Seebeyond HIPAA

8/13/2019 Seebeyond HIPAA

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Department of Mental Health System and Process Documentation

Table of Contents

1 INTRODUCTION...........................................................................................................1

2 ACRONYMS AND TERM DEFINITIONS......................................................................2

3 ASSUMPTIONS............................................................................................................3

4 SEEBEYOND ARCITECTURE ..................................................................................3

4.1 Overview .............................................................................................................34.2 omponent Or!ani"ation and Schemas...............................................................3

4.2.1 Layered System Architecture............................................................................34.3 #iew $ayer...........................................................................................................%

4.3.1 e*Gate Enterprise Manager..............................................................................54.3.2 e*Gate Editors..................................................................................................54.3.3 Monitoring Features..........................................................................................5

4.4 ontrol $ayer.......................................................................................................%4.4.1 e*Gate egistry................................................................................................ 5

&un'time environment...............................................................................................( Sand)o* area for user'specific file development.......................................................(

4.4.2 !ontro" #ro$ers.................................................................................................%4.% +usiness &ules and Data Processin! $ayer.........................................................(

4.5.1 !o""a&oration u"es..........................................................................................%4.5.2 !o""a&orations...................................................................................................%

4.( ,ntelli!ent -ueuin! $ayer..................................................................................... Pu)lisher omponents send /vents to ,-s............................................................... Su)scri)er omponents receive 0ueued /vents ......................................................4. pplication onnectivity $ayer.............................................................................

! BASIC DESI"N............................................................................................................ #

%.1 ,ntroduction .........................................................................................................%.2 DMH H,P ranslator Data low Description....................................................5%.3 DMH H,P ranslator System Desi!n ............................................................ 11%.4 DMH H,P ranslator omponents.................................................................13

5.4.1 E'ent (ypes and E'ent (ype )einitions........................................................135.4.2 +nte""igent ,ueues -+,s and +, Managers (a&"e...........................................145.4.3 e*/ay !onnections........................................................................................145.4.4 e*/ays and !o""a&orations............................................................................155.4.5 !o""a&oration u"e Scripts..............................................................................10

$ DETAI%ED DESI"N....................................................................................................2&

(.1 ew6DMH63P6o6SDM...............................................................................27

(.2 ew6DMH63,6o6SDM.................................................................................21(.3 ew6DMH6e86ePM.............................................................................................22(.4 ew6DMH6e86ePM6+atch..................................................................................23(.% ew6DMH6e86Https6rom6P...........................................................................24(.( ew6DMH6e86Https6o6P...............................................................................2%(. ew6DMH6Poll6&eceive6Https...........................................................................2((. ew6DMH6e86&outer.........................................................................................2(.5 ew6DMH6Process6/rrors..................................................................................25(.17 ew6DMH6Process6&eports.............................................................................37

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(.11 ew6DMH6&outer..............................................................................................31(.12 ew6DMH6SDM6/O+6ppend......................................................................33(.13 ew6DMH6SDM6/O+6Sort............................................................................34(.14 ew6DMH6SDM6/O+6o63%......................................................................3%

' ERROR AND%IN"()A%IDATION.............................................................................3$

.1 H,P #alidation ...............................................................................................3(.2 +usiness and System /rrors.............................................................................. 3(

# RE%ATED DOCUMENTATION...................................................................................3$

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1 Int*o+,-ton

he purpose of this document is to hi!hli!ht the desi!n architecture of the flow of 8123: 55 and 3% messa!es for the DMH H,P ranslator system. his documentaims to outline the desi!n from a functional as well as a technical standpoint ta;in! into

account the interactions and interchan!es )etween the various systems: )ut mainlyoutlinin! the processes involved in the See+eyond e


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2 A-*on/0s an+ Te*0 Defntons

hese are the definitions for the acronyms and terms used in this document.

Collaboration A component of an e*Way that receives and processes Events and forwards the output to other e*Gatecomponents. Collaborations perform three functions: They subscribe to Events of a known type they

apply business rules to Event data and they publish output Events to a specified recipient.Collaborations use !onk translation script files with the e"tension . tsc or #ava translation script fileswith the e"tension .xts to do the actual data manipulation.

e*Xchange PartnerManager(e*Xchange)

An application within the $ee%eyond e%usiness &nte'ration $uite that is used to set up and maintainTradin' (artner profiles and view processed messa'es. e*)chan'e also processes inbound andoutbound messa'es accordin' to certain e%usiness protocols and your validation Collaborations.e*)chan'e also provides prebuilt #ava validation rules for the nine standard transaction sets that areClaredi compliant.

Event (Message) +ata to be e"chan'ed either within e*)chan'e or between e*)chan'e and e"ternal systems whichhas a defined data structure, for e"ample a known number of fields with known characteristics anddelimiters. Events are classified by type usin' Event Type +efinitions.

Event TypeDefinition(ET!

An Event Type template definin' Event fields field se-uences and delimiters. Event Type +efinitionsenable e*)chan'e systems to identify and transform Event Types. An Event Type +efinition is a!onk script file with an e"tension of .ssc or a #ava script file with an e"tension of .xsc indicatin' amessa'e structure script file.

"aci#edi aciledi is a Claredi product that tests inbound and outbound )/0 transactions for 1&(AA compliance.$essage %rofi#e &n the e*)chan'e Web interface a messa'e profile is a set of parameters and other information you

enter about each individual type of transaction that you process with e*)chan'e. This definitionassociates the validation Collaborations that are needed to validate each kind of messa'e.

$$E $u#ti&$ode e'a. ) f#eib#e mu#ti&threaded t%e of e'a that uses e'a connections as itsinterfaces.

99 The "unctiona# )c+no#edgment Transaction -et, 7, has been designed to a##o Tradin' (artnerstoestab#ish a com%rehensi/e contro# function as a %art of their business echange %rocess. There is a one&to&one corres%ondence beteen a 7 and a functiona# grou%. -egments ithin the 7 can identif theacce%tance or re0ection of the functiona# grou%, transaction sets, or segments. ata e#ements in error

can a#so be identified. T%ica##, the 7 is used as a functiona# ac+no#edgment to a %re/ious#transmitted functiona# grou%. e*change can automatica## generate this transaction set through

interna# %arameter settings, and automatica## reconci#e recei/ed ac+no#edgments to functiona#grou%s that ha/e been sent. The benefit to this %rocess is that the sending Tradin' (artnercan

determine if the recei/ing Tradin' (artnerhas recei/ed )-2 1 transaction sets. )s stated%re/ious#, the 7 is a transaction set and thus is enca%su#ated ithin the interchange contro# structure(en/e#o%es! for transmission. 4n#ess named as mandator in the "edera# 5u#es im%#ementing 6IP)),use of the 7, a#though recommended b the authors, is not mandated.

-9 -eeeond.

T!" &n )/0 a TA/ is an interchan'e acknowled'ement. The TA/ acknowled'ment verifies the interchan'eenvelopes only. The TA/ is a sin'le se'ment and is uni-ue in the sense that this sin'le se'ment istransmitted without the G$2GE envelope structures. A TA/ acknowled'ment can be included in aninterchan'e with other functional 'roups and transactions.

Tra#ing Partnerprofile co$ponent

The Tradin' (artner profile component that you use to enter business information about your Tradin'(artner. The name of the Tradin' (artner which could be a subdivision of a company and the peopleyou want to contact are e"amples of information you enter for a Tradin' (artner component.

Transaction set &n )/0 each business 'roupin' of data is called a transaction set. or e"ample a 'roup of benefitenrollments sent from a sponsor to a payer is considered a transaction set. Each transaction set contains

'roups of lo'ically related data in units called se'ments. or e"ample the 34 se'ment conveys thecity state 5&( code and other 'eo'raphic information.A transaction set contains multiple se'ments so the addresses of the different parties for e"ample canbe conveyed from one computer to the other. An analo'y would be that the transaction set is like afrei'ht train, the se'ments are like the train6s cars and each se'ment can contain several data elementsin the same way that a train car can hold multiple crates. $pecifically in )/0 the transaction set iscomprised of se'ments $T throu'h $E.

TP Trading Partner

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3 Ass,0tonsa. -eeeond i## not determine hat data goes into an outbound transaction or do an

data conditiona# %rocessing: the data a/ai#ab#e in the E; i## be used to bui#d theoutbound 83< ithout an conditiona# %rocessing to determine hen=if certain data

shou#d be returned.b. e*change >ogica# name (Pro/ider 9ame node of ET?s!@ efore Trading Partner

%rofi#es can be entered into e*change, a format for the #ogica# name fie#d isreAuired.

c. -eeeond i## not conditiona## dro% data. )## data that is a/ai#ab#e on the

inbound transaction and ma%%ed into the a%%ro%riate %ro%rietar fie#ds.

4 SeeBe/on+ A*-te-t,*e

his section !ives an overview of the !eneral operation: structure: and architecture ofthe e


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Figure 1 : e*Gate Integrator Layered Architecture

s shown in i!ure 1 a)ove: e


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4.3 )e %a/e*

he #iew layer contains those components with which you interactCthe e


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Stores all confi!uration details: either throu!h references to supplemental

confi!uration files or direct containment

Handles: throu!h the &e!istry Service: all re0uests for confi!uration updates and

chan!es the content of the &e!istry when new information is provided

orwards any updates to appropriate clients as necessary

/mploys a eam &e!istry concept that divides the &e!istry into?

o &un'time environment

o Sand)o* area for user'specific file development

4.4.2 !ontro" #ro$ers

he ontrol +ro;er component in a schema?

Starts and stops processes

Selectively forwards alert: status: and confi!uration messa!es to the appropriate

=,s

&outes operational /vents to scripts that help perform )asic maintenance or

administrative actions

4.! B,sness R,les an+ Data P*o-essn5 %a/e*

he +usiness &ules and Data Processin! layer uses olla)oration &ules andolla)orations to implement user'defined )usiness lo!ic in response to input /vents.

4.5.1 !o""a&oration u"es

olla)oration &ules components have the followin! characteristics?

hey specify the details of how applications wor; to!ether: for e*ample: usin!

data identification and transformation rules.

ou can define olla)oration &ules usin! the olla)oration &ules /ditor.

olla)oration &ules can )e written in Eava or See+eyondBs Mon; lan!ua!e or in

another convenient pro!rammin! lan!ua!e: for e*ample: .

he e


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Figure 2 : e*Way Organization

4.$ Intell5ent 7,e,n5 %a/e*

he ,ntelli!ent -ueuin! layer provides for data 0ueuin! functions. e


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! Bas- Des5n

!.1 Int*o+,-ton

his section represents the )asic flow of data )etween components. i!ure 3 )elow

shows the )asic flow of data: startin! at the radin! Partner and flowin! via HPS intoSee+eyond e


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processes and procedures: rather enhancin! the le!acy system to accept and process812 H,P standard claims. his presents a transparent processin! layer for theradin! Partners: ena)lin! them to use e*istin! communication channels even forH,P transactions.

he flow of data is controlled )y e


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!.

radin! Partner

,FSolder

HPSrom,FS

acilediv ia

e8chan!e

ranslate 3P

and 3,

DHSSDM

,FSolder

1.

ranslate 3%

eFay

HPSrom

,FS

2.

1&.

11.

12.

HPSo

,FS

,FSolder

14.

5a.

1!.

3.

4.

HPSo,FS

3a.

,FSolder

3).

3c.

DMHDSS

8.e8chan!e

13.

HPSo

,FS

,FSolder

#.

$.

'.

Figure ( !"# #I$$A %ran&'ator data 'ow

4. he 3s are sent to a core e


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HPS to transfer it to ,FS olders.

(. he claim files are then sent to Short'Doyle Mainframe system afterperformin! some pre'edits and )atchin!.

. he Short'Doyle Mainframe system receives the files from ,FS andperforms the needed claims ad>udication )efore !eneratin! the /O+.

. he /O+ files are sent to the DMH Decision Support Systemwhere theyare separated )y county and service month.

5. he /O+s are placed in the appropriate ,FS folders.

a. radin! Partners view and download the /O+ files.

Steps 1 throu!h 5 illustrate the translation of the 3 to the /O+ while Steps17 throu!h1% descri)e the creation of the 3% from the /O+.

17. he ranslator is tri!!ered once more with the relevant details indicatin!the presence of an /O+ file re0uirin! translation.

11. he /O+ file is transferred to the ranslator via secure HP where the

core ranslator component performs a num)er of steps to !enerate the 3% file withthe appropriate hierarchies encoded.

12. he 3%s pass throu!h e8chan!e for )atchin!.

13. n out)ound component pic;s up the )atched 3% file.

14. he appropriate ,FS folder is populated with 3% file correspondin! tothe e*istin! /O+ file.

1%. he 3% file can )e viewed and downloaded )y the radin! Partners.

he complete cycle from the transmission of the 3 to the !eneration of the 3%involves numerous systems: which ma;es it difficult to estimate the turnaround time forthe claim.

!.3 DM IPAA T*anslato* S/ste0 Des5n

he DMH H,P translator is a modular event'driven system with each componentplayin! an important part either in the transmission: control: or in the actual translationitself. he desi!n for the translator: in the form of a Schema in See+eyond terminolo!y:is shown in i!ure % )elow. ll the components of the translator includin! eFays: eFayonnections: ,ntelli!ent -ueues: and messa!es e*chan!ed )etween the componentsare shown. More detailed descriptions of the individual eFays and the rules that areem)edded in them are !iven in Section ( )elow.

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Figure ) !"# #I$AA %ran&'ator



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!.4 DM IPAA T*anslato* Co0onents

5.4.1 E'ent (ypes and E'ent (ype )einitions

Eent T/es

his ta)le lists all the event types used )y the DMH H,P ranslator. /vents are

identified and handled )y their names. he ta)le contains all the event types that aree*chan!ed )etween the components. ertain events can )e associated with structuresat run'time itself: allowin! them to have no structure at definition.

a+e A&&ociated ,%!

DDDDDDDD E/ent$sg.ssc

9otification 9otification.scc

enericInE/ent enericInE/ent.ssc

eneric;utE/ent eneric;utE/ent.ssc

eFatch eF-tandardFE/ent.ssc

eFError eF-tandardFE/ent.ssc

eFEterna#FE/t

eF6TTP eF-tandardFE/ent.ssc

eF6TTP- eF-tandardFE/ent.ssceF6tt%2#ient 6tt%c#ient.ssc

eF-$PT eF-tandardFE/ent.ssc

eFT2PIP eF-tandardFE/ent.ssc

eFTransactionFPo##

eFfromFTradingFPartner eF-tandardFE/ent.ssc

eFtoF$u eF-tandardFE/ent.ssc

eFtoFTradingFPartner eF-tandardFE/ent.ssc

eFtoFeP$

eFtoFeP$ eF-tandardFE/ent.ssc

etF$6F83F$- $ai#c#ient.sc

etF$6FE55;5F$- etF$6FE55;5F$-.sc

etF$6F"5;$FTPetF$6FE9E5I2FEHT etF$6FE9E5I2FEHT.sc

etF$6F6TTPF"5;$FTP

etF$6F6TTPFT;FTP

etF$6F6TTPF5EG etF$6F6TTPF5EG.sc

etF$6F5EP;5TF$- etF$6F5EP;5TF$-.sc

etF$6F-$2F2>)I$ etF$6F-$2F2>)I$.sc

etF$6F-$2F2#aimF"i#e etF$6F-$2F2#aimF"i#e.sc

etF$6F-$2FE; etF$6F-$2FE;.sc

etF$6F-$2FE;FET etF$6F-$2FE;FET.sc

etF$6F-$2FE;FETF-orted

etF$6F-G> etF$6F-G>.sc

etF$6F-G>FP;>> etF$6F-G>FP;>>.sc

etF$6FFT;FTP



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Eent T/e Defntons

his ta)le lists all the event type definitions for DMH H,P and !ives a )rief descriptionof each.

a+e !e&cri-tionE/ent$sg.ssc

9otification.scc

eFstandardFe/ent.ssc E/ent t%e definition for echanging data ithe*change. It contains nodes such as Partner 9ame,

irection, Pa#oad, etc.

6tt%c#ient.ssc The -eeeond standard ET used for 6TTPcommunication

1FDDBD1D8)1FDDFhi%aaG1F837F6ea#2are2#ai.sc This e/ent defines the structure of the 1 6IP))837P transaction.

$ai#c#ient.sc Emai# message structure

etF$6FErrorF$sg.sc The error message structure used in the $6 6IP))Trans#ator. Error messages from different e'as are

routed and hand#ed a%%ro%riate# using this structure.

etF$6FE9E5I2FEHT.sc ) generic mu#tifunction e/ent structure ith a sing#e

%a#oad node,

etF$6F6TTPF5EG.sc ) sim%#e e/ent t%e for enca%su#ating the informationfor retrie/ing a ne fi#e

etF$6F5EP;5TF$-.sc This e/ent t%e is used for gathering re%orting data

from different e'as.

etF$6F-$2F2>)I$.sc The -$2 Pro%rietar 2#aim format definition

etF$6F-$2FE;.sc The -$2 Pro%rietar E; format definition

etF$6F-$2FE;FET.sc The E; record enhanced ith 6IP)) information

etF$6F-G>.sc The e/ent that emu#ates the structures of the tab#es inthe Pass&through database

etF$6F-G>FP;>>.sc The structure of the IT'- Trigger Tab#e

5.4.2 +nte""igent ,ueues -+,s and +, Managers (a&"e

a+e %y-e !e&cri-tion

dmhFiAmgrFeF$- $- IG

$anager

The IG $anager res%onsib#e for a## the e/ents used beteen

the Trading Partner and echange

iAF$6FeFeadF>etterFGueue

$- IG IG for storing re0ected transactions

iAF$6FeFnFInbFhtt%sFAueue

$- IG IG for storing dnamic 6TTP reAuests generated fromTrigger Tab#e entries

iAF$6FeFTradingFPortFG

ueue

$- IG echange Aueue for hand#ing messages to and from Trading

Partners

iAF$6FeFeP$ $- IG echange Aueue for hand#ing messages to interna# business

a%%#ications and com%onents

dmhFiAmgrF$- $- IG

$anager

IG $anager for hand#ing business %rocess com%onents?

e/entsdmhFiAmgrF--F$- $- IG

$anager-e%arate IG $anager for recei/ing error and re%orting datafrom different com%onents

5.4.3 e*/ay !onnections

e


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e*Way onnection a+e oniguration i'e

Inbound/Outbo

und/

0idirectiona' %y-e

ecFdmhFE$)I> ecFdmhFE$)I>.cfg ;utbound Emai#

ecFdmhFIT'- ecFdmhFIT'-.cfg idirectiona# 6TTP(-!

ecFdmhFiAmgrF$- ecFdmhFiAmgrF$-.cfg idirectiona# -eeeond $-

ecFdmhFiAmgrF--F$- ecFdmhFiAmgrF--F$-.cfg idirectiona# -eeeond $-ecFdmhFiAmgrFeF$- ecFdmhFiAmgrFeF$-.cfg idirectiona# -eeeond $-

ecFdmhF-G> ecFdmhF-G>.cfg idirectiona# -G>-E5HE5

5.4.4 e*/ays and !o""a&orations

"u'ti "ode e*Way a+e ,ecutab'e i'e oniguration i'e Inbou

nd/O

utbou

nd/0o

th

Function

eF$6F837IFToF-$2 binJstcea.ee configsJstceaJeF$6F837IFToF-$2.cfg oth Trans#ation

eF$6F837PFToF-$2 binJstcea.ee configsJstceaJeF$6F837PFToF-$2.cfg

oth Trans#ation

eF$6FeFeP$ binJstcegenericmon+.ee

configsJstcegenericmon+JeF$6FeFeP$.cfg

oth Ha#idation

eF$6FeFE%mFatch binJstcegenericmon+.ee

configsJstcegenericmon+JeF$6FeFatch.cfg

oth Ha#idation

eF$6FeF6tt%sF"romFTP binJstcea.ee oth Transmission

eF$6FeF6tt%sFToFTP binJstcea.ee oth Transmission

eF$6FPo##F5ecei/eF6tt%s binJstcea.ee oth Trigger

eF$6FeF5outer binJstcea.ee oth 5outing

eF$6FProcessFErrors binJstcea.ee oth

eF$6FProcessF5e%orts binJstcea.ee oth

eF$6F5outer binJstcea.ee oth 5outing

eF$6F-$2FE;F)%%end binJstcea.ee oth Trans#ation

eF$6F-$2FE;F-ort binJstcea.ee oth Trans#ation

eF$6F-$2FE;FToF83< binJstcea.ee oth Trans#ation

he followin! !ives a listin! of the colla)oration rules that are used )y the a)ove listedeFays. more detailed description of the wor;in! of eFays and the encapsulation of)usiness rules into the eFays is !iven in hapter 4. he ta)les )elow show eachcolla)oration rule and the types of messa!es that it su)scri)es9pu)lishes.

Gotification&outin!

Pub#ications -ubscri%tions

9otification DDDDDDDD

cr6DMH6=eneric6Passthru

Instance ET irection

a/aPassThrough;ut eneric;utE/ent ;ut

a/aPassThroughIn enericInE/en In

cr6DMH63P6o6SDM


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et$6F5EP;5TF$- etF$6F5EP;5TF$- In

et$6F E55;5F$- etF$6F E55;5F$- In=;ut

et$6F-$2F 2#aimF"i#e etF$6F-$2F 2#aimF"i#e ;ut

et$6F837P 1FDDBD1DD8)1FDDFhi%aaG1F837F6ea#t2are2#ai ;ut

et$6F-G> etF$6F-G> In=;ut

et$6F-G>FP;>> etF$6F-G>FP;>> In=;ut

cr6DMH63,6o6SDM


et$6F5EP;5TF$- etF$6F5EP;5TF$- In

et$6F E55;5F$- etF$6F E55;5F$- In=;ut

et$6F-$2F 2#aimF"i#e etF$6F-$2F 2#aimF"i#e ;ut

et$6F837I 1FDDBD1DD8)1FDDFhi%aaG1F837F6ea#t2are2#ai ;ut



cr6DMH6Process6/rrors



et$6FE$)I>F$- mai#c#ient ;ut

et$6FE55;5F$- etF$6F E55;5F$- In

cr6DMH6Process6&eports



et$6F5EP;5TF$- etF$6F5EP;5TF$- In=;ut

et$6FE55;5F$- etF$6F E55;5F$- ;ut

cr6DMH6&outer6,n)ound


et$6FE9E5I2FEHT etF$6FE9E5I2FEHT ;ut

et$6F5EP;5TF$- etF$6F 5EP;5TF$- ;ut

et$6FE55;5F$- etF$6F E55;5F$- ;ut


et$6FEFT;FEP$ eF-tandardE/ent In

cr6DMH6&outer6Out)ound

Instance ET irectionet$6FEFT;FEP$ eF-tandardE/ent ;ut

et$6FE9E5I2FEHT etF$6FE9E5I2FEHT In

et$6FE55;5F$- etF$6F E55;5F$- ;ut

cr6DMH6SDM6/O+6ppend


et$6F-G> etF$6F-G> In

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et$6FErrorF$sg etF$6F ErrorF$sg ;ut

et$6F-$2FE; etF$6F -$2FE; In

et$6F 5e%ortF$sg etF$6F 5e%ortF$sg ;ut

et$6F -$2FE;FEt etF$6F -$2FE;F"i#eFEt ;ut

cr6DMH6SDM6/O+6SortInstance ET irection

et$6F -$2FE;FEtF-orted etF$6F -$2FE;F"i#eFEt ;ut

et$6F -$2FE;FEt etF$6F -$2FE;F"i#eFEt ;ut

et$6F 5e%ortF$sg etF$6F 5EP;5TF$- In

et$6FErrorF$sg etF$6F E55;5F$- ;ut

cr6DMH6SDM6/O+6o63%


et$6F-G> etF$6F -G> ;ut

et$6FErrorF$sg etF$6F E55;5F$- ;ut

et$6F 5e%ortF$sg etF$6F 5EP;5TF$- In

et$6F-$2FE;FEtF-orted

etF$6F -$2FE;F"i#eFEt In=;ut

et$6F 83< 1FDDBD1DD1)1FDDFhi%aaG1F83


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et$6F-$2FE; etF$6FE9E5I2FEHT ;ut

et$6F-G>FP;>> etF$6F -G>FP;>> In=;ut

et$6FE55;5F$- etF$6F E55;5F$- ;ut

et$6F "5;$FTP etF$6F E9E5I2FEHT In

cr6DMH6e86&outer6Out)oundInstance ET irection

et$6F-G>FP;>> etF$6F -G>FP;>> In=;ut

et$6FEFT;FTP eF-tandardE/ent In

et$6FE55;5F$- etF$6F E55;5F$- ;ut

et$6FT;FTP eF-tandardE/ent ;ut

cr6DMH6e86eP+6+atchin!


eFtoFTradingFPartner eFEterna#FE/t

cr6DMH6e86rom6ePMPub#ications -ubscri%tions

eFtoFTradingFPartner eFEterna#FE/t

r6DMH6e86o6ePM


eFEterna#FE/t eFfromFTradingFPartner eFtoFeP$

5.4.5 !o""a&oration u"e Scripts

his ta)le lists all the colla)oration rules for DMH H,P. See+eyond allows thecolla)oration rules to )e in several different lan!ua!es includin! Mon;: Eava: : etc.Some colla)oration rules are void of any )usiness lo!ic and are simply act as pass'throu!h placeholders.

olla)oration &ule a)le

9ame 2o##aboration -er/ice T%e

enericPassThru a/a

9otification5outing $on+

crF$6F837PFtoF-$2 a/a

crF$6F837IFtoF-$2 a/a

crF$6FenericFPassthru a/a

crF$6FProcessFErrors a/a

crF$6FProcessF5e%orts a/acrF$6F5outerFInbound a/a

crF$6F5outerF;utbound a/a

crF$6F-$2FE;F)%%end a/a

crF$6F-$2FE;F-ort a/a

crF$6F-$2FE;FToF83< a/a

crF$6FeF6tt%sF"romFTP a/a

crF$6FeF6tt%sFToFTP a/a

crF$6FeF6tt%sFToFeP$ Pass Through

crF$6FeFPo##F5ecei/eF6t%%s a/a



21/38


crF$6FeF5outerFInbound a/a

crF$6FeF5outerF;utbound a/a

crF$6FeFePFatching $on+

crF$6FeF"romFeP$ $on+

crF$6FeFToFeP$ Pass Through



22/38


$ Detale+ Des5n

$.1 e9DM9#3'P9To9SDMC

o''aboration co#F$6F837PFToF-$2

o''aboration u'e crF$6F837PFToF-$2

ub&cri-tion

In&tance ,vent %y-e ource

et$6F-G> etF$6F-G> ecFdmhF-G>

et$6F-G>FP;>> etF$6F-G>FP;>> ecFdmhF-G>

et$6F837P etF$6F837P ecFdmhFiAmgrFeF$-

$ub'ication

In&tance ,vent %y-e !e&tination



et$6F-$2F2>)I$F"I>E et$6F-$2F2>)I$F"I>E ecFdmhFiAmgrF$-

et$6FE55;5F$- etF$6FE55;5F$- ecFdmhFiAmgrF--F$-

et$6F5EP;5TF$- EtF$6F5EP;5TF$- ecFdmhFiAmgrF--F$-

he MM/ ew6DMH63P6o6SDM performs the actual translation from H,P 3Pformat to the Short'Doyle Medi'al Proprietary claim format. ll )usiness edits andtransformations are enforced throu!h this eFay. ny chan!es to translation procedureor mappin! documents must )e reflected in the >ava')ased cr6DMH63P6o6SDMcolla)oration rule.

he translation is performed in the same hierarchical order as the 3P: parsin!each unctional =roup: ransaction Set: Provider and so on. /ach record for theproprietary format is e*tracted from the Service $ine @$oop 2477A level.

primary ;ey is assem)led for each service line found in the 3P claim file: andmatched a!ainst the records in the pass'throu!h data)ase as well as those in thecurrent file for duplicates. duplicate primary ;ey results in the roll)ac; of alldata)ase operations for that transaction set and causes the transaction set to )ere>ected: and a notification email to )e sent out.

/ach service line is translated into a proprietary record )ased on the mappin! rules.he pass'throu!h record is !enerated and inserted into the pass'throu!h data)aseta)le DMH6H,P6P6D.

& Systems ,nc Page D &elease Date?192292714

Proprietary laims to )e sent to

,FS

et6DMH6SDM6laim6ile

Pass'throu!h

data)ase

e49DM9#3'P9To9SDMC

col6DMH63P6o6SDM

cr6DMH63P6o6SDM

dmh6i0m!r6EMS

#alidated 3P laims

et6DMH63P

dmh6i0m!r6EMS

dmh6i0m!r6SS6EMS

/rrors and9or /*ceptions if anyet6DMH6/&&O&6MS=

System &eports

et6DMH6&/PO&6MS=

ewc6dmh6S-$

Pass'throu!h data)ase records

et6DMH6S-$

,nternal ED+

ommunication

pdates the tri!!er ta)le

et6DMH6S-$6PO$$


23/38


he claims are sent via the messa!e et6DMH6SDM6laim6ile to thedmh6i0m!r6EMS ,- Mana!er from where they will )e transferred to ,FS viaHPS.

System and error reports are sent to the dmh6i0m!r6SS6EMS ,- Mana!er forfurther processin!.

$.2 e9DM9#3'I9To9SDMC

Proprietary laims to )e sent to

,FS

et6DMH6SDM6laim6ile

Pass'throu!h

data)ase

e9DM9#3'I9To9SDMC

col6DMH63,6o6SDM

cr6DMH63,6o6SDM

dmh6i0m!r6EMS

#alidated 3, laim s

et6DMH63,

dmh6i0m!r6EMS

dmh6i0m!r6SS6EMS


System&eports

et6DMH6&/PO&6MS=

ewc6dmh6S-$

Pass'throu!h data)ase records

et6DMH6S-$

,nternalED+

ommunication

pdates the tri!!er ta)le

et6DMH6S-$6PO$$

o''aboration co#F$6F837IFToF-$2

o''aboration u'e crF$6F837IFToF-$2

ub&cri-tion




et$6F837I etF$6F837I ecFdmhFiAmgrFeF$-

$ub'ication

In&tance ,vent %y-e !e&tinationet$6F-G>FP;>> etF$6F-G>FP;>> ecFdmhF-G>


et$6F-$2F2>)I$F"I>E et$6F-$2F2>)I$F"I>E ecFdmhFiAmgrF$-



he MM/ ew6DMH63,6o6SDM performs the actual translation from H,P 3,format to the Short'Doyle Medi'al Proprietary claim format. ll )usiness edits andtransformations are enforced throu!h this eFay. ny chan!es to translation procedureor mappin! documents must )e reflected in the >ava')ased cr6DMH63,6o6SDMcolla)oration rule.

he translation is performed in the same hierarchical order as the 3,: parsin! each

unctional =roup: ransaction Set: Provider and so on. /ach record for theproprietary format is e*tracted from the Service $ine @$oop 2477A level.

primary ;ey is assem)led for each service line found in the 3, claim file: andmatched a!ainst the records in the pass'throu!h data)ase as well as those in thecurrent file for duplicates. duplicate primary ;ey results in the roll)ac; of alldata)ase operations for that transaction set and causes the transaction set to )ere>ected: and a notification email to )e sent out.



24/38


/ach service line is translated into a proprietary record )ased on the mappin! rules.he pass'throu!h record is !enerated and inserted into the pass'throu!h data)aseta)le DMH6H,P6P6D.

he claims are sent via the messa!e et6DMH6SDM6laim6ile to thedmh6i0m!r6EMS ,- Mana!er from where they will )e transferred to ,FS via

HPS.System and error reports are sent to the dmh6i0m!r6SS6EMS ,- Mana!er forfurther processin!.

$.3 e9DM9e:9ePM

Out)ound 812 Messa!es are

retrieved and sent to9f rom

e8chan!e data)asee1FE*terna#FE/t

i06DMH6e86radin!6Port6-ueue

e49DM9e:9ePM

col6DMH6e86rom6ePM

cr6DMH6e86rom6ePMi06DMH6e86e+PM

col6DMH6e86o6ePM

cr6DMH6e86o6ePM

#alidated 3%: 55 and 1

Messa!es

e86HPS 9 e86HP

,n)ound 812 messa!es are

sent to e8chan!e data)asee1FE*terna#FE/t

+ase (4 encoded mess a!es

f rom radin! Partnerse1FfromFTradingFPartner

#alidated 3P and 3, mess a!es sent f or

translatione1FtoFe7P$

e8chan!e

Data)ase

ranslated 3% messa!es sent f or v alidation

e1FfromFe7P$

o''aboration co#F$6FeFfromFE%m

o''aboration u'e crF$6FeFfromFE%m

ub&cri-tion


eFEterna#FE/t (5eAuired! KETE59)>L

$ub'ication


eFT2PIP iAF$6FeFTradingFPortFGueue

eF)T26 iAF$6FeFTradingFPortFGueue

eFtoFTradingFPartner iAF$6FeFTradingFPortFGueueeF6TTP- iAF$6FeFTradingFPortFGueue

eF-$TP iAF$6FeFTradingFPortFGueue

eF6TTP iAF$6FeFTradingFPortFGueue

eFError iAF$6FeFeadF>etterFGueue

eFtoF$u iAF$6FeFTradingFPortFGueue

eFtoFeP$ iAF$6FeFEb%m

eFtoFeP$ iAF$6FeFeP$

o''aboration co#F$6FeFtoFeP$

o''aboration u'e crF$6FeFtoFeP$

ub&cri-tion


eFfromFTradingFPartner

(5eAuired!

co#F$6FeF5outerFInbound

eFtoFeP$ (5eAuired! K)9L

$ub'ication


eFEterna#FE/t KETE59)>L

he e8chan!e eFay is the main wor;horse in the )ac;'end portion of the e8chan!ePartner Mana!er. he e8chan!e eFay does the followin!?

#alidates protocol'specific data from radin! Partners

Frites /vent data to the data)ase



25/38


&etrieves radin! Partner profile information from the data)ase

/nvelopes the data as re0uired )y the destination radin! Partner

he e86ePM eFay is a )idirectional eFay that communicates with )oth the e86e+PM,- and the e86radin!6Port6-ueue ,-: as well as the e8chan!e data)ase. ,t forms a)rid!e )etween the )usiness process side of the e8chan!e system and the radin!

Partner side of e8chan!e: receivin! /vent information )oth from activity eFays and theeFays that communicate directly with radin! Partners.

$.4 e9DM9e:9ePM9Bat-

,ndiv idual 3%messa!es from

e8chan!e data)asee1FE*terna#FE/t

e9DM9e:9ePM9Bat-

col6DMH6e86ePM6+atchin!

cr6DMH6e86eP+6+atchin!i06DMH6e86radin!6Port6-ueue

Sin!le )atched 3% messa!e

sent to radin! Partnere86HPS 9 e86HP

e8chan!e

Data)ase

o''aboration co#F$6FeFeP$Fatching

o''aboration u'e crF$6FeFePFatching

ub&cri-tion


eFEterna#FE/t (5eAuired! KETE59)>L

$ub'ication


eFT2PIP iAF$6FeFTradingFPortFGueue

eF)T26 iAF$6FeFTradingFPortFGueue

eFtoFTradingFPartner iAF$6FeFTradingFPortFGueue

eF6TTP- iAF$6FeFTradingFPortFGueue

eF6TTP iAF$6FeFTradingFPortFGueue

he ew6DMH6e86ePM6+atch eFay polls the e8chan!e data)ase for /vents )ein!sent to radin! Partners usin! ast +atch transfer mode or +atch transfer mode @ratherthan an ,nteractiveA and prepares them to )e sent to the appropriate radin! Partner.Fhen multiple /vents need to )e sent to the same radin! Partner: the eFay )undlesthese /vents to!ether accordin! to a user'defina)le )undlin! scheme: )efore envelopin!them and pu)lishin! them to the e86radin!6Port6-ueue ,-.



26/38


$.! e9DM9e:9tts9F*o09TP

1. Pic;s up a HP &e0uest

with the &$ of the new file to)e re0uested from ,FS

et6DMH6HP6&/-

2. Sends a re0uest for a file

)y specifyin! its &$

et6DMH6HP6$,/G

dmh6i0m!r6e86EMS

3. &eceives the new file

from ,FS via HPS

et6DMH6HP6$,/G

ewc6dmh6,FS

ew6DMH6e86Https6rom6P

col6DMH6e86Https6rom6P

cr6DMH6e86Https6rom6P

,FS

dmh6i0m!r6SS6EM

S4. Sends the new file for

further processin!

et6DMH6HPS6&OM6

P

DMH rust Store

Fe) ertificates,nternal HPS

ommunication

/rrors and9or /*ceptions if

any

et6DMH6/&&O&6MS=

SS$,nformation

o''aboration co#F$6FeF6tt%sF"romFTP

o''aboration u'e crF$6FeF6tt%sF"romFTP

ub&cri-tionIn&tance ,vent %y-e ource

et$6F6TTPF5EG4E-T etF$6F6TTPF5EG ecFdmhFiAmgrFeF$-

$ub'ication



et$6FF"5;$FTP etF$6F6TTPF "5;$FTP ecFdmhFiAmgrFeF$-

et$6F6TTPF2>IE9T eF6TTP- ecFdmhFIT'-

he ew6DMH6Https6rom6P acts as the communication point )etween the ,FS andthe ranslator. his eFay serves to increase the modularity of the entire ranslator )yallowin! for scala)ility to accommodate other communication protocols. heew6DMH6Https6rom6P eFay can )e replaced or enhanced at any time )y addin! anew eFay that could possi)ly use a different protocol such as P without affectin! any

functionality of the remainin! components of the ranslator. heew6DMH6Https6rom6P receives the et6DMH6HP6&/- messa!e from thedmh6i0m!r6e86EMS 0ueue mana!er and uses the information to ma;e an HPconnection to ,FS and transfer data usin! standard HP methods. he retrieved datais in turn pu)lished to the ,- Mana!er from where it is pic;ed for further processin!. heeFay connection acts as the !ateway to the ,FS and can )e confi!ured e*clusive ofthe data processin! functions within the colla)oration rule itself.

MM/ will retrieve the et6DMH6HP6&/- messa!es from the ,- Mana!erdmh6i0m!r6e86EMS: and will !enerate the appropriate HP methods to retrieve anew file.

he MM/ will pu)lish an et6DMH6HP6$,/G messa!e: which is a See+eyond

standard messa!e type to the ewc6dmh6,FS eFay onnection.

ewc6dmh6,FS will retrieve the necessary certificates from a specified rust Storeand esta)lish HPS communication with ,FS.

MM/ ew6DMH6e86Https6rom6P will retrieve the data and pu)lish it as a !enericmessa!e of the type et6DMH6HPS6&OM6P to the ,- Mana!er.

MM/ will pu)lish an et6DMH6/&&O&6MS= messa!e to the dmh6i0m!r6SS6EMS0ueue in case any errors or e*ceptions are encountered.

& Systems ,nc Page B &elease Date?192292714


27/38


$.$ e9DM9e:9tts9To9TP

Messa!e to )e sent to radin!

Partners via ,FSet6DMH6HPS6O6P

dmh6i0m!r6e86EMS

dmh6i0m!r6SS6EM

S

Sends response messa!es

to e8chan!e data)asee86to6ePM /rrors and9or /*ceptions if

any

et6DMH6/&&O&6MS=

e9DM9e:9tts9To9TP

col6DMH6e86Https6o6P

cr6DMH6e86Https6o6P

col6DMH6e86Https6o6ePM

r6DMH6e86Https6o6ePM

ewc6https6DMH6,FS

,FS

DMH rust

Store Fe)ertificates

,nternal HP

ommunication

SS$

,nformation

i06DMH6e86radin!6Port6-ueue

iles sent to ,FS viaHPS

et6DMH6HP6$,/G

&esponse Messa!ereceived from ,FS

et6DMH6HP6$,/G

o''aboration co#F$6FeF6tt%sFToFTPo''aboration u'e crF$6FeF6tt%sFToFTP

ub&cri-tion


eF-tandE/ent etF$6F6TTP-FT;FTP ecFdmhFiAmgrFeF$-

$ub'ication



eFtoFeP$F-td eFtoFeP$ iAF$6FeFTradingFPortFGueue

6tt%2#ient eF6tt%2#ient ecFdmhFIT'-

o''aboration co#F$6FeF6tt%sFToFeP$

o''aboration u'e crF$6FeF6tt%sFToFeP$

ub&cri-tion


eFEterna#FE/t (5eAuired! K)9L$ub'ication


eFtoFeP$ iAF$6FeFTradingFPortFGueue

& Systems ,nc Page < &elease Date?192292714


28/38


$.' e9DM9Poll9Re-ee9tts

Sends a HPS &e0uest

with the &$ of the new file

to )e pic;ed up

et6DMH6HP6&/-

ri!!er a)le on

Pass'throu!h

Data)ase

e9DM9e:9Poll9Re-ee9tts

col6DMH6e86Poll6&eceive6Https

Polls the ri!!er a)le for

new filename entries

et6DMH6S-$6PO$$

cr6DMH6e86Poll6&eceive6Httpsdmh6i0m!r6e86EMS

&eceives the new fileBs &$

from the ri!!er a)le

et6DMH6S-$6PO$$

ewc6dmh6S-$,nternal ED+

ommunication

o''aboration co#F$6FeFPo##F5ecei/eF6tt%s

o''aboration u'e crF$6FeFPo##F5ecei/eF6tt%s

ub&cri-tion



$ub'ication


et$6F6TTPF5EG4E-T etF$6F6TTPF5EG ecFdmhFiAmgrFeF$-

he multi'mode eFay @MM/A ew6DMH6e86Poll6&eceive6Https polls the ri!!er a)le:

which is a part of the Pass'throu!h data)ase: for new entries. /ntries in the ta)le consistof the &$ and details such as the /ntity ode and Su)mission Date. However: only the&$ of the new file is retrieved from the ta)le and a re0uest messa!e is sent to theew6DMH6e86Https6rom6P eFay via the dmh6i0m!r6e86EMS 0ueue. his eFayperforms the followin! se0uence of operations?

MM/ will pu)lish an et6DMH6S-$ event to the S-$ Server eFay onnectionewc6dmh6S-$: to 0uery the data)ase for new entries )ased on the I,sProcessedBfla! that determines whether the translator has processed a file or not.

MM/ will !enerate an HP re0uest messa!e of the et6DMH6HP6&/- type andpu)lish it to the ,- Mana!er dmh6i0m!r6e86EMS.

& Systems ,nc Page C &elease Date?192292714


29/38


$.# e9DM9e:9Ro,te*

1.a &eceives the messa!econtainin! the new data

et6DMH6HPS6&OM6P

dmh6i0m!r6e86EMS

e49DM9e:9Ro,te*

col6DMH6e86&outer6,n)ound

cr6DMH6e86&outer6,n)ound

i06DMH6e86radin!6Port6-ueue2). Sends a !eneric messa!e

to radin! Partneret6DMH6HPS6O6P

ED+communication

2a. /O+ iles are sent fortranslation

et6DMH6SDM6/O+

col6DMH6e86&outer6Out)ound

cr6DMH6e86&outer6Out)ound

dmh6i0m!r6EMS

dmh6i0m!r6SS6EMS

ewc6dmh6S-$

2a. 3P and 3, iles are sentto e8chan!e for v alidatione86f rom6radin!6Partner

1). 3%: 55 and 1messa!es are received f rom

e8chan!ee86HP:e86HPS

ri!!er a)le onPass'throu!h

Data)ase

pdates t he tri!!er ta)leet6DMH6S-$6PO$$


System&eportset6DMH6&/PO&6MS=

o''aboration co#F$6FeF5outerFInbound

o''aboration u'e crF$6FeF5outerFInbound

ub&cri-tion


et$6F"romFTP etF$6F6TTP-F"romFTP ecFdmhFiAmgrFeF$-

$ub'ication




et$6FEF"5;$FTP eFfromFTradingFPartner iAF$6FeFTradingFPortFGueue

et$6F-$2FE; etF$6F-$2FE; ecFdmhFiAmgrF$-


o''aboration co#F$6FeF5outerF;utbound

o''aboration u'e crF$6FeF5outerF;utbound

ub&cri-tion


et$6FEFT;FTP eF6TTP co#F$6FeFfromFeP$

et$6FEFT;FTP eF6TTP co#F$6FeFeP$Fatching

et$6FEFT;FTP eF6TTP- co#F$6FeFfromFeP$

et$6FEFT;FTP eF6TTP- co#F$6FeFeP$Fatching

$ub'ication


et$6FT;FTP etF$6F6TTP-FT;FTP ecFdmhFiAmgrFeF$-

et$6F-G>FP;>> EtF$6F-G>FP;>> ecFdmhF-G>

he MM/ ew6DMH6e86&outer is a router for messa!es to and from e8chan!e. ,tcontains two colla)orations that act on in)ound and out)ound messa!es at different

instances in the process cycle. he routin! functions in the rules transform specificmessa!es into !eneric messa!es and vice versa.



30/38


he ,n)ound colla)oration is the startin! point for in)ound messa!e processin!. ilesfrom the ,FS are received as data chun;s in the form of !eneric messa!es: and needto )e sent to different eFays )ased on whether the file is an 3 or an /O+. he MM/wor;s as follows?

he MM/ colla)oration col6DMH6e86&outer6,n)ound receives !eneric events

et6DMH6HPS6&OM6P that contain the data from the ,FS.

he /O+ is routed to the dmh6i0m!r6EMS ,- Mana!er for translation to 3% format.

he 3 data is transformed into +ase(4 format re0uired )y e8chan!e: andstatistical information such as the transaction counts are e*tracted: and the tri!!erta)le is updated.

he e86from6radin!6Partner event is populated as follows?

Partner 9ame=>ogica# 9ame

$6FK2ount 2odeLFInboundThe count codes are etracted from the I-)DC fie#d of the 837.

In"i#e The fi#ename from here this %articu#ar transaction as etracted.

Pa#oad The 1 message is encoded in ase&CB format.

irection I (Inbound!

he 3 data is associated with a radin! Partner +2+ Profile Game and sent toi06DMH6e86radin!6Port6-ueue for validation )y e8chan!e and laredi.

System reports are !enerated for )oth the /O+s and the 3s and are sent to theSystem &eports Data)ase via the /t6DMH6&/PO&6MS= /vent.

he out)ound colla)oration wor;s in a similar manner: actin! upon out)ound data frome8chan!e: which is received in the form of 3%s: 55s and 1s. hese messa!es are

decoded from their +ase(4 format and assi!ned filenames )efore )ein! sent out to theradin! Partners via the ,FS.

he colla)oration col6DMH6e86&outer6Out)ound pic;s up e86HPS messa!esfrom e8chan!e via the i06DMH6e86radin!6Port6-ueue ,-.

hese messa!es: which are in the Standard /vent format: are decoded: assi!nedfilenames and are sent out to dmh6i0m!r6e86EMS as et6DMH6HPS6O6Pmessa!es.

he tri!!er ta)le is updated with the num)er of transactions ac;nowled!ed andaccepted via the et6DMH6S-$6PO$$ event.

/rrors and &eports are sent usin! the et6DMH6/&&O&6MS= and

/t6DMH6&/PO&6MS= event types respectively.



31/38


$.8 e9DM9P*o-ess9E**o*s

/rror a)le on Pass'

throu!h Data)ase

e49DM9P*o-ess9E**o*s

col6DMH6Process6/rrors

Sends all error messa!es to/rror a)le

et6DMH6S-$

cr6DMH6Process6/rrors

ewc6dmh6S-$

Sends $ and &=/G

error messa!es to emailet6DMH6/M,$6MS=

ewc6dmh6/M,$

dmh6i0m!r6SS6EMS

SMP Server

,nternalSMP

ommunication

,nternalED+

ommunication

&eceives error messa!es f rom

diff erenteFayset6DMH6/&&O&6MS=

o''aboration co#F$6FProcessFErrors

o''aboration u'e crF$6FProcessFErrorsub&cri-tion



$ub'ication


et$6FE$)I>F$- etF$6FE$)I>F$- ecFdmhF-G>

et$6F-G> etF$6F-G> ecFdmhFE$)I>

he ew6DMH6Process6/rrors plays a very crucial role in the ranslator systemena)lin! error reportin! from every component without the need for individual errorhandlin! methods. /rror reportin! is performed throu!h two channels: throu!h an errorta)le and an email messa!es.

he col6DMH6Process6/rrors su)scri)es to the et6DMH6/&&O&6MS= event fromthe dmh6i0m!r6SS6EMS ,- Mana!er. he ,- Mana!er in 0uestion is used )y allcomponents to su)mit error messa!es and reports.

+ased on the severity of the error: the colla)oration rule ma;es a decision to sendemail alerts or >ust lo! them into the error ta)le.

ll errors are: )y default: lo!!ed into the /rror a)le DMH6SS6/&&O&S with thelocation as well as the details of the error.

/mail messa!es are !enerated only for errors identified as &=/G or $: withthe appropriate su)>ect lines and messa!e )odies )ein! !enerated accordin! to theerror source and cause.

he et6DMH6/M,$6MS= is a See+eyond !eneric event type that encodes all theinformation needed to !enerate a valid email messa!e. his event is sent to theHHSD SMP server throu!h the ewc6dmh6/M,$ eFay connection.



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$.1& e9DM9P*o-ess9Reo*ts

&eports a)le on

Pass'throu!hData)ase

e49DM9P*o-ess9Re1o*ts

col6DMH6Process6&eports

Sends reportin! data to the

&eports a)leet6DMH6S-$

cr6DMH6Process6&eportsdmh6i0m!r6SS6EMS

ewc6dmh6S-$

&eceiv es reportin! data from

diff erenteFay s

et6DMH6&/PO&6MS=

,nternalED+

ommunication

o''aboration co#F$6FProcessF5e%orts

o''aboration u'e crF$6FProcessF5e%orts

ub&cri-tion


et$6F5EP;5TF$- etF$6F 5EP;5TF$- ecFdmhFiAmgrF--F$-

$ub'ication



he ew6DMH6Process6&eports eFay handles all the reportin! data !enerated )y theDMH H,P ranslator. he ,- Mana!er dmh6i0m!r6 SS6EMS acts as a repository forall the reportin! events that are !enerated )y different components in different sta!es ofthe claims cycle. &eportin! data is useful to o)tain statistics for each radin! Partner:such as the num)er of files: transactions: service lines: etc inputted to the system: or

re>ected )y different validation procedures. most useful feature of the reports data isthat it indicates in amounts: the claims that were re>ected on the )asis of H,P errorsand those re>ected due to translation errors.

he colla)oration col6DMH6Process6&eports su)scri)es to the/t6DMH6&/PO&6MS= event that contains fields to hold reportin! data fromdifferent components.

+ased on the county code: year: and month of translation: the reports are updated inthe DMH6SS6&/PO&S data)ase ta)le throu!h the et6DMH6S-$ event type. separate record is created for each county per month9year.

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$.11 e9DM9Ro,te*

1a &eceives validated 3P: 3,

data

e86to6e+PM

i06DMH6e86e+PM

e9DM9Ro,te*

col6DMH6&outer6,n)ound

cr6DMH6&outer6,n)ound

2). Sends a +ase(4

encoded 3% data for

validation

e86to6ePM

2a. #alidated 3P and 3,sent for translation

et6DMH63P:

et6DMH63,

col6DMH6&outer6Out)ound

cr6DMH6&outer6Out)ound

dmh6i0m!r6EMS

dmh6i0m!r6SS6EMS

1). ranslated 3% sent for

validation

et6DMH63%

/rrors and9or /*ceptions if

any

et6DMH6/&&O&6MS=

System &eports

et6DMH6&/PO&6MS=

o''aboration co#F$6F5outerFInbound

o''aboration u'e crF$6F5outerFInbound

ub&cri-tion


et$6FEFT;FEP$ eFtoFeP$ co#F$6FeFfromFeP$

$ub'ication



et$6FE9E5I2FEHT etF$6F837P ecFdmhFiAmgrF$-

o''aboration co#F$6F 5outerF;utbound

o''aboration u'e crF$6F5outerF;utbound

ub&cri-tion


et$6FE9E5I2FEHT etF$6F83< ecFdmhFiAmgrF$-

$ub'ication


et$6FEFT;FEP$ eFtoFeP$ iAF$6F eFeP$

$i;e the ew6DMH6e86&outer: the ew6DMH6&outer also acts as a routin! component:actin! on messa!es on the )usiness application side of the e8chan!e component.e8chan!e is the interface )etween the radin! Partners and the )usiness lo!ic of thetranslator: and needs the placement of routers on either side of it for optimal routin!:reportin!: and fle*i)ility to handle transactions that mi!ht )e added su)se0uently.

he MM/ has two colla)orations that act on in)ound and out)ound data at differentsta!es of the translator cycle. he col6DMH6&outer6,n)ound acts on messa!es comin!from the e8chan!e component after validation. ,t performs the followin! se0uence ofsteps?

he in)ound 3 data is parsed to e*tract the =S7 field value. his value is thenused to determine if the incomin! 3 is whether a professional or institutional claim.he in)ound 3 data is decoded from its +ase (4 format in the e86to6e+PMmessa!e structure to the et6DMH63P or et6DMH63, messa!e @dependin! onthe =S7 valueA.

report messa!e: /t6DMH6&/PO&6MS=: is !enerated indicatin! the detailsa)out the claims includin! valid num)er transactions: services: amount: etc. that can)e used later to !au!e the 0uality of a radin! PartnerBs data.



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he col6DMH6&outer6Out)ound performs a similar process in the reverse direction:operatin! on 3% messa!es.

he et6DMH63% messa!e: which is a !eneric event that encodes the 3% data in itspayload node: is pic;ed up from the dmh6i0m!r6EMS ,- Mana!er.

he data is +ase (4 encoded and assi!ned an appropriate radin! Partner profile

lo!ical name )efore )ein! sent to e8chan!e for validation. he nodes of thestandard event e86to6ePM are populated as follows?

Partner 9ame=>ogica# 9ame

$6FK2ount 2odeLF;utbound

"F49IG4EFI The fi#ename of the in%ut E; from hich the 83< as generated.

"F2;49T The number of batches that ere %resent in the E; and ere transformed into

transactions of the 83


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$.12 e9DM9SDMC9EOB9Aen+

ppends some pass'throu!h

information to t he /O+ andsends it f or further processin!

et6DMH6SDM6/O+6/*t

Pass't hrou!h a)le

e49DM9SDMC9EOB9A11en+

col6DMH6SDM6/O+6ppend

&e0uests f or the pass'throu!h

records f or /O+s

et6DMH6S-$

cr6DMH6SDM6/O+6ppend dmh6i0m!r6EMS

&etrieves the /O+s pass'throu!h records f rom data)ase

et6DMH6S-$

ewc6dmh6S-$

dmh6i0m!r6EMS

dmh6i0m!r6SS6EMS

&etrieves t he /O+ data

received from,FS

et6DMH6SDM6/O+

,nternalED+

ommunication

/rrors and9or /*ceptions if any

et6DMH6/&&O&6MS=


o''aboration co#F$6F -$2FE;F)%%endo''aboration u'e crF$6F -$2FE;F)%%end

ub&cri-tion



et$6F-$2FE; etF$6F -$2FE; ecFdmhFiAmgrF$-

$ub'ication


et$6F-$2FE;FEt etF$6F-$2FE;FET ecFdmhFiAmgrF$-

et$6FE55;5F$- etF$6F E55;5F$- ecFdmhFiAmgrF--F$-


he ew6DMH6SDM6/O+6ppend enhances the /O+ record with information fromthe pass'throu!h ta)le to support the !eneration of 3% transactions with appropriate

claim'service line hierarchies that were e*tracted from the 3 transaction. heenhanced /O+ structure contains the claim level details allowin! the service lines to )e!rouped appropriately )efore )ein! answered in the form of remittances.

he MM/ su)scri)es to the et6DMH6SDM6/O+ event that encapsulates the /O+data received from the ,FS.

he S-$ event type et6DMH6S-$ is used to e*tract the pass'throu!h fields for thecorrespondin! service lines. ,f the pass'throu!h data is not found: the /O+ isre>ected and an error messa!e is !enerated.



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$.13 e9DM9SDMC9EOB9So*t

Sends the sorted set of /O+s f or

translationet6DMH6SDM6/O+6/86Sorted

e9DM9SDMC9EOB9So*t

col6DMH6SDM6/O+6Sort

cr6DMH6SDM6/O+6Sortdmh6i0m!r6EMSdmh6i0m!r6EMS

&eceiv es the e*tended /O+s f or

sortin! and translation

et6DMH6SDM6/O+6/8

dmh6i0m!r6SS6EMS


et6DMH6/&&O&6MS=


o''aboration co#F$6F-$2FE;F-ort

o''aboration u'e crF$6F-$2FE;F-ort

ub&cri-tion

In&tance ,vent %y-e ourceet$6F-$2FE;FEt etF$6F-$2FE;FET ecFdmhFiAmgrF$-

$ub'ication


et$6F-$2FE;FEtF-orted etF$6F-$2FE;FETF-orted ecFdmhFiAmgrF$-

et$6FE55;5F$- etF$6F E55;5F$- ecFdmhFiAmgrF--F$-


he ew6DMH6SDM6/O+6Sort eFay sorts the enhanced /O+ records to allow for the!roupin! of service lines into claim remittances.

he col6DMH6SDM6/O+6Sort su)scri)es to the et6DMH6SDM6/O+6/*t eventfrom i0m!r6DMH6EMS: which is the enhanced /O+ file.

he /O+ records are sorted )ased on the claim level information and sent to thedmh6i0m!r6EMS as et6DMH6SDM6/O+6/86Sorted events for actualtranslation.

/rrors and e*ceptions in the eFay colla)oration rule are sent aset6DMH6/&&O&6MS= event to the dmh6i0m!r6 SS6EMS ,- Mana!er for furtherprocessin!.

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$.14 e9DM9SDMC9EOB9To9#3!

Sends the translated 3%set6DMH63%

Pass'throu!h a)le

e9DM9SDMC9EOB9To9#3!

col6DMH6SDM6/O+6o63%

-ueries f or the pass'throu!h

f ields )ased on primary ;eyet6DMH6S-$

cr6DMH6SDM6/O+6o63%dmh6i0m!r6EMS

&etrieves the pass'throu!hrecords

et6DMH6S-$

ewc6dmh6S-$

dmh6i0m!r6EMS

&etrieves the sorted /O+s

et6DMH6SDM6/O+6/86Sorted

dmh6i0m!r6SS6EMS


et6DMH6/&&O&6MS=


o''aboration co#F$6F -$2FE;FToF83 etF$6F-G> ecFdmhF-G>

he ew6DMH6SDM6/O+6o63% eFay is the main wor;horse of the /O+ to 3%translations: involvin! numerous steps and su)'procedures to effectively !enerate 3%

transactions from the SDM /O+ records. n important fact to )e noted at this point isthat the SDM /O+ records contain no information a)out the hierarchical structure inwhich they were initially encoded when they were su)mitted as 3P transactions. hea)sence of any loopin! information ma;es the 3% !eneration a rather cum)ersomeprocedure involvin! !roupin! structures and runnin! counters to !enerate information foreach hierarchical loop.

he MM/ ew6DMH6SDM6/O+6o63% su)scri)es to theet6DMH6SDM6/O+6/86Sorted event: which contains the sorted and enhanced/O+ records.

he /O+ records are transformed into an 3% transaction and the data is sent as aet6DMH63% event for further H,P validation.

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' E**o* an+ln5()al+aton

he DMH H,P ranslator modularly handles )oth )usiness and system errors throu!hits internal events and eFays. H,P validation is handled )y the e8chan!e component:reportin! errors in the form of 55 and 1 transactions.

'.1 IPAA )al+aton

H,P #alidation is performed )y the aciledi en!ine provided )y laredi orporation asa part of the See+eyond e

Seebeyond HIPAA

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