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2017-05-16

B2B Integration Solution Design Template – Automated Electronic Carrier Process for HIPAA 834 data transmissions

Suppose a Healthcare Benefits Service Provider “ACME Software” is seeking to streamline the maintenance and execution of the electronic carrier feed process of HIPAA 834 files as part of its insurance benefits solution.

The proposed solution is a high-level draft that walks-thru the steps of configuring Adeptia as an EDI Gateway.

The solution built on Adeptia Solution (AS) involves two types of users:

A. Customer Users: Allow customer users to login to the Adeptia Solution as business users and perform various activities such as

  • Manage and modify Transactions (based on user permissions)
  • Manage and modify Data Maps (based on user permissions)
  • Configure outbound data feed rules for a trading partner
  • View transaction history
  • Edit and Resubmit corrected data via workflow tasks
  • View Reports

B. Developer Users: Allow ACME Software developers to login to the Adeptia Solution to build and manage data feeds to different carriers (trading partners) on behalf of its customers. In this component, ACME Software can

  • Automate the rules on running jobs and create output data files for trading partners
  • Design orchestrations for various trading partners and also reuse existing process and mapping templates
  • Implement maps for X12 834 and non-EDI formats
  • Manage services such as maps, triggers and reports

Adeptia Solution is a single installer package that can be installed in the cloud or on-premise (see proposed AWS deployment in the above section). The solution configured in AIS allows ACME Software to define the process of creating an output HIPAA 834 file consists of following parts:

  • Database extraction rules per partner
  • Implement mappings or reuse of an existing HIPAA 834 mapping template
  • Create a process that would generate an output file based on the data extraction rules and the mapping
  • Specify the target location of the trading partner

Adeptia Solution also allows developers to configure outbound relationships for sending the output file to a trading partner and to allow customers to access, view and modify transactions as per user permissions controlled by ACME Software.

Deployment of Adeptia application

Deployment Type: Dedicated AWS environment for ACME Software.

Adeptia would configure and install all the components needed for the installation.

Deployment of Adeptia application

Solution

We will focus on configuring the services needed for creating outbound EDI files. Adeptia Solution is a web-based developer studio that is based on SOA framework. Developers configure services and reuse services as part of developing process flows. Services include database extraction rules, mappings, source/targets, APIs, and process flows that bind all the services together to produce output files.

Adeptia is a multi-tenant application where ACME Software can create a Group per Customer and these are siloed tenants that only see their transactions and trading partner setups.

Services in Integration Suite

Let’s first address the data extraction rules needed to fetch data from MS SQL database for a trading partner. In this section we will discuss how to configure the pointer to the Source database and selecting the tables. We call this “Database Schema Service” which allows users to specify the Tables. We have decoupled the schema from the “select” query logic. This allows us to use the same Database Schema Service and then apply the “select” logic independently based on the trading partner or customer.

Database Extraction Service 

Data extraction services configured in the Integration Suite are:

1. Database Schema Service 

a. Endpoint of the Database location (Dev, Sandbox or Prod)

b. Selection of tables or Views needed for fetching the data

c. Joins: Parent/Child table relationships (this is a logical relationship among tables)

2. Database Source Service (Select Queries)

a. Select queries to be applied on the “Database Schema Service” in order to get the specific data for the trading partner

b. Parameterized queries based on Trading Partner ID and other parameters can be used in the query logic so that the data extraction is “templatized” and dynamically produces source data per trading partner. 

Data Extraction services are managed through a central repository. Users can apply version control on any service and also modify an existing service.

B2B Integration Solution Design Template – Automated Electronic Carrier Process for HIPAA 834 data transmissions
Adeptia Database Schema Service manage page.
Selection of Database Tables for extract data in order to generate HIPAA 834 files
Selection of Database Tables for extract data in order to generate HIPAA 834 files.

Database Source queries

Database Schema defines the endpoint and the tables needed to fetch data per trading partner. In order to provide a specific trading partner query, user creates a separate service “Database Source” and provides the specific logic of extracting the data from the schema that is defined above. Thus you can reuse a schema and apply different extraction logic (in queries) without having to re-define the schema each time.

Source database queries that can be parameterized and runs on the schema defined in the previous step
Source database queries that can be parameterized and runs on the schema defined in the previous step.

Mapping Service

Mapping can be based out of a template map that is reused for majority of the trading partners or it is modified with unique data translation rules specific to a trading partner. In Adeptia, user configures a mappings to generate HIPAA or EDI X12 834 by using a graphical data mapper interface.

Adeptia bundles the X12 data dictionary for 834 Benefit Enrollments. This allows the developer to create a map between the source data and the output X12 834 file as shown in the image below.

Mapping service provides capabilities:

  • Supports Drag and Drop mapping
  • Supports graphical functions for non-technical users
  • Web UI interface
  • Syntax and business rules validation
  • Ability to show errors during validation
  • Supports testing, debugging and run tests with sample data
  • Preview transformation results inside a map
  • Ability to work with large files > 1MB efficiently
  • Supports multiple sources and targets in single map
  • Ability to run Java inside a map
  • Ability to run SQL and stored procedures inside a map
  • Ability to make database calls inside a map
  • Encoding support for Unicode, EDIX12EDIFACT, UTF-8/16 or other
  • Supports many data formats such as XML, Database, Cloud Apps, ERP, CRM, CSV, Excel or other
  • Supports conditional and rules-based mapping
  • Interface auto-generates a Mapping Document in PDF
  • Ability to write custom XSL
  • Supports Axis functions
  • Supports value maps for cross-reference lookups
  • Supports versioning with check-in and check-out
B2B Integration Solution Design Template – Automated Electronic Carrier Process for HIPAA 834 data transmissions
Adeptia Data Mapping for HIPAA 834 Benefits Enrollments

Target Service

Target Service represents the location of the output file that will be placed in a destination as per the trading partner location. This location can be SFTP, FTP, Email or other protocols.

We recommend using standard file naming conventions for the file that contains the Partner ID and any additional parameters such as date/time stamp.

Trading Partner target SFTP location
Trading Partner target SFTP location.
Conceptual view of the Services configured to create the HIPAA 834 process
Conceptual view of the Services configured to create the HIPAA 834 process.

Setting up Trading Partners

In Adeptia, ACME Software developer can setup Trading Partners under each Tenant group and define the outbound relationships for each trading partner. Outbound Relationships consist of the services configured in the previous steps. Each Outbound Relationship consists of:

  • Source Database Event that would extract the data for a trading partner based on the schema and the extraction logic defined in the Schema and Source services. This can also be a scheduled event such as batch job.
  • Mapping service that takes the data from the database and maps to the X12 834 or other non-EDI standards
  • Target location where the file needs to be sent
  • Adeptia automatically sends 997 or 999 to the trading partners for inbound transactions
  • Users can also configure an outbound batch job that aggregates all the individual EDI messages into a single file prior to transmitting it to the trading partner

Developers can setup multiple outbound relationships for each Trading Partner. Since the application is multi-tenant, customers logging into Adeptia would only see their trading partners, B2B Dashboard and B2B Reports.

ACME Software can monitor the transactions globally to view and track all the transactions and also enable archiving to see historical data transfers.

Adeptia can also push data via APIs to the trading partners. Adeptia provides full publish/subscribe model for customers to pull or push payloads to carrier web services.

Below are the screenshots of the Trading Partner Management portal in Adeptia Solution and a sample Outbound Relationship.

Centralized repository of Outbound EDI Relationships in Adeptia

Centralized repository of Outbound EDI Relationships in Adeptia
Centralized repository of Outbound EDI Relationships in Adeptia.

Tracking & Monitoring Dashboards

Customers can login and can view the dashboard, view or edit data via workflow tasks that can be enabled for business users and AS also allow them to modify maps. ACME Software controls the customer user experience.

Here are some screenshots of how the customer user can view B2B dashboard and runtime transactions.

In Adeptia, users can go to the Trading Partner Management portal and create multiple trading partners and configure both inbound and outbound transactions. The Trading Partner Management portal is a centralized repository that shows the number of configured trading partners and their inbound/outbound relationships (as shown below).

B2B Dashboards and Logs allow users to monitor and track all inbound and outbound EDI data transmissions
B2B Dashboards and Logs allow users to monitor and track all inbound and outbound EDI data transmissions
B2B Dashboards and Logs allow users to monitor and track all inbound and outbound EDI data transmissions.

Adeptia provides a rich dashboard capability that shows the transactions based on volume, trading partners and message types. Users can also create custom reports in PDF and Excel. In addition to the reports, users can search B2B logs based on key fields such as Plan Number, Policy Number, Partner Number, Enrollment ID, Insured Name, and or any other custom fields.

Summary

Adeptia Solution provides a full EDI Gateway capability along with a robust API publish/subscribe framework. For more information, please contact [email protected]