Requirements Traceability Matrix

Project Name: Chiropractic Vendor Delegation High

Revision Date: 2/8/2015 Medium
RevisionNumber: 1 Low
RTM Template version: 1
Purpose : To trace requirements across the project life cycle from requirements stage till production. Bi-directional traceability is supported by this template e.g. based on a functional requirement, its associated business requirement and test cases can be traced.

Business Requirements Document: Functional and Non-functional Requirements Detailed Design Coding Testing

BR Business Requirements or Use Case Priority Updated By How FR / NFR FR ID / NFR ID FR / NFR Name Updated By Detailed Design Updated By Reference to Updated By Testing type Test Case Test Test Case ID Test Case Updated By
#'s: Description Addressed - Type Document name Code/script (Unit / Document Specification Name
(TRD name or Functional / name (scenario)
Name of Other Integration / Name
Document / End to end /
Solution) Performance /
UAT)

Horizon shall be required to send the

Developers -
BR 1.1 in-scope Chiropractic pended claims High Sneha Goel FR Claim Pend file should be sent to HW daily TBD TC 1.1
file daily to Healthways. Technical team

A unique vendor pend shall be on the A unique vendor pend should be displayed on the claim Developers -
BR 2.1 claim header level Sneha Goel FR header level. TBD Technical team TC 2.1

Claims that are out of scope for

Healthways delegation shall not pend Claim file should not pend with the unique pend created Developers -
BR 2.2 with the unique pend created for this Sneha Goel FR for this project TBD Technical team TC 2.2
project.

In-scope claims shall be sent to

Developers -
BR 2.3 Healthways based on the Date of Sneha Goel FR The claim should be sent to HW. TBD TC 2.3
Technical team
Service.

The unique vendor pend shall be the

only edit on the claim when the claim Claim received by HW should be the same, except for the Developers -
BR 2.4 Sneha Goel FR TBD TC 2.4
is sent to Healthways (Simultaneous unique pend Technical team
edits).

The vendor pended claims shall remain

in a pended status at Horizon until the 4. Claim should remain in pend status. 5. Claim should
Developers -
BR 2.5 recommendation from Healthways is Sneha Goel FR remain in pend status until the release date if TBD TC 2.5
Technical team
received or until the agreed upon recommendation not received.
release date has been met

If Healthways recommends that a

claim/claim line is Medically Necessary
Claim should be sent to Carecore for the RVD review Developers -
BR 3.1 (MN or ASP indicator), it should be Sneha Goel FR TBD TC 3.1
process Technical team
sent to Carecore for the RVD review
process as applicable.

If Healthways recommends that a

claim/claim line is Not Medically
Necessary, (NM or MR1 indicator), it
1. Claim should not be sent to Carecore for the RVD review Developers -
BR 3.2 should not be sent to Carecore for the Sneha Goel FR TBD TC 3.2
process. 2. Claim lines should be denied at Horizon Technical team
RVD review process and those claim
lines should be denied at Horizon-
BCBSNJ.

Horizon shall be required to send

Chiropractic rendering PAR and NON Developers -
BR 4.0 Sneha Goel FR NA TBD TC 4.0
PAR provider’s data on file to Technical team
Healthways weekly

Healthways shall send one of the

Developers -
BR 5.1 following recommendations on each Sneha Goel FR TBD TC 5.1
Technical team
claim line review:

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 Requirements Traceability Matrix

BR Business Requirements or Use Case Priority Updated By How FR / NFR FR ID / NFR ID FR / NFR Name Updated By Detailed Design Updated By Reference to Updated By Testing type Test Case Test Test Case ID Test Case Updated By
#'s: Description Addressed - Type Document name Code/script (Unit / Document Specification Name
(TRD name or Functional / name (scenario)
Name of Other Integration / Name
Document / End to end /
Solution) Performance /
UAT)

The codes sent by Healthways shall be

Developers -
BR 5.2 sent to EDW and stored for reporting Sneha Goel FR Code sent by HW should be sent to EDW for storage TBD TC 5.2
Technical team
purposes.

Claim lines received from Healthways

with a ‘MN indicator are considered
Claim recommended by HW as MN should follow the Developers -
BR 5.3 medically necessary and shall follow Sneha Goel FR TBD TC 5.3
current adjudication process by Horizon Technical team
the current adjudication process at
Horizon.

Claim lines received from Healthways

with an ASP indicator are considered
Claim recommended by HW as ASP should follow the Developers -
BR 5.4 medically necessary and shall follow Sneha Goel FR current adjudication process by Horizon TBD Technical team TC 5.4
the current adjudication process at
Horizon

Claims lines received from Healthways

with a ‘NM indicator are considered
Claim should be denied by Horizon. New EOB and EOP Developers -
BR 5.5 not medically necessary and shall be Sneha Goel FR TBD TC 5.5
message should be sent for the claim denied Technical team
denied at Horizon with the applicable
new EOB and EOP denial message.

Claims lines received from Healthways

with a MR1’ indicator are considered
Claim should be denied by Horizon. New EOB and EOP Developers -
BR 5.6 not medically necessary and shall be Sneha Goel FR TBD TC 5.6
message should be sent for the claim denied Technical team
denied at Horizon with the applicable
new EOB and EOP denial message.

The recommendation values that were

sent by Healthways for a claim to Developers -
BR 5.7 Sneha Goel NFR NA TBD TC 5.7
Horizon should be stored as an audit Technical team
trail for SLA reporting purposes.

Claim lines received from Healthways

with a CRR code indicate that HW shall send one letter to the provider per claim to Developers -
BR 5.8 Sneha Goel FR TBD TC 5.8
Healthways has requested medical request for medical records Technical team
records for that claim line.

If Healthways sends a CRR code for a

claim line, Horizon shall apply an
Horizon shall apply an indicator to the claim line to
indicator to the claim line to indicate Developers -
BR 5.9 Sneha Goel FR indicate that medical records have been requested in TBD TC 5.9
that medical records have been Technical team
order to stop the clock from prompt pay calculation.
requested in order to stop the clock
from prompt pay calculation.

If Healthways does not receive

medical records and sends MR1
indicator to Horizon, Healthways will HW should provide written notification to the provider
provide written notification to the mentioning that medical records were not received and Developers -
BR 6.1 Sneha Goel FR TBD TC 6.1
provider mentioning that medical the claim line / claim is recommended to be ‘Not Medically Technical team
records were not received and the Necessary’.
claim line / claim is recommended to
be ‘Not Medically Necessary’.

If Healthways determines a claim

line / claim to be ‘Not Medically
Necessary’ and sends NM indicator to
Healthways should provide written notification to the
Horizon, Healthways will provide Developers -
BR 6.2 Sneha Goel FR provider mentioning that the claim line / claim is TBD TC 6.2
written notification to the provider Technical team
mentioning that the claim line / claim recommended to be ‘Not Medically Necessary’
is recommended to be ‘Not Medically
Necessary’

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 Requirements Traceability Matrix

BR Business Requirements or Use Case Priority Updated By How FR / NFR FR ID / NFR ID FR / NFR Name Updated By Detailed Design Updated By Reference to Updated By Testing type Test Case Test Test Case ID Test Case Updated By
#'s: Description Addressed - Type Document name Code/script (Unit / Document Specification Name
(TRD name or Functional / name (scenario)
Name of Other Integration / Name
Document / End to end /
Solution) Performance /
UAT)

If Healthways does not receive medical

records and sends MR1 indicator to
Horizon, Healthways will provide Healthways should provide written notification to the
written notification to the member member mentioning that medical records were not Developers -
BR 7.1 Sneha Goel FR TBD TC 7.1
mentioning that medical records were received and the claim line / claim is recommended to be Technical team
not received and the claim line / claim ‘Not Medically Necessary’.
is recommended to be ‘Not Medically
Necessary’.

If Healthways determines a claim line /

claim to be ‘Not Medically Necessary’
and sends NM indicator to Horizon,
Healthways should provide written notification to the
Healthways will provide written Developers -
BR 7.2 Sneha Goel FR member mentioning that the claim line / claim is TBD TC 7.2
notification to the member mentioning Technical team
that the claim line / claim is recommended to be ‘Not Medically Necessary’
recommended to be ‘Not Medically
Necessary’

All appropriate communications and

process flows shall be developed for
Developers -
BR 8.0 this project and will be tracked Sneha Goel FR NA TBD TC 8.0
Technical team
separately in the communications
plan.

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 Requirements Traceability Matrix

RTM Template version: 1

Business Requirements Document <name> Functional and Non-functional Requirements Detailed Design Coding Testing
Testing type
(Unit / Test
Business Technical
Business Functional / Test Case Specifica Test
Requirements, Requirements FR ID / NFR FR / NFR Updated Detailed Design Document Reference to Updated
Requirements, Rules or Priority Updated By FR / NFR Type Updated By Updated By Integration / Document tion Test Case ID Case
or Use Case Document ID Name By name Code/script By
Use Case Description End to end / name (scenario Name
IDs name
Performance / ) Name
UAT)
Provide name of Provide description of the Identify the Priority of the Provide Provide name Select the type of functional ID for Provide Provide Provide name of the Detailed Provide name of Identifier of the Provide name Select the type Provide name Provide Unique Id for Provide Provide
the BRD with Business Requirement or requirement name of the of the TRD with and non-functional Functional or name of the name of the Design Document. the person with program/code/sc of the person of testing from of the test case name of each test case short name of
version number the Use Case and Path person with version number requirements from the list. Non-functional functional/no person with role, who will ript that meets with role, who the list. If document the test depending on name of the
and/or the date it from BRD. role, who will and/or the date If required additional types Requirement n-functional role, who Provide details (section update the row(s) the requirement. will update the required name with specificati the type of the test person
was published. update the it was can also be keyed in. from requirement will update number, name and paragraph row(s) additional version number on(test testing case as with role,
Make sure the row(s) published. Technical the row(s) or diagram) in the design testing types and/or date scenario) (functional, provided who will
file naming Make sure the Below are the types of Requirements document that is associated can also be when it was integration, end in the test update
convention file naming functional and non- Document with the requirements keyed in. published. to end, etc) case the row(s)
suggested in the convention functional requirements, associated document
TRD template is suggested in but not limited to the list: with the
followed. the TRD - FR-Functionality business
template is - FR-User interface requirement.
The Unique ID of followed. If the - FR-Data
the Business Business - FR-System integration
Requirement or Requirement is - FR-Reporting
Use Case and not addressed - NFR-Production
Path from BRD. through the Environment or Volume
Traceability to TRD, indicate Consideration
requirements is how it will be - NFR- Performance
required addressed. - NFR-Security
regardless of the - NFR-Data Archival
format in which - NFR-Disaster Recovery
they are - NFR-System availability
documented. - NFR-Compliance and
Standards/Governance
mandates
- NFR- Others

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 Requirements Traceability Matrix

Project Name: Chiropractic Vendor Delegation

Revision Date: 42043
RevisionNumber: 1

RTM Template version: 1

Work Instructions :

1. Place the mouse pointer on cell A8 or A9. ->Right click on the mouse. -> Select "Refresh Data" from the options so that the table is populated with the recent changes.

2. You can use this table to analyze association of deliverables.

3. To change the values, click inside the table so you can see "Pivot Table Field List", drag and drop the required fields inside the table either as rows, columns or data
items.

4. To remove the rows, columns or data items from the table, just click on the field that appears inside the table drag and drop them to "Pivot Table Field List".

Count of FR ID / NFR ID FR ID / NFR ID

Business Requirements, or Use Case IDs (blank) Grand Total
(blank)
BR1.0
BR1.1
BR1.2
BR1.3
BR2.0
BR2.1
BR2.1.1
BR2.2
BR2.3
BR2.4
BR2.5
BR3.0
BR3.1
BR3.1.1
BR3.1.2
BR3.1.3
BR3.2
BR3.3
BR3.4
BR3.5
BR3.6
BR4.0
BR5.0
BR6.0
BR6.1
BR6.2
BR6.3
BR7.0
BR7.1
BR7.2
BR7.3
BR8.0
BR9.0
BR9.1
BR9.2
BR9.3
BR9.4
BR9.5
BR10.0
BR11.0
BR12.0
BR12.1
BR12.2
BR13.0
BR13.1
BR13.2
BR13.3

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 Requirements Traceability Matrix

BR14.0
BR15.0
BR16.0
BR17.0
BR18.0
BR19.0
BR19.1
BR20.0
BR20.1
BR20.2
BR21.0
BR22.0
BR23.0
BR23.1
BR23.2
BR23.3
BR23.4
BR24.0
BR25.0
BR26.0
Grand Total

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 Revision Date: 2/8/2015
Project Name Chiropractic Vendor Delegation
RevisionNumber: 1

Business
Requirements, Business Requirements or Use Case Addressed in UAT Test Case Passed /
Priority SIT or UAT
UAT Test Specification (scenario) Name
ID
UAT Test Case Name
Failed
Comment (Required if test failed) Updated By
or Use Case Description
IDs
BR 1.1 Horizon shall be required to send the in-scope High
Chiropractic pended claims file daily to
Healthways.
BR 2.1 A unique vendor pend shall be on the claim 0
header level
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#REF! #REF! #REF!
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#REF! #REF! #REF!
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#REF! #REF! #REF!
UATRTM Instructions
For each Requirment in the BRD, including all Use Cases, list the requirement, its test scenarios and
test cases.

.
Business Requirements, or Use Case This will show the business requirement or Use Case
IDs ID entered into the primary RTM
Business Requirements or Use Case This will show the Business Requirement or Use Case
Description description that was entered into the Primary RTM
This will show the priority of the requirement as it was
Priority
entered into the Primary RTM

This needs to be selected to indicate whether the

requirement will be teested un the SIT and reviewed by
the business or wether it will require UAT. Rmember,
Addressed in SIT or UAT
any requirement that involves user interaction requires
UAT. (Note: if SIT is selected then the UAT test
specifrication fields will be blacked out)

UAT Test Specification (scenario) Provide name of the UAT test specification(test
Name scenario)

UAT Test Case ID Unique Id for each UAT test case

Provide short name of the UAT test case as provided

UAT Test Case Name
in the test case document
Indicates is the UAT test case met expected results or
Passed / Failed
not
This field is available for any comments; however it
Comments
muist be populated to describe any test failures

Updated By The name of the person who updated the row

 Requirements Traceability Matrix

Project Name: Chiropractic Vendor Delegation

Revision Date: 42043
RevisionNumber: 1
RTM Template
1
version:

Date
Version Author Description of Change
(mm/dd/yy)
Praveen
0.1 11/09/12 RTM updated with ClaimsXten Stage 3 BRD requirements
Somasundaram
0.2 11/19/12 Neville S Mitchell RTM updated with HLR requirements (Response for each Business requirement provided)
RTM updated based on review comments from review meeting held on 26-Nov-12.
Neville S Mitchell /
0.3 12/04/12 Attendees for review meeting on 26-Nov-12: Annette Anderson, Sonia Buck, Kit Miller, Tammy Mindo, Antoinette Foreman, Pooja
Annette Anderson
Devaravar, Rajiv Walia, Archana Venkatesan and Praveen Somasundaram

Baselined version "Stage3_Requirements_Traceability_Matrix_120412.xlsx" sent out to the group (CXT business

12/04/12 N/A (Wendy/Tammy/Antoinette), NASCO (Barbara/Sonia/Kit), McKesson (Sandra S/Sandra B), Project team
(Annette/Neville/Pooja/Rajiv/Archana/Praveen)

Praveen
0.4 01/08/13 Attached NASCO TDR (technical design) document provided by NASCO Technical team.
Somasundaram
Rajiv Walia /
0.5 02/01/13 Updated wrt to Test Case ID's.
Sanjai Sathaiyan

498388550.xls Page 9 of 11
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Attachment description

Adjustment Codes

Exclusion Criteria document

NASCO TDR document (Technical design provided by NASCO Technical team)

Stage3_AdjCode_M
apping_102912_
provided on 2-Nov
by Annette and
attached to BRD
v1.0.xlsx

Stage 3 Exclusion
Criteria v1.0
10022012.xls

NJ069251
NAST591 Technical
Design Review
12_18_2012.docx