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). The official user guide confirms the operator identity as SFPI / M3 (e.g. its TLO definition refers to a case terminating "with SFPI/M3") and names Medical Data Research Corp. (MDR) as the supplier of the UCR and R&C pricing tables (User Guide ch. 27).

The official user guide (User Guide, contents)

An official HOMER user guide (authored at SFPI, 1998–99) was recovered alongside the source. Its table of contents opens with four front-matter sections — Preface, System Overview, Logging into the System, and Main Menu — whose body text was not recovered (only the 28 chapter files survive), and then organizes the product into 28 chapters. The chapter list is the business's own statement of HOMER's functional scope and corroborates the module inventory reconstructed from code:

Enrollment/Eligibility (incl. COB, COBRA, HIPAA, drug plans, proof of good health, ID cards, QMCSO); Client Maintenance; COBRA Administration; Billing (A/R); Funding; Plan Design; Provider Maintenance; Commissions; Client Service Log System (Notes); Claims Entry (EDI scanning and manual); Adjudication (pre-processing, automated, manual); Repricing Rules; Reporting; Claims Output (electronic, letters, registers, RA/EOB/checks); Capitation; Auditing; Stoploss; Case Management; Utilization Review; Sales Support (proposals, underwriting, census); Managed Care (budgeting); Miscellaneous (accounting, CP2100, department/function list, naming conventions, menu definitions, navigation rules, EDI processing); Programming Standards; SFPI AP; SFPI HR; SFPI AR; Glossary; Security.

Chapters with no direct counterpart in the capability table below — Commissions, Capitation, Sales Support/Underwriting, Managed Care budgeting, and the internal SFPI AP/HR/AR chapters — indicate functionality that either lives inside broader libraries (e.g. sales) or was administered outside the recovered code; reconcile when those guide chapters are integrated into their module pages.

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. The user guide describes this officially as a six-level security model — Oracle account, Homer user, role (one Oracle role per department) and class (client visibility), PFC object-level permissions at department and individual level, and client segmentation (User Guide ch. 28). See Security Model.