top
100000 else specified top count will be fetched
Note:
 It will clear the screenshots from previous 2 days runs
 Fresh inventory will be fetched on next run and any pending records from
previous run will be processed first
 If there are no records to process and stop the process
 This automation caters to following Claim Classes –
o Class 2 – Professional Non-Medicare
o Class 8 – Professional Medicare
o Class 3 – Facility Non-Medicare
o Class 7 – Facility Medicare
o Class 5 - Dental
 The Script Status and Remarks Mapping between Global Table and
Inventory Master will be referred from new lookup table
(tbl_Global_Apply_Provider_Status_Code_Mapping) –
(SDD)
Once we identify that we have records to process, we take each record from the
Global Table Pull output and perform the following steps –
 Add an item to Blue Prism Queue, with Item Key as
[claim number] ~<Today’s Date>
 Tag = “NASCO Processing”
When more than one bot tries to add records to queue, the Environment Locking
would allow only one Bot to do it. The other Bots must wait until the lock is released
by the acquired Bot or pending items is found for processing.
Load Items to Queue (Loader) will load all the fresh inventory and place it under
Bot’s Queue.
Global Table will then be updated as per below -
Table: tbl_Global_Claim_Reset_Lines
 UpdatedDate - CurrentDateTime
 RPAUser - <_RPAROBO01/2>
Populate Blue  RPAStatus - “01”
Prism Queue and  RPAItemID - <BluePrism Item ID>
2
Update Inventory
Master New record will be inserted into Inventory Master with the following values –
DB: ClaimOps_Script
Table: tbl_SQLScript_InventoryMaster
 date - CurrentDate
 icn - <claim number>
 Script - “GlobalClaimReset-RPA”
 Script Type - “Claim”
 Run Mode - 1 for Dev/QA | 2 for Prod (Process variable)
 VIP - "<VIP>"
 Script Status - "01"
 Script Status Date - CurrentDateTime
 Scripting Computer Name - <BotName> (Name of the Computer)
 Scripting LAN ID - <_RPAROBO01/2>
 Scripting ID - " <Process Variable. NASCOCredentialsName> "
 Scripting Start Update Date – CurrentDateTime
Launch and Login Once we have identified that there are records to process, launch and login to
3 NASCO HEHK
to NASCO
Get Next Claim Get Next Item from Blue Prism Queue with Tag = “NASCO Processing”
4 from Blue Prism
Queue
5 Validate Inputs Once we have identified the item to process, we will perform following validations –
 Validate ICN –
o Validate if ICN is present with Valid 14-digit Number, if validation
(SDD)
failed skip this claim and move on to next item/action after
updating queue and both Inventory Master, Global Reset Table.
o Update Inventory Master
 Script Remarks - “GLOBCRE006 – Invalid ICN”
 Status - 90
o Update Global Table
 Status – 10
 Remarks – “GLOBCRE006 – Invalid ICN”
 UpdatedDate – <CurrentDateTime>
 RPA User– <Present>
 RPA Status – 90
 RPA Remarks – “GLOBCRE006 – Invalid ICN”
 RPAWorkedTime – “Bot Processing Time”
o Update Blue Prism Queue
 Tag - “NASCO 90” i.e., Business Exception
 Mark Blue Prism Queue Item as exception with message,
“GLOBCRE006 – Invalid ICN”
 Validate Input Line Number –

o Validate the Specified input line number Values, it should not have
any other delimiter then semi colon (;) OR Range (-), If so, skip this
claim and move on to next item/action after updating queue and
both Inventory Master, Global Reset Table.
 Script Remarks - “GLOBCRE007 – Invalid Line Number”
 Status - 90
 Status – 10
 Remarks – “GLOBCRE007 – Invalid Line Number”
 RPA Remarks – “GLOBCRE007 – Invalid Line Number”
 Tag - “NASCO 90” i.e., Business Exception
“GLOBCRE007 – Invalid Line Number”
6 Search Claim We will then search that claim on NASCO and If any of the following skip messages
are detected, skip that claim and move to next action/item –
 Sub ID Locked (Previous Worksheet Locked) –

 Script Remarks - “GLOBCRE001 – Step 7 - Sub ID Locked”
(SDD)
 Status - “90”
 Status – 10
 Remarks – “GLOBCRE001 – Step 7 - Sub ID Locked”
 RPA Remarks – “GLOBCRE001 – Step 7 - Sub ID Locked”
 Update Tag - “NASCO 90” i.e., Business Exception
“GLOBCRE001 – Step 7 - Sub ID Locked”
 Claim Already Finalized

 Script Remarks - “GLOBCRE005 – Step 9 - Claim Already
Finalized”
 Status – 91
 Remarks – “GLOBCRE005 – Step 9 - Claim Already Finalized”
 RPA Remarks – “GLOBCRE005 – Step 9 - Claim Already
Finalized”
 Update Tag - “NASCO 80”
“GLOBCRE005 – Step 9 - Claim Already Finalized”
 Keyed ICN Not Found

o Press F3 to cancel out the claim and proceed to next action/item
 Script Remarks - “GLOBCRE002 – Step 8 - Keyed ICN Not
Found”
 Status – 10
 Remarks – “GLOBCRE002
– Step 8- Keyed ICN Not Found”
 RPA Remarks – “GLOBCRE002 – Step 8 - Keyed ICN Not
Found”
(SDD)
“GLOBCRE002 – Step 8 - Keyed ICN Not Found”
 Else if any other error message is identified or claim does not successfully
open, then
 Script Remarks - “GLOBCRE003 – Step 10 - Claim Did Not
Open”
 Script Status - “90”
 Status – 10
 Remarks – “GLOBCRE003 – Step 10 - Claim Did Not Open”
 RPA Remarks – “GLOBCRE003 – Step 10 - Claim Did Not
Open”
“GLOBCRE003 – Step 10 - Claim Did Not Open”
 If “lineNo” field is Blank in global table,
o Type ‘S’ in ‘A’ Field in All Claim Lines
 If “lineNo” field is present with Specific claim line numbers

Line Numbers
7 (3;7;9),
Specified in Input?
o Type ‘S’ in ‘A’ Field of Specific/mentioned Claim Lines
 If “lineNo” field is present with range (3-9)

o Type ‘S’ in ‘A’ Field of Claim Lines in specified range
Check if New PPI is specified in input, and if a value that is different from what exists
New PPI Specified on EEC Screen is provided then, proceed to step 9, else proceed to step 10
8
in Input?
Note – PPI Value of Blank or 0 are considered same
9 Update PPI Update the value of PPI as specified in input, proceed to step 10
10 Press F5 To  Press F6 to last claim line

Submit  Press F5 to submit claim
 Check if Force Prohibited Error appears,
o Press F3 to cancel out claim and proceed to next action/claim
 Status - 90
 Script Remarks: “GLOBCRE004 – Step 13 - Force Prohibited”
 Status – 10
(SDD)
 Remarks – “GLOBCRE004 – Step 13 - Force Prohibited”
 RPA Remarks – “GLOBCRE004 – Step 13 - Force Prohibited”
 Update Tag: “NASCO 90”
 Mark Blue Prism Queue item as exception with message,
“GLOBCRE004 – Step 13 - Force Prohibited”
 Else Proceed to Step 11
11 Release Claim o If we are in Testing Phases, Perform PPI9 Step as follows -
 Set PPI Value as ‘9’
 Press F6 till Last Claim Line
 Force Submit by Pressing F5
 If Force Prohibited Error Occurs, Press F3 to cancel out
claim and proceed to next action/claim
 Status - 90
 Script Remarks: “GLOBCRE004 – Step 13 - Force Prohibited”
 Status – 10
 Remarks – “GLOBCRE004 – Step 13 - Force Prohibited”
 RPA Remarks – “GLOBCRE004 – Step 13 - Force Prohibited”
 Mark Blue Prism Queue item as exception with message,
“GLOBCRE004 – Step 13 - Force Prohibited”
o Else Continue as below
o Else, if we are in Prod Phase or after performing PPI9 Step,
Press F4 to release claim
o Check if RTCP Totals is not displayed,
 Script Status – “12”
 Script Remarks: “GLOBCRS002 – Step 14 - <Claim Processing
Actions>”
 Status – 80
 Remarks – “GLOBCRS002 – Step 14 - <Claim Processing
Actions>”
 RPA Remarks – “GLOBCRS002 – Step 14 - <Claim Processing
(SDD)
Actions>”
 Mark Blue Prism Queue Item as complete
o Proceed to Step 12
o Else if, RTCP Totals displayed
 Update Inventory Master
 Script Status:”11”,
 Script Remarks - “GLOBCRS001 – Step 14 - <Claim
Processing Actions>”
 Total Charge – <Pick from RTCP Totals segment>
 Approved To Pay amount - <Pick from RTCP Totals
segment >
 Update Global Table
 Status – 90
 Remarks – “GLOBCRS001 – Step 14 - <Claim
 UpdatedDate – <CurrentDateTime>
 RPA User– <Present>
 RPA Status – 11
 RPA Remarks – “GLOBCRS001 – Step 14 - <Claim
 RPAWorkedTime – “Bot Processing Time”
 Update Blue Prism Queue
 Update Tag: “NASCO 11”
 Mark Blue Prism Queue Item as complete
o Proceed to Step 12
Get Next Claim Ensure, that previous claim is released, before proceeding to Next Case from Blue
12
from BP Queue Prism
6.5 Out Of Scope List:

Sr No Out Of Scope Description
1 All claim classes except for 2,3,5,7 and 8 will be considered out of scope
6.6 IA Technology
# Name Version Comment
1 Blue Prism 6.10.4
6.7 Work Queues

# Work Queue Name Max Attempts Key Value
1 Global Claim Reset Queue 1 [claim number] ~<Today’s Date>
(SDD)
6.8 Directory Structure for Files

Input excel file will be placed in following directory structure –
# Environment Path
1 Development NA
2 Test/QA NA
3 Production NA
6.9 Process Variables

Will be attached post completion of development.
6.10 Tables and Queries

Provide any additional tables being used or query strings here and a description of how they are being
used.
# Query/Table Description Code/Table details

1 tbl_Global_Claim_Reset_Lines Contains list of all claims Refer Step 1 under
require for performing Section 6.4
Global Claim Reset process
2 MorningRoutine.BluePrismMessageCo Table exception and
des success messages
3 tbl_Global_Apply_Provider_Status_Co Global Table and IM Script
de_Mapping Status/Code Mapping Table
6.11 Process Model

6.11.1 Processes and Objects
Orde Name
Process / Object
r
1 Process OC_Global Reset Claim – Loader_LAT
2 Process OC_Global Reset Claim – Main_LAT
ClaimOps_Script
3 Object
 Inventory Master – INSERT/UPDATE
ClaimOps_3
4 Object  Tbl_Global_Claim_Reset - UPDATE
(SDD)
6.12 Object Model
Place Standard BP ODI here. This will be attached on development complete
6.13 Exception Handling

Include all known business and system exceptions and respective remediation steps/contact
information.
# Exception Type Exception Name Action to be taken

Send email to Post Production Support Team with
BOT unable to log into NASCO
1 System Exception exception reason post 3 retries (# set in process
system
variable) and end the process
BOT unable query database
tables
Application Timeout – Unable to
find landing screen
GLOBCRE001 – Step 7 - Sub ID Skip with “Script Remarks” message and Status 90
4 Business Exception
Locked in IM and Status 10 in Global Table
GLOBCRE005 – Step 9 - Claim Skip with “Script Remarks” message and Status 90
Already Finalized in IM and Status 91 in Global Table
GLOBCRE002 – Step 8 - Keyed Skip with “Script Remarks” message and Status 90
ICN Not Found in IM and Status 10 in Global Table
GLOBCRE003 – Step 10 - Claim Skip with “Script Remarks” message and Status 90
Did Not Open in IM and Status 10 in Global Table
GLOBCRE004 – Step 13 - Force Skip with “Script Remarks” message and Status 90
Prohibited in IM and Status 10 in Global Table
GLOBCRE006 – Invalid ICN Skip with “Script Remarks” message and Status 90
in IM and Status 10 in Global Table
GLOBCRE007 – Invalid Line Skip with “Script Remarks” message and Status 90
Number in IM and Status 10 in Global Table
Success Message GLOBCRS001 – Step 14 -
(Not success Approved to Pay Update Inventory with “Script Remarks” message
11 message will be and Status 11 - <Update the Claim Processing
part of exceptions Action> and Global Table with Status - 90
table)
12 Success Message GLOBCRS002– Step 14 - Update Inventory with “Script Remarks” message
(Not success Repended and Status 12 - <Update the Claim Processing
message will be Action: Override or Reject> and Global Table with
(SDD)
part of exceptions
Status - 80
table)
For all unknown exceptions, please contact <solutionsdevelopmentteam@bcbsma.com> Must be

Distribution List
6.14 E-Mail Templates

Mail should be sent in the below formats for process completion, or to notify of an exception:
Email Format for System Exceptions

To: <ExceptionEmailTo from Process Variable>
Subject: System Exception Occurred for Global Claim Reset on Dev/QA/Prod
Body: Hi Team,
System exception occurred while executing Global Claim Reset process
Please find Exception Details below:
Exception Type: System Exception or Internal
Exception Details: Exception Reason
Environment Instance Name: Dev/QA/Prod
Robot ID: _RPAROBO01 / _RPAROBO02
Robot Machine: VMLAB-P<410>
Execution Date: 09/13/2022 07:14 PM
**This is an automatically generated e-mail. Do not reply to this message**
Email Format for Process Completion

To: <SuccessEmailTo from Process Variable> <Needed?>
Subject: Process Successful – Global Claim Reset on Dev/QA/Prod
Body: Hi Team,
Reconciliation Process completed successfully for Global Claim Reset PROCESS
Please find completion Details below:
< report>
**This is an automatically generated e-mail. Do not reply to this message**
(SDD)
6.15 Development Specification Details

# Development Specification Details
1 Logging Level Error Only, Except for exceptions (for Prod)
2 Project Repository
3 List of Reused Code / Components Refer section 6.2.1
Configuration Method (Assets, Config
4
File, json File)
5 Configuration Details
7 Service Level Agreement (SLA)

Item Description
Service Level Agreement (SLA) An hour of processing time needed in a day to run this process and
process execution must complete within business hours
SLA Reason(s)
SLA Breech Implications
Response Type Time since queue item created or trigger activated, Specified time of day
in the week/month/date, Immediate
Deadline Type Work started within, completed within, finished, …
Deadline Timeframe Should be completed within business hours (5 PM EST)
Working Hours 6 AM EST to 11 PM EST (NASCO Uptime Hours) on Weekdays (This will be
updated in subsequent phases)
Resource Group – VM Labs TBD
Trigger Time interval
Queue Global Claim Reset Queue
Parallel Sessions Limit Multiple for Worker Process
Queue Item State
Comments
8 Scheduling & BOT Run Time

Sr No BOT Schedule Process Execution Cycle Time Zone Comments
(SDD)
Run Time type

6 AM EST to 11 Adhoc EST
PM EST (NASCO
1
Uptime Hours)
on Weekdays
9 Applications Uptime
Up Period Up Time Comments
Sr No Application Name
(Time Zone)
NASCO Mainframe 6 AM EST to 11 PM EST EST Run this process based on the Tag
1
on Weekdays for the scheduled duration
2 MS SQL Server 24/7 EST
10 Password Policy
Sr No Application Name Password Expiry Password Setting Comments
NASCO N/A <Process Variable.
1
NASCOCredentialsName>
11 Security
11.1 Credentials
A robot account for the applications used in the process will be created with sufficient privileges
to perform the process. The robot will maintain its own credentials with no expiry passwords.
Credentials will be stored in Blue Prism Credential Manager under Settings in encrypted format.
11.2 Data Privacy

All account data held in Blue Prism will be stored encrypted in the Blue Prism work queue. The
case key visible to the Control Room will be created using the Group Number.
Stage logging across the process will be set to Log Errors Only. PHI/PII will not be stored in
folders/logs/queues.
11.3 Data Storage

Input data files will continue to be stored at the current shared locations.
A new folder will be created to accommodate the exception reports.
(SDD)
12 Testing Validation
Test cases should include QA and UAT scenarios. Provide the test case details for this process
below, or a link to a dedicated test case document.
13 Reusable Assets to be Created

Output
# Name Description Input Argument(s)
Argument(s)
14 Assumptions
List of assumptions that are made during the development of the RPA process:
14.1 Technical
1. The server is configured as per the specifications before development/deployment starts.
2. The required licenses for the licensed software have been procured and are available till the end
of the project completion.
3. Any changes to the process flow will need to be addressed through Change Management.
4. The network/application is available during the planned RPA Business hours while in the
Development phase.
5. The developer machine is installed and equipped with all necessary software.
6. Sanity Testing is done whenever applications are upgraded, or any major enhancement being
done during the development. This testing is done to ensure that all the controls or objects in
the applications are still accessible through the Automation Tool. And if the Sanity fails, then a
Change Request is made to rescript the Robots.
7. Any changes to the Applications, process flow or the data in the configuration files need to be
intimated to the development/maintenance team before the change is made.
8. There is no enterprise level initiative is planned to sunset current applications and replaced by
another one in coming three quarters.
9. RPA Automation is allowed by all application’s application owners.
14.2 Business
1. Bot already have access to all the involved application.
2. All the required test data is already available before commence development, testing and UAT.
3. No changes to be done on any of the involved files, online reports or assets naming
conventions.
4. This is based on current understanding of process in case any change in process estimate and
development time will also change.
5. Any records pending to be processed for current day will be ignored/discarded, before next
day’s run
(SDD)
15 Risks
Provide details regarding any risks that could occur that would affect the bot’s operations or
performance
Risk Details Mitigants

All the involved Application must not experience any None
downtime during development and testing hours.
All the required test data is already available before None

commence testing.
There are no UI Level changes for any of the involved None

application without prior notice to the Dev team.
All the involved template for the Bot processing None

purpose must not be altered without prior notice to
Dev team.
16 Code Change Log

# Date Change Type Approver Change Description and Details
1
2
3
17 Appendix
Sr No Document Name Attachments (If Any) Comments
3
4

BCBSMA - Claims Ops - Global Claim Reset SDD 1.0

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Blue Cross Blue Shield of

Solution Design Document

Global Claim Reset

Date Version Name Role Function Comment

2.1 Purpose of Document

2.2 Document Contributors and Key Contacts

2.3 Document References

2.4 Robotic Resource Requirement

An hour of processing time needed in a

3 Master Project Details

Master Project Name (Process Name) OC_Global Claim Reset Data

Environment Prerequisites (OS details, NASCO Mainframe,

6.1 Applications & Accesses

Application Name Environment Login Login Mode / Access

Prod <Process Variable.

6.2 Design Considerations and Justification

HEHK – Facility Claims EEC TBD

HEHK – Dental Claims EEC TBD

All access to systems will be from within BCBSMA machines.

6.2.5 Potential or future enhancements

6.3 Process Maps

6.3.3 High Level Solution Architecture

Solution Process Flow

6.4 Process Steps – To Be Process

Step # Step Description/ Screen Shot

Initial Pull SP – sp_001_ClaimOps_GlobalClaimReset_Load_Fresh_Inventory

Initial Pull Criteria –

Global Table will then be updated as per below -

 Validate Input Line Number –

 Sub ID Locked (Previous Worksheet Locked) –

 Claim Already Finalized

 Keyed ICN Not Found

 If “lineNo” field is present with Specific claim line numbers

 If “lineNo” field is present with range (3-9)

10 Press F5 To  Press F6 to last claim line

6.5 Out Of Scope List:

6.7 Work Queues

6.8 Directory Structure for Files

6.9 Process Variables

6.10 Tables and Queries

# Query/Table Description Code/Table details

6.11 Process Model

6.13 Exception Handling

# Exception Type Exception Name Action to be taken

For all unknown exceptions, please contact <solutionsdevelopmentteam@bcbsma.com> Must be

6.14 E-Mail Templates

Email Format for System Exceptions

**This is an automatically generated e-mail. Do not reply to this message**

Email Format for Process Completion

**This is an automatically generated e-mail. Do not reply to this message**

6.15 Development Specification Details

7 Service Level Agreement (SLA)

SLA Breech Implications

8 Scheduling & BOT Run Time

Run Time type

11.2 Data Privacy

11.3 Data Storage

13 Reusable Assets to be Created

Risk Details Mitigants

All the required test data is already available before None

This is an automatically generated e-mail. Do not reply to this message

This is an automatically generated e-mail. Do not reply to this message