Understanding EIPs for PeopleSoft Enterprise Policy and Claims Presentment

This chapter discusses the:

Policy creation enterprise integration point (EIP).
Policy application EIP.
Billing history EIP.
Payment history EIP.
Change policy EIP.
First notice of loss (FNOL) EIP.
Claim header EIP.
Claim detail display EIP.

EIPs for PeopleSoft Policy and Claims Presentment

PeopleSoft Enterprise Policy and Claims Presentment delivers a number of EIPs that are designed for the Insurance industry.

Policy Creation EIP

The legacy system creates the policy and performs all the checks and business processes that are required. The legacy system sends a message to the Integration Broker. Translation is not required for the incoming message, but a subscription code is required to read the message content and create the business transaction in the PeopleSoft Enterprise CRM table structure. The code uses the policy number to determine whether this is a new or existing policy. For a new policy, the system inserts new sets of data into the CRM table. For existing policies, the system issues an update statement on the account and deletes and reissues policy header and data in the remaining tables. The message structure includes policy information, covered assets, covered asset details, coverages, deductibles, options, and limits.

EIP Name	Description	Message Name	Direction of Integration	Technology
Create Policy	Receive policy information.	RBI_POLICY	CRM < --- External System	Integration Broker

Policy Application EIP

The policy application EIP is used to send the information captured in the application process to the legacy system where the policy is created.

EIP Name	Description	Message Name	Direction of Integration	Technology
Request Policy Creation	Request accepted quote to legacy system for policy creation.	RBF_SALES_ENTRY	CRM --- > External System	Integration Broker

Billing History EIP

Billing data is stored and maintained in an external system. The billing history EIPs request and receive billing history information from external systems.

EIP Name	Description	Message Name	Direction of Integration	Technology
Billing History	Synchronous request to obtain the billing history from external system.	RBI_BILLING_HISTORY_REQ	CRM --- >External System	Integration Broker
Billing History	Synchronous reply to billing history request from external system.	RBI_BILLING_HISTORY_RES	External System --- > CRM	Integration Broker
Billing History	Populate table when integration broker flag is 'Off' for 'Default for Account' under Setup CRM >Product Related > Financial Services > FSI Options This is an asynchronous message.	RBI_BILLING_HISTORY	External System --- > CRM	Integration Broker.

Payment History EIP

Payment data is stored and maintained in an external system. The payment history EIPs request and receive payment history information from external systems. Payment history is available in the Financial Account record.

EIP Name	Description	Message Name	Direction of Integration	Technology
Payment History	Synchronous request to obtain payment history from external system.	RBI_PAYMENT_HISTORY_REQ	CRM --- >External System	Integration Broker
Payment History	Synchronous Reply to payment history request from external system.	RBI_PAYMENT_HISTORY_RES	External System --- > CRM	Integration Broker
Payment History	Populate table when integration broker flag is 'Off 'for 'Default for Account' under Setup CRM >Product Related > Financial Services > FSI Options This is an asynchronous message.	RBI_PAYMENT_HISTORY	External System --- > CRM	Integration Broker

Change Policy EIP

The change policy EIP is used to communicate the policy modification messages to the legacy system. If the Policy Modification requires re-quoting, the a Quote is generated and then it follows the sales entry process.

EIP Name	Description	Message Name	Direction of Integration	Technology
Change Policy Request	Asynchronous request to change policy to external system.	RBF_SALES_ENTRY	CRM --- > External System	Integration Broker
Update Change Policy Status	Asynchronous reply to Policy change request from external system.	RBI_CHANGE_POLICY_STATUS	External System --- > CRM	Integration Broker

FNOL EIP

The FNOL EIP is used to publish the message when a FNOL is saved to the claims system. The message consists of the FNOL number, policy number, and the questions and answers from the branch script or application form. The FNOL number is stored and mapped to a claim in the PeopleSoft Enterprise CRM system.

EIP Name	Description	Message Name	Direction of Integration	Technology
Publish FNOL Details	Sends the first notice of loss information from the PeopleSoft CRM system to the claims administration system.	RBI_ISSUE_PUBLISH	CRM --- > External System	Integration Broker

Claim Header EIP

The claim header EIP is used to create the claim header in the PeopleSoft Enterprise Policy and Claims Presentment system. This one-way message creates the claims from the FNOL and returns the claim header. One or more claims may be generated from a FNOL. The subscription code creates the claim header records and establishes the relationship between the FNOL and the claim.

EIP Name	Description	Message Name	Direction of Integration	Technology
Get Claim Header	Receive claim header information.	RBI_CLAIM_HDR	CRM< --- External System	Integration Broker

Claim Detail Display EIP

The claim detail display EIP retrieves claims data from the claims system and displays the data on the View Claim page. The synchronous message retrieves the claim header number and claim detail.

EIP Name	Description	Message Name	Direction of Integration	Technology
Get Claim Details	Synchronous request to obtain claim details from external system.	RBI_CLAIMNO_RES	CRM < --- External System	Integration Broker
Get Claim Details	Synchronous reply to claim details request from external system. This is a synchronous message and gets realtime claims information.	RBI_CLAIMNO_SYNC	External System --- > CRM	Integration Broker
Get Claim Details	Populate table when integration broker flag is 'Off 'for 'Default for Account' under Setup CRM >Product Related > Financial Services > FSI Options. This is an asynchronous message.	RBI_CLAIM _DETAILS	External System --- > CRM	Integration Broker