Technical Landscape

Anthem Inc
Provider Workflow -PLM2 Application

Team Dream Viewers

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Contents

1 Introduction................................................................................................................................... 1
1.1 Acronyms........................................................................................................................... 1
1.2 Purpose............................................................................................................................. 1
1.3 Revision History................................................................................................................. 1
2 Current State Architecture........................................................................................................... 1
3 Future State Architecture............................................................................................................. 1
3.1 High Level Design............................................................................................................. 2
4 Enterprise Class Structure........................................................................................................... 3
4.1.1 Pega Product Layer...................................................................................................... 4
4.1.1 Enterprise Reuse Layer................................................................................................ 4
4.1.2 Division Reuse Layer.................................................................................................... 4
4.1.3 Framework Layer.......................................................................................................... 4
4.1.6 Implementation Layer................................................................................................... 4
5 PLM2 Application Structure......................................................................................................... 6
5.1 Acccess groups and Roles of Users for Provider Workflow Application...........................6
6 A Provider Workflow Ruleset Stack........................................................................................... 7
6 B Interfaces(This is in progress)................................................................................................ 8
1 Introduction
1.1 Acronyms
PRPC – PegaRules Process Commander

PLM – Provider Life cycle Management

SPS – Strategic Provider Workflow

PDM – Provider Data Management

PS - Provider Workflow

Filenet – Enterprise Content Management System

1.2 Purpose
The purpose of this document is to explain the future state technical architecture
and Enterprise class structure of the Provider Workflow Application and the various
components in the application framework. Provider Workflow Application will be built
using PRPC 7.2.2. Provider Workflow Application will have Implementation and
Framework layers, as per the Pega best practices.

1.3 Revision History

Date Author Version Comments

21/03/2020 Rahul Chaher V1.1 Draft

2 Current State Architecture

The current Provider Workflow is having 2 different applications PLM and SPS for
updating provider information in SPS DB.

3 Future State Architecture

Technical Architecture – PLM2

 The future state Provider Workflow Application will be implemented using PRPC 7.2.2.
Both PLM and SPS will be merged into application(PLM2), so that user can login into one
application to view ticket and perform provider updates.

3.1 High Level Design

PMF PDM

PLM2

SPS JAVA CORE Service

PLM
PEGA
DB
FW
PEGA
PRPC Layer
SPS
External
DB

SPS

SPS
PEGA
DB

Provider Workflow Application

Technical Architecture – PLM2 2

4 Enterprise Class Structure

Enterprise Reuse
Organizational
Layer

Divisional Reuse PRPC Base

Layer Product

Implementation
Framework Layer
Layer

Enterprise Class Structure - Conceptual

 As an integral part of every PRPC application, the Enterprise Class Structure (ECS)
design pattern is the basis for divisional and enterprise-wide reuse of frameworks
and components
 The PRPC platform offers two dimensions of inheritance: pattern and directed. The
ECS leverages both mechanisms to their fullest extent.
 The ECS is automatically generated by the Pega Application Express, based on the
values keyed in during the application setup process.

Technical Architecture – PLM2 3

 4.1.1 Pega Product Layer

This layer includes the out of the box PRPC base product. These rules can be
customized, as per specific customer requirements at subsequent layers.

1.1.1 Enterprise Reuse Layer

 Antm- is the extension point for enterprise wide reusable work rules.
 Antm-FW- is the container for Anthem frameworks
 Antm-Data- is the container for enterprise wide reusable data classes.
 Antm-Int- is the container for enterprise wide reusable connectors rules.
(Interfaces).
 Interfaces such as <<>> webservice connectors, <<>> webservice
connectors and Connect-SQL rules, <<>> Webservice connectors, etc,
are all being built at the Enterprise Anthem reuse Layer, so that any
Pega application within the Anthem, can reuse these interfaces.

4.1.2 Division Reuse Layer

 Antm-XX- is the extension point for Division wide reusable work rules.
 Antm-XX-Data- is the container for Division wide reusable data classes
o Antm-XX-Int- is the container for Division wide reusable connectors rules.
(Interfaces)

4.1.3 Framework Layer

Framework is a generalized application using common rules. It serves as the

basis for implementation by one or more Business units. This layer will contain
the rules which are generic and can be reused across different Intake
implementations for anthem. This layer will be flexible so that multiple
implementations can extend from it and customize as per the business
requirements. Antm-FW-PLMFW-Work will reside in the Framework Layer.

Different framework rulesets were created to hold the rules which are needed
differently for applications.

PLMFW holds the common framework rules which are reused across applications.

4.1.6 Implementation Layer

This layer will inherit from the Framework Layer. Antm-PS-PLM-Work class
will reside at the Implementation layer. This layer consists of business specific
rules that override their counterparts in the anthem framework layer.

Technical Architecture – PLM2 4

Implementation Layer - Layout

ANTM- (Work-)

PS- (Work-) Enterprise Reuse Organizational

Layer

FW- (Work-)

Data- (Data-)

Int- (Int-)

Divisional Reuse
ANTM-PS (Work-) Layer

Data- (Data-)

Int-

@baseclass

ANTM-FW-PLMFW-
Implementation Work-
ANTM-PS-PLM- (ANTM-FW-PLMFW-)
Layer
Work Framework Layer Work-
(PLMFW) Cover-
Work- (ANTM-FW-PLMFW-Work) Outreach

Work-
Object-
OutReach (ANTM-FW-PLMFW-Work) PDM

PDM (ANTM-FW-PLMFW-Work)
Data-
Transaction

Comments (ANTM-PS-PLM-Work-PDM)

Roster
Transaction (ANTM-PS-PLM-Work-PDM)

Comments

Data- (Data-)

Int- Int-)

Enterprise Reuse Layer Implementation Layer Pattern Inheritance

Divisional Reuse Layer Directed Inheritance

Framework Layer

Data- (Data-)

Int- (Data-)

Implementation
ANTM-PS-SPS- (ANTM-FW-PLMFW-)
Layer

Work- (ANTM-FW-PLMFW-Work)

AddEntry (Antm-PS-SPS-Work)

Address (Antm-PS-SPS-Work)

AddressEdit (Antm-PS-SPS-Work)

Provider

Data- (Data-)

Int- (Data-)

Technical Architecture – PLM2 5

5 PLM2 Application Structure
PLM2 Application is built on top of PLWFW framework and contains PLM, PLMInt rulesets.

5.1 Acccess groups and Roles of Users for Provider Workflow Application

Role Access group Comments

Develope
r PLM :Administrators  

User PLM :Users  

     

     

     

     

     

6 A Provider Workflow Ruleset Stack

Technical Architecture – PLM2 6

 PLM, PLMInt
(Implemenation for Provider Workflow )

PLMFW, PLMFWInt (Framework for Provider Workflow )

PBRE, PBREInt (BRE for Provider Workflow )

AntmBRE, AntmBREInt, AnthemSPSData, AnthemSPSInt, Antm, AntmInt,

AntmSPSUILib, AntmUnauth, AntmCSWGS, AntmUtils (Integration and
Organization Rulesets)

Pega Framework Rulesets

Technical Architecture – PLM2 7

6 B Interfaces(This is in progress)

PLM2 Application communicates with multiple systems using Java API or Webservices.

The following are the interfaces which use one or another form of Java API:

 LDAP
o LDAP is for Java API based interface for verifying the User’s network
credentials. This interface is called during User login.
 Email Server
o This is a out of the box java API which can be leveraged for sending
Emails to the parties.

The following are the interfaces which use Webservices:

 Filenet
o Filenet is the enterprise content management system for Anthem. This
interfaces provides webservice methods to get Document image from
filenet. It also provides webservice methods to store Document image
back to Filenet for any new documents which are attached to an existing
authorization.

The following are the interfaces use both connect REST/Connect SOAP

SPS
PLM2 APP CORE
SERVICE SPS DB

Connectors Based Integration/Interface

Technical Architecture – PLM2 8