International Journal of Trend in Scientific Research and Development (IJTSRD)

Volume 4 Issue 4, June 2020 Available Online: www.ijtsrd.com e-ISSN: 2456 – 6470

Web Based Claims Processing System (WCPS)

S. Vishnu Priya, S Amaresan (MCA M Phil M Tech)
PRIST University Thanjavur, Tamil Nadu, India

ABSTRACT How to cite this paper: S. Vishnu Priya | S

Web Based Claims Processing System (WCPS) developed in website so that the Amaresan "Web Based Claims Processing
employee can fill the form online and submit it so that the form is sent to System (WCPS)" Published in
Claim Processing Department (CPD) through Internet. Claim processing the International Journal
form needs to be checked without human intervention by a program which of Trend in Scientific
will compute the amount that needs to be reimburse to the employee for the Research and
action undertake. All the employees in a company are provided medical Development (ijtsrd),
reimbursement facility which means that the expenditure incurred by the ISSN: 2456-6470,
employee for treatment is reimbursed by the company. For repayment, the Volume-4 | Issue-4,
employee needs to fill in a form detail the treatment undertake which include June 2020, pp.1725- IJTSRD31688
the name & cost of medicines, laboratory tests, surgery. The employee 1729, URL:
accordingly signs the form and it will be sent to the concerned Web based www.ijtsrd.com/papers/ijtsrd31688.pdf
Claims Processing Department by messenger for processing. CPD will process
it and the order regarding the reimbursement is sent to the Cash counter (CC) Copyright © 2020 by author(s) and
where in the employee can receive the reimbursement amount. International Journal of Trend in Scientific
Research and Development Journal. This
KEYWORDS: Web Based Claims Processing System (WCPS), Claims Processing is an Open Access article distributed
Department (CPD), Cash counter (CC) under the terms of
the Creative
Commons Attribution
License (CC BY 4.0)
(http://creativecommons.org/licenses/by
/4.0)
1. INTRODUCTION
The advents of computer technologies have revolutionized web based so that the employee can fill the form online and
our life in many ways. It is no longer the monopoly of the submit it so that the form is sent to CPD through Internet. At
elite class, but also has reached the masses. For the haves, CPD, the form needs to be checked automatically by a
they may possess their own personal computers, but for the program which will compute the amount that needs to be
have-nots there are various ways that they can feel the touch reimbursed to the employee for the treatment undertaken.
of the computer systems such as Internet and e-mails at Our web processing system is very user friendly and
designated places. For some, this is the time to make provides several facilities. Basically, we are developing our
lucrative business of hiring them according to hours. system on web browser; in future we will give a platform on
android. This study is meant to develop a Web-based Claims
A company which is having employee strength of at least system for staff who have to perform duties. Currently, all
500. All the employees are provided medical reimbursement claims have to be made manually by filling up the claim
facility which means that the expenditure incurred by the forms by the claimants. This is a very tedious process and
employee for treatment is reimbursed by the company. For time consuming. It is not unusual for the claimants that they
reimbursement, the employee needs to fill in a form detailing have to refer to the Treasury Circulars to check on their
the treatment undertaken which includes the name & cost of entitlements that they are unsure of each time they have to
medicines, laboratory tests, surgery. make claims.

The form is duly signed by the employee and it will be sent 2. LITERATURE SURVEY
to the concerned Claims Processing Department (CPD) by In this paper [1] software can be easily upgraded in the
messenger for processing. CPD will process it and the order future. And also include many more features for existing
regarding the reimbursement is sent to the Cash counter system. It is connected to the network for easy retrieval of
(CC) where in the employee can come and receive the data and many more location or many districts or cities in
reimbursement amount. To overcome problems like manual different states. All the information can be easily accessed by
application forms can may miss during transit; form is prone the employee like their details, mails, departments. It can be
to weariness due to which the company may not be able to modified and the other details can be easily provided to
read data in it after some years. customer.

The employees who claimed for medical reimbursement In this paper [2] Mobile applications are a rapidly growing
need to visit the CC from time to time enquiring about the segment of the global mobile market. Mobile applications are
status of their application. This results in enormous wastage evolving at a meteor pace to give users a rich and fast user
of time of the employee. It is proposed to develop software experience. In this paper, Android mobile platform for the
titled Web Based Claims Processing System (WCPS) which is mobile application development, layered approach and the

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 International Journal of Trend in Scientific Research and Development (IJTSRD) @ www.ijtsrd.com eISSN: 2456-6470
details of security information for Android is discussed. root of the system starts from registration of the customer.
Google released Android which is an open-source, mobile This system is enhancing the facilities provided to the
phone operating system with Linux-based platform. It customers by converting it into an automated and mobile
consists of the operating system, middleware, and user system.
interface and application software.
Advantages
In this paper [3] Providers sending professional and
The employers can directly register under the Insurance
supplier claims to Medicare on paper must use Form CMS- firm online and as far as the rest of the process is
1500 in a valid version. This form is maintained by the concerned, the entire processing of transactions is
National Uniform Claim Committee (NUCC), an industry automated.
organization in which CMS participates. Any new version of
The access of the data is restricted to un-authorized
the form must be approved by the White House Office of users of the head office and the branch office. And the
Management and Budget (OMB) before it can be used for official details are kept confidential. The time lag
submitting Medicare claims. When the NUCC changes the involved in the manual system is completely wiped out
form, CMS coordinates its review, any changes, and approval
Registering, declaration by the employees and ultimately
with the OMB The NUCC has recently changed the Form the claim, payment etc is computerized. Retrieving
CMS-1500, and the revised form received OMB approval on information and follow up about each aspect becomes
June 10, 2013. easier.

The Objective of this system is to provide the
In this paper [4] begins with a discussion on the use of functionalities to the policyholders, which is helpful to
information and communication technology (ICT) for claims claim their auto accident and damages of the vehicle
management in the construction industry. This is followed online. It facilitates company wide integrated system
by the findings from case studies conducted on the end- covering all functional areas of a claim processing.
users’ requirements for the design of a Web-based
Mobile Application Software
construction claims management system. This paper forms
Very Short Time Process
part of the initial findings of an ongoing research.
Record Maintained is very easy.

Claim checking the administration is very user friendly
3. METHODOLOGY apps
3.1. EXISTING SYSTEM
All the employee are provide medical claim facility which 4. EXPERIMENT AND RESULTS
mean that the expenditure incurred by the employee for Implementation is one of the important tasks in project.
treatment is reimburse by the company for reimbursement, Implementation is the phase in which one has to be cautions,
the employee need to fill in a form detailing the treatment because all the efforts undertaken during the project will be
undertaken which includes the name & cost of medicines, fruitful only if the software is properly implemented
laboratory tests, surgery The form is duly signed by the according to the plans made.
employee and it will be sent to the concerned Claims
Processing Department (CPD) by messenger for processing Login:
CPD will process it and the order regarding the This module is the first module. From this page only the user
reimbursement is sent to the Cash counter (CC) where in the can navigate to project. Only the authorized person can enter
employee can come and receive the reimbursement amount. by giving valid information. If the user provides the invalid
Some of the problems in the existing system are The form information then permission denied navigating to other
may miss during transit The form is prone to weariness due pages. This login module concentrates the security of the
to which the company may not be able to read data in it after project from the unauthorized users.
some years The employees who claimed for medical
reimbursement need to visit the CC from time to time New User
enquiring about the status of their application. This module is designed for new users who need the
quarters. The new user has to register with the proper
DISADVANTAGE details. This system requires a proper user authentication

Manual Process for accessing the features behind in this system. For getting

Very Long Time Process the rights to accessing the features users have to register

Record Maintance is very difficult their identity to this system. Once registered the system will
provides the accessibility rights to the users to work in this
3.2. PROPOSED ALGORITHMS system.
The Claim processing system is an automated facility mobile
apps. This system is enhancing the facilities provided to the Employee:
employees claim apply easy and very fast processing in Employee Module is used to entry the details of an employee.
mobile apps. Claim request is accepted or rejected by the All the employees of an organization will be added in to this
administrator. After viewing the claim report the site. Administrator makes an entry for every new employee.
administrator will accept or reject the claim depends upon
the claim status. Claim checking process using techniques Claim:
Feature Extraction Frequent Pattern Mining. The amount An employee can make a claim request to the administrator
computed will be routed to the e-mail account of the with is module. They enter all the medical information for a
employee as well as to the Bank which holds the accounts of claim request. This claim entry will send to the
all the employees of the details. The Claim processing system administrator.
is an automated insurance facility for all walks of life. The

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 International Journal of Trend in Scientific Research and Development (IJTSRD) @ www.ijtsrd.com eISSN: 2456-6470
Admin Login 4.2.1. Admin Login
This module is designed for administrator. From this page
only the administrator can navigate to project. Only the
administrator can allot the quarters for required staff. The
admin can view all details of the user who need quarters. If
the user provides the invalid information then the process
will getting delay. This login module concentrates that the
administrator can only login and not the other.
Claim Details
Administrator can view all claim request details. This
module displays all the claim details requested by an
employee.
Approve/Reject Claim:
This module is used to decide whether the claim request is
accepted or rejected by the administrator. After viewing the
claim report the administrator will accept or reject the claim
depends upon the claim status. This claim accepted or
rejected details will store into the database and send to
employees.
View Status: Fig: 4.2.2 Add Employee
Employee can view the claim status details, whether the
claim is approved or rejected by the administrator.
4.1. USE CASE DIAGRAM

Fig: 4.2.3 Employee View

Figure 4.1 Use Case Diagram

4.2. RESULT

Fig: 4.2.4 View Claim

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 International Journal of Trend in Scientific Research and Development (IJTSRD) @ www.ijtsrd.com eISSN: 2456-6470

Fig: 4.2.8 Employee Login

Fig: 4.2.5 Approval/Rejected Claim

Fig: 4.2.9 Apply Claim

Fig: 4.2.6 Claim Status

Fig: 4.2.7 Employee Report Fig: 4.2.10 View Status

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 International Journal of Trend in Scientific Research and Development (IJTSRD) @ www.ijtsrd.com eISSN: 2456-6470
simplying the life of healthcare professionals as well as
patients (by way of less denials and quicker claims
reimbursement). A web based claims processing system is
definitely considered to be a better option as it provides the
flexibility to operate it through any place. It can also pass
through various channels (departments) for further
processing.

FUTURE ENHANCEMENT
In this competitive world, developing a concern with their
opponent is a challenging process, which wants better
improvement. For that this system keeps Mobile Based claim
processing sector and try to solve the problem at most
extent. This system helps to enables the web application
development and enriches their way of dealing.

REFERENCES
[1] Ghezzi, C., Jazayeri, M. &Mandrioli, D., Fundamentals of
Software Engineering, Prentice Hall, New Jersey, 1991.
[2] A. Stevens, Database Management, Press asian, India,
Fig: 4.2.11 View Profile 2000, p. 80
[3] Hawryszkiewycz, I. System Analysis and Design, 4th
ed., Prentice Hall, Sydney, 1998.
[4] Syed Zulkarnain Syed Idrus, Database Encryption for a
Web-based Claims System, Master’s Thesis, Universiti
Malaysia Perlis, Malaysia, 2008.
[5] HTML5 W3C Recommendation 28 October 2014 (@
http://www.w3.org/TR/html5).
[6] MySQL 5.7 "SQL Statement Syntax" @
http://dev.mysql.com/doc/refman/5.7/en/sqlsyntax.h
tml..html).
[7] HTML 4.01 Specification W3C Recommendation 24
December 1999 (@ http://www.w3.org/TR/html401).
[8] CSS3 Selectors module (@
http://www.w3.org/TR/selectors/); CSS3 Colors
module (@ http://www.w3.org/TR/css3-color/).
[9] Matthew MacDonald, "Creating a Website - The Missing
Fig: 4.2.12 Change Password Manual", 3rd ed, 2011, O’Reilly.
[10] PHP Language Reference @
5. CONCLUSION
http://php.net/manual/en/langref.php. [11] Codd E.
A Web Based claims processing system is an intelligent piece
F., "A Relational Model of Data for Large Shared Data
of software that helps to automate the process of claims
Banks", Communications of the ACM, vol. 13, issue 6,
submission. It helps to simplify the process - the task of
pp. 377–387, June 1970.
coding becomes simpler, readily available data entry form,
error handing and many more features. The systems aim at

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