May 18 th 2009 Gateway 5010 Agenda MITA TAC Group Gateway 5010 Goals Gateway 5010 Deliverables Gateway 5010 Architecture Business Services Inquire Member Eligibility Technical Services and Functions ID: 159391
Download Presentation The PPT/PDF document "MITA Gateway 5010 Overview" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
MITA Gateway 5010 Overview
May 18
th
2009Slide2
Gateway 5010 - Agenda
MITA TAC Group
Gateway 5010 Goals
Gateway 5010 Deliverables
Gateway 5010 Architecture
Business Services
Inquire Member Eligibility
Technical Services and Functions
Connectivity - CORE Service
Eligibility Adapter
Authentication & Authorization
Auditing
Prototype
Next StepsSlide3
MITA TAC Group
Recommends technical standards for use within
MITA
Made up of states and leading healthcare vendors
Ensure MITA aligns with industry standards and
direction
Creates working prototypes and proof of conceptsSlide4
Gateway 5010 – Goals
Align TAC committees to real working projects
Collaborative development of one MITA business
service
and associated technical services
Iterative approach going from very simple to
complex
interface
Publish recommendations to the TARB
Deliver real solution sets
Recommend rules for interoperability
Identify and integrate with other industry
initiatives
HITSP, HL7, OASIS, WS-I …….Slide5
PowerPoint has new layouts that give you more ways to present your words, images and media.
Gateway 5010
Architecture
Gateway 5010 OverviewSlide6
Gateway 5010 – Deliverables
Publish recommendations to the TARB on details
of
the MITA technical architecture
Deliver s
olution sets that will allow any CORE
compliant
provider to conduct eligibility inquires with any MMIS that deploys the solution set
Create technical service(s) in the Gateway suite of technical services that will allow MITA to exchange standards based data
A development community that has been educated on building MITA based systemsSlide7
Gateway 5010 – Architecture
Provides pathway for implementing new X12 5010 Standard
Includes use of a MITA business service
Inquire Member Eligibility
Includes use of MITA technical services and
functions
Connectivity – CORE Service
Translator – Eligibility Adapter
Authentication
AuthorizationAuditingSlide8
Gateway 5010 – ArchitectureSlide9
Gateway 5010 – ArchitectureSlide10
Inquire Member Eligibility Service (IME)
Business Service from the MITA business model
Interface developed iteratively
S1M1 – Simple interface using Member Id
S1M2 – Interface has some complex objects e.g. returns a list of benefits
S1M3 – Interface has complex and more complete
objects
e.g. more benefit and healthcare provider data
S1M4 – Interface uses some HL7 base objects to define data such as address and provider
Incorporating HL7 objects in the data schema definitionDeveloping standard WSDL to be used by all implementersSlide11
Inquire Member Eligibility –
Data ModelSlide12
Inquire Member Eligibility – OverviewSlide13
CORE Service
Developed by CAQH
Widely used within the Healthcare industry
Adopted as a HITSP standard – HITSP-T85
Provides communication via a web service or MIME Multipart
Supports real time and batch processing
Interface will be implemented iteratively - 3 options for SOAP/HTTP(S) implementation
S2M1 – Uses username and password (unencrypted)
S2M2 – Uses username and password (encrypted)
S2M3 – Uses certificates for authenticationOne option for the MIME Multipart implementationS2M4 – Uses username and passwordSlide14
CORE Service – Real Time ModelSlide15
CORE Service – Batch ModelSlide16
Inquire Member Eligibility Adapter
Technical service that transforms an X12 270
request
into a MITA compliant message and
transforms
a MITA compliant response into an X12 271 response
Will be able to communicate with multiple
Eligibility
systemsSlide17
IME Adapter – ModelSlide18
Gateway 5010 – CMS TARB Artifacts
For each technical and business service
the following
artifacts will be generated and submitted
Business or Technical template describing the
service
UML Model of the service
The data schemas (XSD) and Web service Definition Language(WSDL) for the service
Document describing how the service worksSlide19
Gateway 5010 - Prototype
Based on an existing Eligibility system in production
The front end application was modified to call the
CORE
Service for connectivity
The CORE Service calls the Eligibility Adapter
Translates the 270 request into MITA compliant request
Translates MITA compliant response into a 271 response
The Eligibility Adapter calls the MITA compliant
Eligibility ServiceThe Eligibility Service retrieves that data from the eligibility database or legacy system.Slide20
IME Activity DiagramSlide21
Gateway 5010 – Next Steps
Complete the interface specification for Inquire
Member
Eligibility
Create a package of IME artifacts for the TARB
review
TAC members to implement the published IME
interface
Show a demo of IME at the MMIS conference in
August 2009Slide22
Gateway 5010 - Questions