Approved
Approved
EESSI Business Use Case
H_BUC_04_Subprocess Reimbursement of Administrative Check or Medical Information
Table of Contents
6.1. Issues 12
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Document Title:
Business Use Case
H_BUC_04_Subprocess-Reimbursement of Administrative Check or Medical Information
Project Title:
EESSI (Electronic Exchange of Social Security Information) Project
Document Author:
European Commission, DG EMPL F5
System Owner:
European Commission, DG EMPL D2
Doc. Version:
v4.1.0
Sensitivity:
Public
Date:
31/08/2018
Document history:
The Document Author is authorized to make the following types of changes to the document without requiring that the document be re- approved:
Editorial, formatting, and spelling
Clarification
To request a change to this document, contact the Document Author or
Owner.
Revision
Date
Created by
Short Description of Changes
v0.1.0
17/10/2016
Anda Mirita
Initial Draft
v0.2.0
23/02/2017
Anda Mirita
Changes incorporated after AC review
v0.3.0
27/02/2017
Anda Mirita
Alignment of title and SED names to main process following comments received from AC
Branch 4 and Branch 5 removed in alignment with main process
Description of Other Participant(s) has been updated
v0.99.0
28/02/2017
Anda Mirita
Candidate for AC Approval
v1.0.0
16/03/2017
Anda Mirita
AC Approved version
v1.0.1
30/06/2017
Gelu Mitu
Updated BPMN diagram in "Section 5. Business Processes" to correspond to the described process.
v1.0.2
08/11/2017
Eric Briffoz
- Added the BPMN version of the diagram in section 5.
- Removed reference to BUC confluence page in Configuration Management.
v4.1.0
31/08/2018
Novella Bacelli
- Section 4.4 merged 2 tables (for SED & for Subprocesses) into 1 BUC Artefact table."
- Version adaptations to release 4.1.0
Introduction
Purpose
The purpose of this document is to construct an external view of, part of, the 'EESSI business system' as described in EC Regulations 883/2004 and 987/2009. The ‘EESSI Business System’ describes the business and expected business processes without consideration as to which part(s) may be realized by an IT System (i.e. the proposed EESSI IT System).
The external view comprises of models and descriptions of business use cases, the services of a business system offered to business actors: customers, business partners, or other business systems.
A business use case is described from an actor's perspective; it describes the interaction between an actor and the business system, meaning it describes the behaviours of the business system that the actor utilizes. The Business Use Case includes Use Case Diagrams and Business Process Models.
Use case diagrams show actors, business use cases, and their relationships. Use case diagrams do not describe procedures. Alternative scenarios also remain hidden. These diagrams give a good overview of the behaviours of the EESSI business system which will direct and govern part of the expected behaviours and functionality delivered by the EESSI IT System.
Scope
This document is limited to the external view on the horizontal sector process Reimbursement of Administrative Check. The different elements like use case description, actors, and business process as well as supporting UML diagrams and BPMN models pertaining to the ending of
a process.
Definitions, Accronyms and Abbreviations
Please see the EESSI Project Glossary.
References
#
Description
1
EC Regulation 883/2004
Regulation EC No 883- 2004.pdf
2
EC Regulation 987/2009
Regulation EC No 987-2009.pdf
3
UML 2.x
http://www.omg.org/spec/UML/
4
BPMN 2.0
http://www.omg.org/spec/BPMN/index.htm
5
UML 2.0 In Action
Henriette Baumann, Patrick Grassle & Philippe Baumann, 2005, ISBN 1904811558
6
RUP@EC standard 5.0
http://www.cc.cec/RUPatEC_Standard/
7
RUP op maat
http://www.rupopmaat.nl/
Overview
Chapter 1 introduces the external view on the business system under review and lists the elements of this specification.
Chapter 2 introduces us to the Reimbursement of Administrative Check or Medical Information business process. The chapter gives a short and detailed description as well as a reference to business process´ legal base.
Chapter 3 lists the actors involved in the Administrative Check or Medical Information business process.
Chapter 4 describes in detail the Administrative Check or Medical Information business process based on the RUP use case template, as well as the relationship to other use cases.
Chapter 5 describes the Administrative Check or Medical Information
business process using business process modelling notation (BPMN).
Description
Business Scenario
H_BUC_04_Subprocess is a subprocess that may be used only after administrative checks / medical exams were requested, confirmed and provided within a sector case.
Legal Base
This Business Use Case document's legal base is described in the following Regulations:
Implementing Regulation (EC) No 987/2009
The following matrix specifies the SEDs that are used in this Business Use Case and documents the articles that provide the legal basis for each SED.
SED
Implementing Reg (987/2009)
87
H020
H021
Table 1: SED – Legal base relationship matrix
Actors & Roles
This chapter captures details of the actors which are important to understanding the different types of system users. An actor is anyone or anything that exchanges data with the business system. An actor can be a user, external hardware, or another system.
The overarching description of each actor described in this Business Use Case can be found in the Glossary. Below you will find a short description which provides further clarity of this actor within the context of this Business Use Case.
Actor name
Description
Triggering Participant
The Triggering Participant is an active participant in the main process who triggers this BUC. This will be an Institution where the main process permits their role to do so.
Other Participant(s)
Other Participant represents the other active participant in the main process. This will be one Institution as determined by the main process.
Table 2: Actors & Roles
Use Case
RUP Table Representation
Use Case ID:
H_BUC_04_Subprocess
Use Case Name:
Reimbursement of Administrative Check or Medical Information
Created By:
Anda Mirita
Last Updated By:
Novella Bacelli
Date Created:
17/10/2016
Last Revision Date:
31/08/2018
Actors:
Triggering Participant
Other Participant(s)
Description:
H_BUC_04_Subprocess is a subprocess that may be used only after
administrative checks / medical exams were requested, confirmed and provided within a sector case.
Trigger:
The Triggering Participant wants to claim a reimbursement for Administrative or medical check(s).
Preconditions:
Administrative or medical check was requested; confirmed and provided within another sectorial case.
Post conditions:
The claim for reimbursement has been sent and a reply to the request has been received.
Main Scenario:
The Triggering Participant fills in a Claim for - Reimbursement - Administrative check/Medical Information (H020) by entering all the required information;
The Triggering Participant sends the H020 including any optionally attached, to other Participant;
The other Participant receives and views H020, and any possible attachments;
The other Participant (s) fills in a "Reply to Claim for Reimbursement – Administrative check/Medical Information" (H021) by entering all required information;
The other Participant sends the H021 to Triggering participant;
The Triggering Participant receives the "Reply to Claim for Reimbursement – Administrative check/Medical Information" (H021);
The use case ends here.
Alternative Scenarios:
Branch 1: at Step 4, the other Participant wants to reject the whole claim.
The other Participant fills in a "Reply to Claim for Reimbursement – Administrative check/Medical Information" (H021) by entering necessary information regarding the reject of the whole claim;
The other Participant sends its H021 to the Triggering Participant, including any attachment(s) if necessary;
The Triggering Participant receives the H021 reply, including any attachments if provided, and verifies its content and sees that the whole claim was rejected;
[This Branch] Ends and Process Reverts to [Step 1] of the Main Scenario in order to potentially send another claim.
Branch 2: at Step 4, the other Participant wants to reject a part of the requested amount of the claim.
The other Participant fills in a "Reply to Claim for Reimbursement – Administrative check/Medical Information" (H021) by entering necessary information regarding the partial rejection;
The other Participant sends its H021 to the Triggering Participant, including any attachment(s) if necessary;
The Triggering Participant, receives the H021 reply, including any attachments if provided, verifies its content and takes note that part of the requested amount of the claim was rejected;
[This Branch] Ends and;
Process Reverts to [Step 1] of the Main Scenario in order to potentially send another claim.
The Following Branches Determine the use of Administrative Processes within this Business Process
Branch 4: Removed
Branch 5: Removed
Branch 7: at any step between [step 2] and [step 6] any Participant may optionally choose to Request another participant who previously sent them Information provides clarification of the data that they have sent.
The participant executes business use case AD_BUC_08_Subprocess Clarify Content;
[This Branch] Ends.
Exceptions:
Includes:
This BUC is exclusively used as an <<include>> in other sectorial business processes.
Special Requirements:
SR1: Rules about the invoking of Branches:
[Branch 1] – May be invoked more than once;
[Branch 2] – May be invoked more than once;
[Branch 4] – Removed
[Branch 5] – Removed
[Branch 7] – May be invoked more than once;
Assumptions:
Notes and Issues:
Request – Reply SEDs
The following table specifies the SED that have a logical pairing to one another, usually this is known as a request-reply pair.
REQUEST SED
REPLY SED(s)
H020
H021
Attachments Allowed
The following table specifies whether attachments are permitted to be included when sending a SED type.
SED
Attachments
H020
Allowed
H021
Allowed
Artefacts used
The following table specifies the artefacts that are used in this Business Use Case.
Artefact name
Artefact type
H020
SED
H021
SED
Business Processes
The following model decribes the Business Use Case Reimbursement of Administrative Check or Medical Information subprocess using BPMN 2.0.
Appendices
Issues
#
Issue date
Description
Replies
Action/Resolution
Close date
1
2
3
4
5
6
7
8
9