Understanding Enterprise Integration Points for Policy and Claims Presentment

This chapter discusses enterprise integration points (EIPs) for Policy and Claims Presentment.

EIPs for Policy and Claims Presentment

This section discusses:

• Policy creation EIP.

• Policy application EIP.

• Billing history EIP.

• Payment history EIP.

• Change policy EIP.

• First notice of loss (FNOL) EIP.

• Claim header EIP.

• Claim detail display EIP.

These EIPs are designed for the insurance industry.

Policy Creation EIP

When a customer completes the policy application, the PeopleSoft CRM system sends the completed application information to the legacy system. The legacy system then creates the policy in its own system and performs all the checks and business processes that are required. Next, the legacy system sends a message to Integration Broker to create the policy in the CRM system. Translation is not required for the incoming message, but a subscription code is required to read the message content and create the policy and associated records in the PeopleSoft CRM table structure. The code uses the policy number to determine whether this is a new or existing policy. For a new policy, the system inserts new sets of data into the CRM tables. For existing policies, the system issues an update statement on the account header part and deletes and reinserts policy detail and coverage data in the remaining tables. The message structure includes policy information, covered assets, covered asset details, coverages, deductibles, options, and limits.

This table describes the Create Policy EIP:

Policy Application EIP

The policy application EIP is used to send the information captured in the application process to the legacy system where the policy is created.

This table describes the Request Policy Creation EIP:

Billing History EIP

Billing data is stored and maintained in an external system. The billing history EIPs request and receive billing history information from external systems.

This table describes the Billing History EIPs:

Payment History EIP

Payment data is stored and maintained in an external system. The payment history EIPs request and receive payment history information from external systems. Payment history is available in the Financial Account record.

This table describes the Payment History EIPs:

Change Policy EIP

The change policy EIP is used to communicate the policy modification messages to the legacy system. If the Policy Modification requires a new quote, then a quote is generated and it follows the sales entry process.

This table describes the Change Policy EIPs:

FNOL EIP

The FNOL EIP is used to publish the message when a FNOL is saved in the PeopleSoft CRM system and the associated business project tasks are completed. The message consists of the FNOL number, policy number, and the questions and answers from the branch script or application form. The FNOL number is stored and mapped to a claim in the PeopleSoft CRM system.

This table describes the FNOL EIP:

Claim Header EIP

The claim header EIP is used to create the claim header in the Policy and Claims Presentment system. This one-way message creates the claims in the CRM system that was created in the legacy system as a result of a FNOL . One or more claims may be generated from a FNOL. The subscription code creates the claim records and establishes the relationship between the FNOL and the claim.

This table describes the Claim Header EIP:

Claim Detail Display EIPs

The claim detail display EIPs retrieve claims data from the claims system and display the data on the View Claim page. This synchronous message retrieves the claim header number and claim detail.

This table describes the Claim Detail EIPs: