HCF Legacy Core System (Version 1.0)

Overview

The HCF Legacy Core System is the foundational enterprise application for HCF Australia's private health insurance operations. Built on IBM DB2, this system handles the complete member lifecycle from enrollment through claims processing and billing.

Architecture

This is a traditional three-tier enterprise architecture:

┌─────────────────────────────────────────────────────────────────┐
│                      Presentation Layer                          │
│              (CICS Screens / Green Screen Terminals)             │
└─────────────────────────────────────────────────────────────────┘
                               │
┌─────────────────────────────────────────────────────────────────┐
│                      Business Logic Layer                        │
│                    Java Services & Batch Jobs                    │
│  ┌─────────┐ ┌─────────┐ ┌─────────┐ ┌─────────┐ ┌─────────┐   │
│  │ Member  │ │ Claims  │ │ Billing │ │Provider │ │ Product │   │
│  │ Service │ │ Service │ │ Service │ │ Service │ │ Service │   │
│  └─────────┘ └─────────┘ └─────────┘ └─────────┘ └─────────┘   │
└─────────────────────────────────────────────────────────────────┘
                               │
┌─────────────────────────────────────────────────────────────────┐
│                      Data Access Layer                           │
│                         DAO Classes                              │
│                    DB2 Stored Procedures                         │
└─────────────────────────────────────────────────────────────────┘
                               │
┌─────────────────────────────────────────────────────────────────┐
│                      IBM DB2 Database                            │
│  ┌─────────┐ ┌─────────┐ ┌─────────┐ ┌─────────┐ ┌─────────┐   │
│  │ HCFMEM  │ │ HCFCLM  │ │ HCFBIL  │ │ HCFPRV  │ │ HCFPRD  │   │
│  │ Members │ │ Claims  │ │ Billing │ │Providers│ │Products │   │
│  └─────────┘ └─────────┘ └─────────┘ └─────────┘ └─────────┘   │
└─────────────────────────────────────────────────────────────────┘

Core Domains

1. Member Administration (HCFMEM)

• Member enrollment and policy management
• Dependant administration
• Lifetime Health Cover (LHC) loading
• Waiting period management
• Policy suspensions and cancellations
• Portability (fund transfers)

2. Claims Management (HCFCLM)

• Hospital claims (DRG-based)
• Ancillary/Extras claims
• Medical gap scheme claims
• Prostheses claims
• Real-time HICAPS integration
• Benefit calculation and payment

3. Billing & Contributions (HCFBIL)

• Premium calculation
• PHI Rebate processing
• Age-based discount
• Direct debit processing
• BPAY reconciliation
• Arrears management

4. Provider Network (HCFPRV)

• Hospital contracting
• Provider credentialing
• AHPRA verification
• Gap scheme registration
• Provider payment

5. Product Management (HCFPRD)

• Product configuration
• Benefit schedules
• Clinical category mapping
• Premium rate tables

Database Tables

Schema	Table	Description
HCFMEM	MEMBER	Core member demographics
HCFMEM	POLICY	Policy header and status
HCFMEM	DEPENDANT	Policy dependants
HCFMEM	WAITING_PERIOD	Waiting period tracking
HCFMEM	LHC_LOADING	Lifetime Health Cover loading
HCFCLM	CLAIM_HEADER	Claim master record
HCFCLM	CLAIM_LINE	Individual service lines
HCFCLM	BENEFIT_CALC	Benefit calculations
HCFCLM	PAYMENT	Payment records
HCFBIL	CONTRIBUTION	Premium contributions
HCFBIL	INVOICE	Member invoices
HCFBIL	PAYMENT_SCHEDULE	Direct debit schedules
HCFBIL	ARREARS	Arrears tracking
HCFPRV	PROVIDER	Provider master
HCFPRV	HOSPITAL	Hospital details
HCFPRV	CONTRACT	Hospital contracts
HCFPRV	GAP_SCHEME	Medical gap registrations
HCFPRD	PRODUCT	Product master
HCFPRD	BENEFIT_SCHEDULE	Benefit limits
HCFPRD	RATE_TABLE	Premium rates

Batch Jobs

Job ID	Description	Frequency
HCFMEM001	Daily member synchronization	Daily 6AM
HCFCLM001	Hospital claim batch processing	Daily 8AM
HCFCLM002	Ancillary claim auto-adjudication	Hourly
HCFBIL001	Direct debit processing	Daily 4AM
HCFBIL002	Arrears notification	Weekly
HCFRPT001	APRA HRS reporting	Monthly

Configuration

Database connection parameters are configured in:

• src/main/resources/config/db2.properties

Building

mvn clean package

Running

java -jar target/hcf-legacy-db2-1.0.0.jar

Regulatory Compliance

This system supports:

• APRA prudential requirements
• Private Health Insurance Act 2007
• Health Insurance (General) Rules
• PHIO reporting requirements
• Risk Equalisation Trust Fund

Support

For technical support, contact:

• Enterprise Architecture: [email protected]
• IT Operations: [email protected]