System Overview

What HOMER is

HOMER is the core operating system of a third-party administrator (TPA) for self-funded employee health benefit plans. It is a Windows client/server application (PowerBuilder front end, Oracle back end) used internally by the TPA's staff — claims examiners, enrollment clerks, billing staff, customer-service representatives, underwriting/stop-loss analysts, and utilization-review nurses — to administer the full lifecycle of group health plans on behalf of employer clients ("groups").

The application identifies itself as the "SFPI Homer application" (homersys/n_cst_sfpiappmanager); SFPI configuration appears throughout (HOMER.INI client segment=SFPI).

Business capabilities

Capability	What it covers	Primary modules
Claims administration	Entry, adjudication, editing, EOB production, printing, reporting of medical/dental/vision/UB92 (institutional) claims	claims, clmentry, clmforms, clmprint, clmrpt, clmsproc
Coordination of benefits	Other-insurance tracking, COB rules, accident/subrogation handling	cob, claims (accidents)
Pre-existing conditions	Pre-ex investigation and restriction handling	preex
Enrollment & eligibility	Members, dependents, elections, coverages, eligibility windows, audits	enroll, enrollutils, enrolaud, enrolrpt
Group/client management	Employer groups, contacts, plan setup, benefit rules, rates	client, benplans, bensupport, sales
Billing	Premium/admin-fee billing to groups, charges, recalculation	billing, billfunc
Funding & payments	Claim funding, check runs, check registers, reprints, 1099-NEC reporting	funding, chkrundw, reprint
COBRA administration	Qualifying events, notice letters, COBRA billing	cobra, cobradw, cobrarpt
Drug plans	Pharmacy benefit administration and PBM interfaces (PCS, Caremark)	drugplan
Utilization & case management	Pre-certification, utilization review, case management	um_main, um_maint, um_cm, um_ur
Stop-loss	Specific/aggregate stop-loss contracts, tracking and filings	stoploss
Provider & network management	Providers, PPO networks, repricing, fee schedules, negotiations	provider, pricing, moon
ID cards	Member ID card production	idcard
Customer service	Service call logging	svclog
System administration	Users, role-based security, data-driven navigation menu, reference codes	homersys, system, app_sec

Shape of the system

• 546 screens (windows) organized under an MDI frame; navigation is data-driven from a system_menu database table filtered by user security class.
• 2,110 DataWindows — PowerBuilder's data-bound form/grid/report objects — carry nearly all data access: 1,921 embed their own SQL against the Oracle schema.
• 456 database tables (reconstructed) with ~4,500 columns.
• External interfaces: PBM eligibility/claim feeds (PCS/Caremark), outbound EDI claim extracts, Melissa Data address validation, check printing, 1099 forms.

Users and roles

Access is controlled by an application security module (app_sec) with user classes (security_user_class and related tables), department groups, and per-group data restrictions (f_check_group_security). The menu each user sees is the intersection of the system_menu table with their class permissions. See Security Model.