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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 ARC ITECTURE ..................................................................................3 4.1 Overview ............................................................................................................. 3 4.2 omponent Or!ani"ation and Schemas...............................................................3 4.2.1 Layered System Architecture............................................................................3 4.3 #iew $ayer...........................................................................................................% 4.3.1 e*Gate Enterprise Manager..............................................................................5 4.3.2 e*Gate Editors..................................................................................................5 4.3.3 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.. 1pplication onnectivity $ayer.............................................................................. ! BASIC DESI"N............................................................................................................ # %.1 ,ntroduction .........................................................................................................2 %.2 DMH H,P11 3ranslator Data 4low Description....................................................5 %.3 DMH H,P11 3ranslator System Desi!n ............................................................11 %.4 DMH H,P11 3ranslator omponents.................................................................13 5.4.1 E'ent (ypes and E'ent (ype )e*initions........................................................13 5.4.2 +nte""igent ,ueues -+,s. and +, Managers (a&"e...........................................14 5.4.3 e*/ay !onnections........................................................................................14 5.4.4 e*/ays and !o""a&orations............................................................................15 5.4.5 !o""a&oration u"e Scripts..............................................................................10 $ DETAI%ED DESI"N....................................................................................................2& (.1 (.2 (.3 (.4 (.% (.( (.. (.2 (.5 (.17 ew6DMH623.P63o6SDM ...............................................................................27 ew6DMH623.,63o6SDM .................................................................................21 ew6DMH6e86ePM.............................................................................................22 ew6DMH6e86ePM6+atch..................................................................................23 ew6DMH6e86Https64rom63P...........................................................................24 ew6DMH6e86Https63o63P...............................................................................2% ew6DMH6Poll6&eceive6Https...........................................................................2( ew6DMH6e86&outer.........................................................................................2. ew6DMH6Process6/rrors..................................................................................25 ew6DMH6Process6&eports.............................................................................37

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(.11 (.12 (.13 (.14 ..1 ..2

ew6DMH6&outer..............................................................................................31 ew6DMH6SDM 6/O+61ppend......................................................................33 ew6DMH6SDM 6/O+6Sort............................................................................34 ew6DMH6SDM 6/O+63o623%......................................................................3% AND%IN"()A%IDATION.............................................................................3$ H,P11 #alidation ...............................................................................................3( +usiness and System /rrors..............................................................................3(

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

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1 Int*o+,-t.on
3he purpose of this document is to hi!hli!ht the desi!n architecture of the flow of 812 23.: 55. and 23% messa!es for the DMH H,P11 3ranslator system. 3his document aims 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 mainly outlinin! the processes involved in the See+eyond e<=ate and e<8chan!e applications. 3his document will thorou!hly detail the confi!uration and connectivity of the See+eyond e<=ate and e<8chan!e components. Messa!e and data flows )etween the e*ternal components and the See+eyond components will )e illustrated in various dia!rams. 3his document itself does not descri)e the H,P11 23.P: 23., or 23% transactions in detail. 3he details a)out the H,P11 standards can )e found in the accompanyin! ompanion =uide. 3his document will not provide a tutorial or an overview: or hi!hli!ht the virtues of the e<=ate and e<8chan!e applications. 3his document addresses the followin! four different processes involved in the pro>ect? ,n)ound process? 3his process consists of the 812 23.< Healthcare laim transaction flow from the 3radin! Partners via H33PS to the DMH H,P11 3ranslator: transaction validation: archival: routin!: and delivery of the proprietary standard document to the Short'Doyle Medi' al System @SDM A. Out)ound process? 3his process is concerned with the retrieval of proprietary /*planation of +alances @/O+sA from the SDM system: archival and routin! via e8chan!e: transformation to 812 23% Health are 1dvice9&emittance: and delivery for retrieval )y the 3radin! Partners. 3his process also deals with the creation and routin! of 812 55. and 311 transactions via e8chan!e in response to the in)ound 23. transactions. #alidation Process? 3he validation process is concerned with the validation of )oth in)ound and out)ound transactions to ensure H,P11 compliance. 3he validation is primarily handled )y the 4aciledi and e8chan!e components. /rror handlin! and reportin! processes? 3his process deals with error handlin!: system reportin!: and other common services that can )e used9re'used across different pro>ects.

Throughout this document, an 837 refers to both 837P and 837I transactions. Page 1 &elease Date?192292714

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2 A-*on/0s an+ Te*0 Def.n.t.ons


3hese 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*Gate components. 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 files with the e"tension .xts to do the actual data manipulation. An application within the $ee%eyond e%usiness &nte'ration $uite that is used to set up and maintain Tradin' (artner profiles and view processed messa'es. e*)chan'e also processes inbound and outbound messa'es accordin' to certain e%usiness protocols and your validation Collaborations. e*)chan'e also provides pre*built #ava validation rules for the nine standard transaction sets that are Claredi compliant. +ata to be e"chan'ed either within e*)chan'e or between e*)chan'e and e"ternal systems which has a defined data structure, for e"ample a known number of fields with known characteristics and delimiters. Events are classified by type usin' Event Type +efinitions. An Event Type template definin' Event fields field se-uences and delimiters. Event Type +efinitions enable 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' a messa'e structure script file. .aciledi is a Claredi product that tests inbound and outbound )/0 transactions for 1&(AA compliance. &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 definition associates the validation Collaborations that are needed to validate each kind of messa'e. $u#ti&$ode e'a(. ) f#e*ib#e mu#ti&threaded t(%e of e'a( that uses e'a( connections as its interfaces. The "unctiona# )c+no,#edgment Transaction -et, ..7, has been designed to a##o, Tradin' (artners to estab#ish a com%rehensi/e contro# function as a %art of their business e*change %rocess. There is a one& to&one corres%ondence bet,een a ..7 and a functiona# grou%. -egments ,ithin the ..7 can identif( the acce%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*1change 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' (artner can determine if the recei/ing Tradin' (artner has recei/ed )-2 113 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. -ee7e(ond. &n )/0 a TA/ is an interchan'e acknowled'ement. The TA/ acknowled'ment verifies the interchan'e envelopes only. The TA/ is a sin'le se'ment and is uni-ue in the sense that this sin'le se'ment is transmitted without the G$2GE envelope structures. A TA/ acknowled'ment can be included in an interchan'e with other functional 'roups and transactions. 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 people you want to contact are e"amples of information you enter for a Tradin' (artner component. &n )/0 each business 'roupin' of data is called a transaction set. .or e"ample a 'roup of benefit enrollments 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 the city 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 can be conveyed from one computer to the other. An analo'y would be that the transaction set is like a frei'ht train, the se'ments are like the train6s cars and each se'ment can contain several data elements in the same way that a train car can hold multiple crates. $pecifically in )/0 the transaction set is comprised of se'ments $T throu'h $E. Trading Partner

e*Xchange Partner Manager (e*Xchange) Event (Message) Event Type Definition (ET ! "aci#edi $essage %rofi#e

$$E 99

-789 T!"

Tra#ing Partner profile co$ponent Transaction set

TP

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3 Ass,01t.ons
a. -ee7e(ond ,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;7 ,i## be used to bui#d the outbound 83< ,ithout an( conditiona# %rocessing to determine ,hen=if certain data shou#d be returned. b. e*1change >ogica# name (Pro/ider 9ame node of ET ?s!@ 7efore Trading Partner %rofi#es can be entered into e*1change, a format for the #ogica# name fie#d is reAuired. c. -ee7e(ond ,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*-2.te-t,*e
3his section !ives an overview of the !eneral operation: structure: and architecture of the e<=ate system. ,n addition: it descri)es the systemBs )asic components.

4.1

O3e*3.e4

3he )asic purpose of e<=ate is to move data from one point to another. 3he e<=ate system has the followin! )asic features? Distri)uted 1rchitecture? e<=ate uses a distri)uted architecture that is open and fle*i)le: allowin! components to reside on different wor;stations within a !lo)al networ;. /ffective ommunication? e<=ate uses the protocols and adapters you choose. 3hese allow e<=ate to communicate with and lin; multiple applications9data)ases across different operatin! systems. #ersatile Performance? e<=ate can function with a lar!e num)er of hardware: messa!e standards: operatin! systems: data)ases: and communication protocols. Multi'mode Operation? e<=ate operates in )oth real'time and )atch9scheduled inte!ration modes. onvenient +rid!es? e<=ate can )rid!e )etween older and newer systems: resultin! in a centrally mana!ed and unified enterprise. 3he different components of an e<=ate system do not have to reside on the same machine. ,nstead: it is possi)le to distri)ute them across various machines in a total networ;.

4.2

Co01onent O*5an.6at.on an+ S-2e0as

e<=ate system components can )e or!ani"ed into confi!urations called schemas. e<=ate allows the set up of as many customi"ed schemas as needed: to or!ani"e and to maintain the system efficiently.

4.2.1

Layered System Architecture

3he e<=ate system has a layered architecture: as shown in 4i!ure 1 )elow.

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Figure 1 : e*Gate Integrator Layered Architecture

1s shown in 4i!ure 1 a)ove: e<=ate architecture consists of the followin! functional layers? #iew

ontrol +usiness rules and data processin! ,ntelli!ent 0ueuin! 1pplication connectivity

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4.3

).e4 %a/e*

3he #iew layer contains those components with which you interactCthe e<=ate user interfaces. Most #iew layer components implement !raphical user interfaces @=D,sA to simplify their use. 3he system contains the followin! types of =D,s and viewin! features? e<=ate /nterprise Mana!er

e<=ate editors Monitorin! features 4.3.1 e*Gate Enterprise Manager

3he e<=ate /nterprise Mana!er is used to create and confi!ure the components of the e<=ate system. Dsin! the e<=ate /nterprise Mana!er window: you can define and maintain your confi!uration schemas. 4.3.2 e*Gate Editors

1ll e<=ate systems have editor =D,s that you can use to set up: view: and revise each element in the system. 3he e<=ate editors include? See+eyond Eava /vent 3ype Definition @/3DA /ditor

See+eyond Mon; /vent 3ype Definition @/3DA /ditor See+eyond Eava olla)oration &ules /ditor See+eyond Mon; olla)oration &ules /ditor See+eyond olla)oration',D &ules /ditor e<Fay /ditor 4.3.3 Monitoring Features

e<=ate contains the followin! =D, and other viewin! features to help you with system monitorin!: control: and maintenance? e<=ate Monitor

e<=ate 1lert 1!ent confi!uration tool e<=ate SGMP 1!ent

4.4

Cont*ol %a/e*

3he ontrol layer carries out the followin! e<=ate operations? Stores and distri)utes all system confi!uration information

Starts up and shuts down e<=ate processes /nforces access control mechanisms 4orwards alert: status: and confi!uration messa!es to the correct a!ents

ontrol layer components include? e<=ate &e!istry: includin! the &e!istry Service ontrol +ro;ers 4.4.1 e*Gate egistry

3he e<=ate &e!istry?

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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 4orwards any updates to appropriate clients as necessary o o /mploys a 3eam &e!istry concept that divides the &e!istry into? &un'time environment Sand)o* area for user'specific file development 4.4.2 !ontro" #ro$ers

3he ontrol +ro;er component in a schema? Starts and stops processes Selectively forwards alert: status: and confi!uration messa!es to the appropriate =D,s &outes operational /vents to scripts that help perform )asic maintenance or administrative actions

4.!

B,s.ness R,les an+ Data P*o-ess.n5 %a/e*

3he +usiness &ules and Data Processin! layer uses olla)oration &ules and olla)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? 3hey specify the details of how applications wor; to!ether: for e*ample: usin! data identification and transformation rules. Hou 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: . 3he e<=ate olla)oration Services interface with other lan!ua!es allowin! you to define )usiness rules usin! non'e<=ate tools. 4.5.2 !o""a&orations

olla)oration components allow you to? Define data mappin! from n input /vents to m output /vents usin! olla)oration &ules Define how systems 0uery data)ases in response to re0uest /vents: for e*ample: how 1P,s: havin! one or more applications: can re0uest coordinated action.

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Figure 2 : e*Way Organization

4.$

Intell.5ent 7,e,.n5 %a/e*

3he ,ntelli!ent -ueuin! layer provides for data 0ueuin! functions. e<=ate ,ntelli!ent -ueue @,-A components aid in data communication as follows? ,-s continuously record /vent'state information. 3his process ensures that the ri!ht data !oes to the ri!ht places: in the correct se0uence: and without duplication: even after hardware failures. ,-s support the pu)lish'and'su)scri)e @pu)9su)A processin! in e<=ate as follows? o o Pu)lisher omponents send /vents to ,-s Su)scri)er omponents receive 0ueued /vents

Speciali"ed ,- features help in e<=ate 0ueuin! as follows? ,- Mana!ers reor!ani"e ,-s: archive ,- information: and loc; ,-s for maintenance. ,- Services provide the transport of components within ,-s: handlin! low'level data e*chan!e operations. ,n addition to the See+eyond Standard ,-: e<=ate supports a num)er of different ,types: for e*ample: Eava Messa!in! Service @EMSA: memory loop')ac;: Sy)ase: and Oracle.

4.'

A11l.-at.on Conne-t.3.t/ %a/e*

3he 1pplication onnectivity layer consists of one or more e<Fays and optional +usiness O)>ect +ro;er @+O+A components. e<Fay components are the points of contact )etween e<=ate and )usiness applications. e<Fays esta)lish connectivity with e*ternal )usiness applications: utili"in! the appropriate communication protocols. Hou can use e<Fays for the followin! purposes? onnectin! e*ternal )usiness applications with the e<=ate system: while communicatin! with )oth e*ternal applications and ,-s &eceivin! unprocessed data from e*ternal components: transformin! it into /vents: and forwardin! it to other components within e<=ate via ,-s Sendin! processed data to e*ternal systems

,nte!ratin! different applications: usin! the appropriate e<Fay as an adapter on each end of the route to ena)le seamless /vent flows

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! Bas.- Des.5n
!.1 Int*o+,-t.on
3his section represents the )asic flow of data )etween components. 4i!ure 3 )elow shows the )asic flow of data: startin! at the 3radin! Partner and flowin! via H33PS into See+eyond e<8chan!e and e<=ate eventually endin! up in SD9M . 3his section also )riefly addresses the eFays: eFay connections: colla)orations: colla)oration rules: and the pu)lications and su)scriptions re0uired for processin! the 23. in)ound and 23% out)ound transactions of the DMH H,P11 3ranslator pro>ect. 3his document will not descri)e each component availa)le in e<=ate and e<8chan!e unless that component is directly in the process flow or is a component that re0uires modification to ma;e it wor;.

Figure 3 : Overview o !"# #I$AA %ran&'ator

4i!ure 3 also illustrates the position of the See+eyond e<=ate system in the DMH claims processin! system. 3he presence of the e<=ate ,nte!rator and the e<8chan!e Partner Mana!er )etween the 3radin! Partners and the Short'Doyle Medi' al System facilitates scala)ility and fle*i)ility of the communication channels to )e used. ,n short: the 3ranslator acts as a front'end to DHSB le!acy SD9M system without affectin! e*istin!

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processes and procedures: rather enhancin! the le!acy system to accept and process 812 H,P11 standard claims. 3his presents a transparent processin! layer for the 3radin! Partners: ena)lin! them to use e*istin! communication channels even for H,P11 transactions. 3he flow of data is controlled )y e<=ate only to a certain e*tent allowin! 3radin! Partners to send and receive data in the proprietary formats without affectin! any e*istin! functionality and )usiness processes. 3his allows the 3radin! Partners to !radually mi!rate into the H,P11 realm from the proprietary formats in order to comply with federal re!ulations. DMHBs ,3FS plays a prominent part in the DMH H,P11 3ranslator )y actin! as a hu) for all data transfer )etween the 3radin! Partners and the 3ranslator. ,3FS uses e*istin! folder structures and we) interfaces to accept and present H,P11 data to 3radin! Partners. ,t also performs pre'processin! in order to tri!!er the 3ranslator via a tri!!er ta)le: allowin! the translator to 0ueue and process transactions almost interactively.

!.2

DM

IPAA T*anslato* Data Flo4 Des-*.1t.on

3he DMH H,P11 translator uses an advanced 0ueuin! system to transfer and hold transactions for entire duration of the claims processin! cycle. 3he flow data )etween 3radin! Partners: ,3FS: 3ranslator and the Short'Doyle system are illustrated in 4i!ure 4 )elow. 3his dia!ram enhances the Hi!h'$evel 1rchitecture dia!ram @4i!ure , in the followin! document? 2 ' Physical H,P11 3ransactions 1rchitecture Model@1.7A ' DMH.docA and illustrates the complete cycle of claims startin! from the 23.P all the way throu!h the !eneration of the 23%. 3he red arrows illustrate the flow of data in the form of claims and remittances: the )ro;en arrows indicatin! intermediate outputs of the system. 3he dia!ram illustrates: from the point of view of the 3radin! Partner: the processes and systems involved for processin! payments )ased on the su)mitted H,P11 claims. 1 more detailed description of the steps involved in the flow of data is !iven )elow? 1. 3radin! Partners upload 812 H,P11 23.P files to the assi!ned ,3FS folder via its we) interfaces. 2. Dsin! secure H33P protocol: the translator retrieves the 23.P file sends it to e8chan!e for further validation and processin!. 3. 3he e8chan!e component of the 3ranslator uses 4aciledi to validate the data for H,P11 compliance. a. ). c. 1 55. ac;nowled!ement file containin! the validations results is !enerated )y e8chan!e. 3he 55. file is almost instantly transferred to the appropriate ,3FS folder. 3radin! Partners can view and download the 55. file throu!h the ,3FS we) interface.

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1. 3c.

3radin! Partner

1!.

5a.

,3FS4older

,3FS4older

,3FS4older

1&.

,3FS4older

2.

3).

14.

H33PS4rom ,3FS

H33PS3o ,3FS

H33PS4rom ,3FS

H33PS3o ,3FS

3.

13.

4acilediv ia e8chan!e

3a.

8.

11.

e8chan!e

4.

3ranslate 23.P and 23.,

!.

H33PS3o ,3FS

3ranslate 23% eFay

$.

,3FS4older

DMH DSS

'. #. DHSSDM 12.

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

4. 3he 23.s are sent to a core e<=ate components for translation that encapsulates all the )usiness rules needed for convertin! H,P11 claims to proprietary ones. %. 3he translated claims files are sent to an out)ound component that uses

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H33PS to transfer it to ,3FS 4olders. (. 3he claim files are then sent to Short'Doyle Mainframe system after performin! some pre'edits and )atchin!. .. 3he Short'Doyle Mainframe system receives the files from ,3FS and performs the needed claims ad>udication )efore !eneratin! the /O+. 2. 3he /O+ files are sent to the DMH Decision Support System where they are separated )y county and service month. 5. a. 3he /O+s are placed in the appropriate ,3FS folders. 3radin! Partners view and download the /O+ files. Steps 1 throu!h 5 illustrate the translation of the 23. to the /O+ while Steps 17 throu!h1% descri)e the creation of the 23% from the /O+. 17. 3he 3ranslator is tri!!ered once more with the relevant details indicatin! the presence of an /O+ file re0uirin! translation. 11. 3he /O+ file is transferred to the 3ranslator via secure H33P where the core 3ranslator component performs a num)er of steps to !enerate the 23% file with the appropriate hierarchies encoded. 12. 13. 3he 23%s pass throu!h e8chan!e for )atchin!. 1n out)ound component pic;s up the )atched 23% file.

14. 3he appropriate ,3FS folder is populated with 23% file correspondin! to the e*istin! /O+ file. 1%. 3he 23% file can )e viewed and downloaded )y the 3radin! Partners. 3he complete cycle from the transmission of the 23. to the !eneration of the 23% involves numerous systems: which ma;es it difficult to estimate the turnaround time for the claim.

!.3

DM

IPAA T*anslato* S/ste0 Des.5n

3he DMH H,P11 translator is a modular event'driven system with each component playin! an important part either in the transmission: control: or in the actual translation itself. 3he desi!n for the translator: in the form of a Schema in See+eyond terminolo!y: is shown in 4i!ure % )elow. 1ll the components of the translator includin! eFays: eFay onnections: ,ntelli!ent -ueues: and messa!es e*chan!ed )etween the components are shown. More detailed descriptions of the individual eFays and the rules that are em)edded in them are !iven in Section ( )elow.

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

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!.4

DM
5.4.1

IPAA T*anslato* Co01onents


E'ent (ypes and E'ent (ype )e*initions

E3ent T/1es 3his ta)le lists all the event types used )y the DMH H,P11 3ranslator. /vents are identified and handled )y their names. 3he ta)le contains all the event types that are e*chan!ed )etween the components. ertain events can )e associated with structures at run'time itself: allowin! them to have no structure at definition.
*a+e DDDDDDDD 9otification EenericInE/ent Eeneric;utE/ent e1F7atch e1FError e1FE*terna#FE/t e1F6TTP e1F6TTPe1F6tt%2#ient e1F-$PT e1FT2PIP e1FTransactionFPo## e1FfromFTradingFPartner e1FtoF$u* e1FtoFTradingFPartner e1FtoFe7P$ e1FtoFeP$ etF $6F83< etF $6F837P etF $6FE$)I>F$-E etF $6FE55;5F$-E etF $6F"5;$FTP etF $6FEE9E5I2FEHT etF $6F6TTPF"5;$FTP etF $6F6TTPFT;FTP etF $6F6TTPF5EG etF $6F5EP;5TF$-E etF $6F- $2F2>)I$ etF $6F- $2F2#aimF"i#e etF $6F- $2FE;7 etF $6F- $2FE;7FE1T etF $6F- $2FE;7FE1TF-orted etF $6F-G> etF $6F-G>FP;>> etF $6FFT;FTP A&&ociated ,%! E/ent$sg.ssc 9otification.scc EenericInE/ent.ssc Eeneric;utE/ent.ssc e1F-tandardFE/ent.ssc e1F-tandardFE/ent.ssc e1F-tandardFE/ent.ssc e1F-tandardFE/ent.ssc 6tt%c#ient.ssc e1F-tandardFE/ent.ssc e1F-tandardFE/ent.ssc e1F-tandardFE/ent.ssc e1F-tandardFE/ent.ssc e1F-tandardFE/ent.ssc e1F-tandardFE/ent.ssc 113FDDBD1D1.8)1FDDFhi%aaG1F837F6ea#2are2#ai.*sc $ai#c#ient.*sc etF $6FE55;5F$-E.*sc etF $6FEE9E5I2FEHT.*sc

etF etF etF etF etF etF

$6F6TTPF5EG.*sc $6F5EP;5TF$-E.*sc $6F- $2F2>)I$.*sc $6F- $2F2#aimF"i#e.*sc $6F- $2FE;7.*sc $6F- $2FE;7FE1T.*sc

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

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E3ent T/1e Def.n.t.ons 3his ta)le lists all the event type definitions for DMH H,P11 and !ives a )rief description of each.
*a+e E/ent$sg.ssc 9otification.scc e1FstandardFe/ent.ssc 6tt%c#ient.ssc 113FDDBD1D1.8)1FDDFhi%aaG1F837F6ea#2are2#ai.*sc $ai#c#ient.*sc etF $6FErrorF$sg.*sc etF $6FEE9E5I2FEHT.*sc etF $6F6TTPF5EG.*sc etF $6F5EP;5TF$-E.*sc etF etF etF etF $6F- $2F2>)I$.*sc $6F- $2FE;7.*sc $6F- $2FE;7FE1T.*sc $6F-G>.*sc !e&cri-tion

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

E/ent t(%e definition for e*changing data ,ith e*1change. It contains nodes such as Partner 9ame, irection, Pa(#oad, etc. The -ee7e(ond standard ET used for 6TTP communication This e/ent defines the structure of the 113 6IP)) 837P transaction. Emai# message structure The error message structure used in the $6 6IP)) Trans#ator. Error messages from different e'a(s are routed and hand#ed a%%ro%riate#( using this structure. ) generic mu#tifunction e/ent structure ,ith a sing#e %a(#oad node, ) sim%#e e/ent t(%e for enca%su#ating the information for retrie/ing a ne, fi#e This e/ent t(%e is used for gathering re%orting data from different e'a(s. The - $2 Pro%rietar( 2#aim format definition The - $2 Pro%rietar( E;7 format definition The E;7 record enhanced ,ith 6IP)) information The e/ent that emu#ates the structures of the tab#es in the Pass&through database The structure of the IT'- Trigger Tab#e

5.4.2

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


%y-e I$IG $anager I$- IG I$- IG I$- IG I$- IG I$IG $anager I$IG $anager !e&cri-tion The IG $anager res%onsib#e for a## the e/ents used bet,een the Trading Partner and e1change IG for storing re0ected transactions IG for storing d(namic 6TTP reAuests generated from Trigger Tab#e entries e1change Aueue for hand#ing messages to and from Trading Partners e1change Aueue for hand#ing messages to interna# business a%%#ications and com%onents IG $anager for hand#ing business %rocess com%onents? e/ents -e%arate IG $anager for recei/ing error and re%orting data from different com%onents

*a+e dmhFiAmgrFe1FI$iAF $6Fe1F eadF>etterFG ueue iAF $6Fe1F (nFInbFhtt%sF Aueue iAF $6Fe1FTradingFPortFG ueue iAF $6Fe1Fe7P$ dmhFiAmgrFI$dmhFiAmgrF-8-FI$-

5.4.3

e*/ay !onnections

e<Fay connections are the interfaces )etween e*ternal systems and See+eyond components. 1ll necessary confi!uration for each e<Fay onnection is defined in this section. 3he specific confi!uration file parameters and values will vary )y the type and re0uirements of the e<Fay onnection
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e*Way .onnection *a+e e,cFdmhFE$)I> e,cFdmhFIT'e,cFdmhFiAmgrFI$e,cFdmhFiAmgrF-8-FI$e,cFdmhFiAmgrFe1FI$e,cFdmhF-G>

.on iguration i'e e,cFdmhFE$)I>.cfg e,cFdmhFIT'-.cfg e,cFdmhFiAmgrFI$-.cfg e,cFdmhFiAmgrF-8-FI$-.cfg e,cFdmhFiAmgrFe1FI$-.cfg e,cFdmhF-G>.cfg

Inbound/Outbo und/ 0idirectiona'

;utbound 7idirectiona# 7idirectiona# 7idirectiona# 7idirectiona# 7idirectiona#

%y-e Emai# 6TTP(-! -ee7e(ond I$-ee7e(ond I$-ee7e(ond I$-G>-E5HE5

5.4.4

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


,1ecutab'e i'e .on iguration i'e Inbou nd/O utbou nd/0o th 7oth 7oth 7oth 7oth 7oth 7oth 7oth 7oth 7oth 7oth 7oth 7oth 7oth 7oth Function

"u'ti "ode e*Way *a+e

e,F $6F837IFToF- $2 e,F $6F837PFToF- $2 e,F $6Fe1FeP$ e,F $6Fe1FE%mF7atch e,F e,F e,F e,F e,F e,F e,F e,F e,F e,F $6Fe1F6tt%sF"romFTP $6Fe1F6tt%sFToFTP $6FPo##F5ecei/eF6tt%s $6Fe1F5outer $6FProcessFErrors $6FProcessF5e%orts $6F5outer $6F- $2FE;7F)%%end $6F- $2FE;7F-ort $6F- $2FE;7FToF83<

binJstce,a(.e*e binJstce,a(.e*e binJstce,generic mon+.e*e binJstce,generic mon+.e*e binJstce,a(.e*e binJstce,a(.e*e binJstce,a(.e*e binJstce,a(.e*e binJstce,a(.e*e binJstce,a(.e*e binJstce,a(.e*e binJstce,a(.e*e binJstce,a(.e*e binJstce,a(.e*e

configsJstce,a(Je,F $6F837 IFToF- $2.cfg configsJstce,a(Je,F $6F837 PFToF- $2.cfg configsJstce,genericmon+Je,F $6Fe1FeP$.cfg configsJstce,genericmon+Je,F $6Fe1F7atch.cfg

Trans#ation Trans#ation Ha#idation Ha#idation Transmission Transmission Trigger 5outing

5outing Trans#ation Trans#ation Trans#ation

3he followin! !ives a listin! of the colla)oration rules that are used )y the a)ove listed eFays. 1 more detailed description of the wor;in! of eFays and the encapsulation of )usiness rules into the eFays is !iven in hapter 4. 3he ta)les )elow show each colla)oration rule and the types of messa!es that it su)scri)es9pu)lishes. Gotification&outin!
Pub#ications 9otification -ubscri%tions DDDDDDDD

cr6DMH6=eneric6Passthru
Instance Ia/aPassThrough;ut Ia/aPassThroughIn ET Eeneric;utE/ent EenericInE/en irection ;ut In

cr6DMH623.P63o6SDM
Instance ET irection

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et et et et et et

$6F5EP;5TF$-E $6F E55;5F$-E $6F- $2F 2#aimF"i#e $6F837P $6F-G> $6F-G>FP;>>

etF $6F5EP;5TF$-E etF $6F E55;5F$-E etF $6F- $2F 2#aimF"i#e 113FDDBD1D1D.8)1FDDFhi%aaG1F837F6ea#t2are2#ai etF $6F-G> etF $6F-G>FP;>>

In In=;ut ;ut ;ut In=;ut In=;ut

cr6DMH623.,63o6SDM
Instance et $6F5EP;5TF$-E et $6F E55;5F$-E et $6F- $2F 2#aimF"i#e et $6F837I et $6F-G> et $6F-G>FP;>> ET etF $6F5EP;5TF$-E etF $6F E55;5F$-E etF $6F- $2F 2#aimF"i#e 113FDDBD1D1D.8)1FDDFhi%aaG1F837F6ea#t2are2#ai etF $6F-G> etF $6F-G>FP;>> irection In In=;ut ;ut ;ut In=;ut In=;ut

cr6DMH6Process6/rrors
Instance et $6F-G> et $6FE$)I>F$-E et $6FE55;5F$-E ET etF $6F-G> mai#c#ient etF $6F E55;5F$-E irection In=;ut ;ut In

cr6DMH6Process6&eports
Instance et $6F-G> et $6F5EP;5TF$-E et $6FE55;5F$-E ET etF $6F-G> etF $6F5EP;5TF$-E etF $6F E55;5F$-E irection In=;ut In=;ut ;ut

cr6DMH6&outer6,n)ound
Instance et $6FEE9E5I2FEHT et $6F5EP;5TF$-E et $6FE55;5F$-E et $6F-G>FP;>> et $6FE1FT;FE7P$ ET etF $6FEE9E5I2FEHT etF $6F 5EP;5TF$-E etF $6F E55;5F$-E etF $6F-G>FP;>> e1F-tandardE/ent irection ;ut ;ut ;ut In=;ut In

cr6DMH6&outer6Out)ound
Instance et $6FE1FT;FEP$ et $6FEE9E5I2FEHT et $6FE55;5F$-E ET e1F-tandardE/ent etF $6FEE9E5I2FEHT etF $6F E55;5F$-E irection ;ut In ;ut

cr6DMH6SDM 6/O+61ppend
Instance et $6F-G> ET etF $6F-G> irection In

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et et et et

$6FErrorF$sg $6F- $2FE;7 $6F 5e%ortF$sg $6F - $2FE;7FE*t

etF etF etF etF

$6F ErrorF$sg $6F - $2FE;7 $6F 5e%ortF$sg $6F - $2FE;7F"i#eFE*t

;ut In ;ut ;ut

cr6DMH6SDM 6/O+6Sort
Instance et $6F - $2FE;7FE*tF-orted et $6F - $2FE;7FE*t et $6F 5e%ortF$sg et $6FErrorF$sg ET etF etF etF etF $6F - $2FE;7F"i#eFE*t $6F - $2FE;7F"i#eFE*t $6F 5EP;5TF$-E $6F E55;5F$-E irection ;ut ;ut In ;ut

cr6DMH6SDM 6/O+63o623%
Instance et $6F-G> et $6FErrorF$sg et $6F 5e%ortF$sg et $6F - $2FE;7FE*tF-orted et $6F 83< ET etF etF etF etF $6F -G> $6F E55;5F$-E $6F 5EP;5TF$-E $6F - $2FE;7F"i#eFE*t irection ;ut ;ut In In=;ut ;ut

113FDDBD1D1D.1)1FDDFhi%aaG1F83<F6ea#2are2#aiPa(m

cr6DMH6e86Https64rom63P
Instance et $6F6TTPF5EG4E-T et $6F"5;$FTP et $6F6TTPF2>IE9T et $6FErrorF$sg ET 0a/a6tt%5eAuest etF $6FEE9E5IHFEHT htt%c#ient etF $6F E55;5F$-E irection ;ut In ;ut ;ut

cr6DMH6e86Https63o63P
Instance 6tt%2#ient e1FtoFeP$F-td et $6FT;FTP et $6FE55;5F$-E et $6F-G>FP;>> ET htt%c#ient e1F-tandardE/ent e1F-tandardE/ent etF $6F E55;5F$-E etF $6F-G>FP;>> irection ;ut ;ut In ;ut In=;ut

cr6DMH6e86Https63o6ePM
e1FE*terna#FE/t e1FE*terna#FE/t e1FE*terna#FE/t e1FE*terna#FE/t

cr6DMH6e86Https6Poll6&eceive6Https
Instance et $6F6TTPF5EG4E-T et $6F-G>FP;>> ET etF $6F6TTPF5EG etF $6F-G>FP;>> irection ;ut In=;ut

cr6DMH6e86&outer6,n)ound
Instance et $6FE1F"5;$FTP et $6F5EP;5TF$-E ET e1F-tandardE/ent etF $6F 5EP;5TF$-E irection ;ut ;ut

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et et et et

$6F- $2FE;7 $6F-G>FP;>> $6FE55;5F$-E $6F "5;$FTP

etF etF etF etF

$6FEE9E5I2FEHT $6F -G>FP;>> $6F E55;5F$-E $6F EE9E5I2FEHT

;ut In=;ut ;ut In

cr6DMH6e86&outer6Out)ound
Instance et $6F-G>FP;>> et $6FE1FT;FTP et $6FE55;5F$-E et $6FT;FTP ET etF $6F -G>FP;>> e1F-tandardE/ent etF $6F E55;5F$-E e1F-tandardE/ent irection In=;ut In ;ut ;ut

cr6DMH6e86eP+6+atchin!
Pub#ications e1FtoFTradingFPartner -ubscri%tions e1FE*terna#FE/t

cr6DMH6e864rom6ePM
Pub#ications e1FtoFTradingFPartner -ubscri%tions e1FE*terna#FE/t

r6DMH6e863o6ePM
Pub#ications e1FE*terna#FE/t -ubscri%tions e1FfromFTradingFPartner e1FtoFeP$

5.4.5

!o""a&oration

u"e Scripts

3his ta)le lists all the colla)oration rules for DMH H,P11. See+eyond allows the colla)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 3a)le
9ame EenericPassThru 9otification5outing crF $6F837PFtoF- $2 crF $6F837IFtoF- $2 crF $6FEenericFPassthru crF $6FProcessFErrors crF $6FProcessF5e%orts crF $6F5outerFInbound crF $6F5outerF;utbound crF $6F- $2FE;7F)%%end crF $6F- $2FE;7F-ort crF $6F- $2FE;7FToF83< crF $6Fe1F6tt%sF"romFTP crF $6Fe1F6tt%sFToFTP crF $6Fe1F6tt%sFToFeP$ crF $6Fe1FPo##F5ecei/eF6t%%s 2o##aboration -er/ice T(%e Ia/a $on+ Ia/a Ia/a Ia/a Ia/a Ia/a Ia/a Ia/a Ia/a Ia/a Ia/a Ia/a Ia/a Pass Through Ia/a

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crF crF crF crF crF

$6Fe1F5outerFInbound $6Fe1F5outerF;utbound $6Fe1FeP7F7atching $6Fe1F"romFeP$ $6Fe1FToFeP$

Ia/a Ia/a $on+ $on+ Pass Through

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$ Deta.le+ Des.5n
$.1 e49DM 9#3'P9To9SDMC
Proprietary #alidated 23.P laims et6DMH623.P dmh6i0m!r6EMS e49DM 9#3'P9To9SDMC col6DMH623.P63o6SDM cr6DMH623.P63o6SDM laims to )e sent to ,3FS et6DMH6SDM 6 laim64ile

dmh6i0m!r6EMS

/rrors and9or /*ceptions if any et6DMH6/&&O&6MS= System &eports et6DMH6&/PO&36MS= dmh6i0m!r6SHS6EMS

Pass'throu!h data)ase records et6DMH6S-$ Dpdates the tri!!er ta)le et6DMH6S-$6PO$$

ewc6dmh6S-$

,nternal ED+ ommunication

Pass'throu!h data)ase

.o''aboration .o''aboration 2u'e 3ub&cri-tion In&tance et $6F-G> et $6F-G>FP;>> et $6F837P $ub'ication In&tance et $6F-G>FP;>> et $6F-G> et $6F- $2F2>)I$F"I>E et $6FE55;5F$-E et $6F5EP;5TF$-E

co#F $6F837PFToF- $2 crF $6F837PFToF- $2 ,vent %y-e etF $6F-G> etF $6F-G>FP;>> etF $6F837P ,vent %y-e etF $6F-G>FP;>> etF $6F-G> et $6F- $2F2>)I$F"I>E etF $6FE55;5F$-E EtF $6F5EP;5TF$-E 3ource e,cFdmhF-G> e,cFdmhF-G> e,cFdmhFiAmgrFe1FI$!e&tination e,cFdmhF-G> e,cFdmhF-G> e,cFdmhFiAmgrFI$e,cFdmhFiAmgrF-8-FI$e,cFdmhFiAmgrF-8-FI$-

3he MM/ ew6DMH623.P63o6SDM performs the actual translation from H,P11 23.P format to the Short'Doyle Medi' al Proprietary claim format. 1ll )usiness edits and transformations are enforced throu!h this eFay. 1ny chan!es to translation procedure or mappin! documents must )e reflected in the >ava')ased cr6DMH623.P63o6SDM colla)oration rule. 3he translation is performed in the same hierarchical order as the 23.P: parsin! each 4unctional =roup: 3ransaction Set: Provider and so on. /ach record for the proprietary format is e*tracted from the Service $ine @$oop 2477A level. 1 primary ;ey is assem)led for each service line found in the 23.P claim file: and matched a!ainst the records in the pass'throu!h data)ase as well as those in the current file for duplicates. 1 duplicate primary ;ey results in the roll)ac; of all data)ase operations for that transaction set and causes the transaction set to )e re>ected: and a notification email to )e sent out. /ach service line is translated into a proprietary record )ased on the mappin! rules. 3he pass'throu!h record is !enerated and inserted into the pass'throu!h data)ase ta)le DMH6H,P116P36D131.

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3he claims are sent via the messa!e et6DMH6SDM 6 laim64ile to the dmh6i0m!r6EMS ,- Mana!er from where they will )e transferred to ,3FS via H33PS. System and error reports are sent to the dmh6i0m!r6SHS6EMS ,- Mana!er for further processin!.

$.2

e49DM 9#3'I9To9SDMC
Proprietary #alidated 23., laims et6DMH623., dmh6i0m!r6EMS e49DM 9#3'I9To9SDMC col6DMH623.,63o6SDM cr6DMH623.,63o6SDM laims to )e sent to ,3FS et6DMH6SDM 6 laim64ile

dmh6i0m!r6EMS

/rrors and9or /*ceptions if any et6DMH6/&&O&6MS= Sy stem &eports et6DMH6&/PO&36MS= dmh6i0m!r6SH S6EMS

Pass'throu!h data)ase records et6DMH6S-$ Dpdates the tri!!er ta)le et6DMH6S-$6PO$$

ewc6dmh6S-$

,nternalED+ ommunication

Pass'throu!h data)ase

.o''aboration .o''aboration 2u'e 3ub&cri-tion In&tance et $6F-G> et $6F-G>FP;>> et $6F837I $ub'ication In&tance et $6F-G>FP;>> et $6F-G> et $6F- $2F2>)I$F"I>E et $6FE55;5F$-E et $6F5EP;5TF$-E

co#F $6F837IFToF- $2 crF $6F837IFToF- $2 ,vent %y-e etF $6F-G> etF $6F-G>FP;>> etF $6F837I ,vent %y-e etF $6F-G>FP;>> etF $6F-G> et $6F- $2F2>)I$F"I>E etF $6FE55;5F$-E EtF $6F5EP;5TF$-E 3ource e,cFdmhF-G> e,cFdmhF-G> e,cFdmhFiAmgrFe1FI$!e&tination e,cFdmhF-G> e,cFdmhF-G> e,cFdmhFiAmgrFI$e,cFdmhFiAmgrF-8-FI$e,cFdmhFiAmgrF-8-FI$-

3he MM/ ew6DMH623.,63o6SDM performs the actual translation from H,P11 23., format to the Short'Doyle Medi' al Proprietary claim format. 1ll )usiness edits and transformations are enforced throu!h this eFay. 1ny chan!es to translation procedure or mappin! documents must )e reflected in the >ava')ased cr6DMH623.,63o6SDM colla)oration rule. 3he translation is performed in the same hierarchical order as the 23.,: parsin! each 4unctional =roup: 3ransaction Set: Provider and so on. /ach record for the proprietary format is e*tracted from the Service $ine @$oop 2477A level. 1 primary ;ey is assem)led for each service line found in the 23., claim file: and matched a!ainst the records in the pass'throu!h data)ase as well as those in the current file for duplicates. 1 duplicate primary ;ey results in the roll)ac; of all data)ase operations for that transaction set and causes the transaction set to )e re>ected: and a notification email to )e sent out.

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/ach service line is translated into a proprietary record )ased on the mappin! rules. 3he pass'throu!h record is !enerated and inserted into the pass'throu!h data)ase ta)le DMH6H,P116P36D131. 3he claims are sent via the messa!e et6DMH6SDM 6 laim64ile to the dmh6i0m!r6EMS ,- Mana!er from where they will )e transferred to ,3FS via H33PS. System and error reports are sent to the dmh6i0m!r6SHS6EMS ,- Mana!er for further processin!.

$.3

e49DM 9e:9ePM
+ase (4 encoded messa!es f rom 3radin! Partners e49DM 9e:9ePM col6DMH6e863o6ePM cr6DMH6e863o6ePM ,n)ound 812 messa!es are sent to e8chan!e data)ase

e1FfromFTradingFPartner

e1FE*terna#FE/t

i06DMH6e863radin!6Port6-ueue

e8chan!e Data)ase Out)ound 812 Messa!es are retriev ed and sent to9f rom e8chan!e data)ase

e1FE*terna#FE/t e1FfromFe7P$

col6DMH6e864rom6ePM #alidated 23%: 55. and 311 Messa!es e86H33PS 9 e86H33P cr6DMH6e864rom6ePM

3ranslated 23% messa!es sent f or v alidation i06DMH6e86e+PM #alidated 23.P and 23., messa!es sent f or translation

e1FtoFe7P$

.o''aboration .o''aboration 2u'e 3ub&cri-tion In&tance $ub'ication In&tance

co#F $6Fe1FfromFE%m crF $6Fe1FfromFE%m ,vent %y-e e1FE*terna#FE/t (5eAuired! ,vent %y-e e1FT2PIP e1F7)T26 e1FtoFTradingFPartner e1F6TTPe1F-$TP e1F6TTP e1FError e1FtoF$u* e1FtoFeP$ e1FtoFe7P$ co#F $6Fe1FtoFeP$ crF $6Fe1FtoFeP$ ,vent %y-e e1FfromFTradingFPartner (5eAuired! e1FtoFeP$ (5eAuired! ,vent %y-e e1FE*terna#FE/t 3ource KE1TE59)>L !e&tination iAF $6Fe1FTradingFPortFGueue iAF $6Fe1FTradingFPortFGueue iAF $6Fe1FTradingFPortFGueue iAF $6Fe1FTradingFPortFGueue iAF $6Fe1FTradingFPortFGueue iAF $6Fe1FTradingFPortFGueue iAF $6Fe1F eadF>etterFGueue iAF $6Fe1FTradingFPortFGueue iAF $6Fe1FEb%m iAF $6Fe1Fe7P$

.o''aboration .o''aboration 2u'e 3ub&cri-tion In&tance

3ource co#F $6Fe1F5outerFInbound K)98L !e&tination KE1TE59)>L

$ub'ication In&tance

3he e8chan!e eFay is the main wor;horse in the )ac;'end portion of the e8chan!e Partner Mana!er. 3he e8chan!e eFay does the followin!? #alidates protocol'specific data from 3radin! Partners Frites /vent data to the data)ase

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&etrieves 3radin! Partner profile information from the data)ase /nvelopes the data as re0uired )y the destination 3radin! Partner

3he e86ePM eFay is a )idirectional eFay that communicates with )oth the e86e+PM ,- and the e863radin!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 3radin! Partner side of e8chan!e: receivin! /vent information )oth from activity eFays and the eFays that communicate directly with 3radin! Partners.

$.4

e49DM 9e:9ePM9Bat-2
e49DM 9e:9ePM9Bat-2 col6DMH6e86ePM6+atchin! e8chan!e Data)ase cr6DMH6e86eP+6+atchin! i06DMH6e863radin!6Port6-ueue Sin!le )atched 23% messa!e sent to 3radin! Partner e86H33PS 9 e86H33P

,ndiv idual 23%messa!es f rom e8chan!e data)ase

e1FE*terna#FE/t

.o''aboration .o''aboration 2u'e 3ub&cri-tion In&tance $ub'ication In&tance

co#F $6Fe1FeP$F7atching crF $6Fe1FeP7F7atching ,vent %y-e e1FE*terna#FE/t (5eAuired! ,vent %y-e e1FT2PIP e1F7)T26 e1FtoFTradingFPartner e1F6TTPe1F6TTP 3ource KE1TE59)>L !e&tination iAF $6Fe1FTradingFPortFGueue iAF $6Fe1FTradingFPortFGueue iAF $6Fe1FTradingFPortFGueue iAF $6Fe1FTradingFPortFGueue iAF $6Fe1FTradingFPortFGueue

3he ew6DMH6e86ePM6+atch eFay polls the e8chan!e data)ase for /vents )ein! sent to 3radin! Partners usin! 4ast +atch transfer mode or +atch transfer mode @rather than an ,nteractiveA and prepares them to )e sent to the appropriate 3radin! Partner. Fhen multiple /vents need to )e sent to the same 3radin! Partner: the eFay )undles these /vents to!ether accordin! to a user'defina)le )undlin! scheme: )efore envelopin! them and pu)lishin! them to the e863radin!6Port6-ueue ,-.

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$.!

e49DM 9e:9 tt1s9F*o09TP


1. Pic;s up a H33P &e0uest with the D&$ of the new file to )e re0uested from ,3FS ew6DMH6e86Https64rom63P et6DMH6H33P6&//rrors and9or /*ceptions if any et6DMH6/&&O&6MS= dmh6i0m!r6SHS6EM S

dmh6i0m!r6e86EMS

col6DMH6e86Https64rom63P cr6DMH6e86Https64rom63P

4. Sends the new file for further processin! et6DMH6H33PS64&OM63 P 2. Sends a re0uest for a file )y specifyin! its D&$ et6DMH6H33P6 $,/G3

3. &eceives the new file from ,3FS via H33PS et6DMH6H33P6 $,/G3 DMH 3rust Store Fe) ertificates

,3FS

,nternal H33PS ommunication

ewc6dmh6,3FS

SS$ ,nformation

.o''aboration .o''aboration 2u'e 3ub&cri-tion In&tance et $6F6TTPF5EG4E-T $ub'ication In&tance et $6FE55;5F$-E et $6FF"5;$FTP et $6F6TTPF2>IE9T

co#F $6Fe1F6tt%sF"romFTP crF $6Fe1F6tt%sF"romFTP ,vent %y-e etF $6F6TTPF5EG ,vent %y-e etF $6FE55;5F$-E etF $6F6TTPF "5;$FTP e1F6TTP3ource e,cFdmhFiAmgrFe1FI$!e&tination e,cFdmhFiAmgrF-8-FI$e,cFdmhFiAmgrFe1FI$e,cFdmhFIT'-

3he ew6DMH6Https64rom63P acts as the communication point )etween the ,3FS and the 3ranslator. 3his eFay serves to increase the modularity of the entire 3ranslator )y allowin! for scala)ility to accommodate other communication protocols. 3he ew6DMH6Https64rom63P eFay can )e replaced or enhanced at any time )y addin! a new eFay that could possi)ly use a different protocol such as 43P without affectin! any functionality of the remainin! components of the 3ranslator. 3he ew6DMH6Https64rom63P receives the et6DMH6H33P6&/- messa!e from the dmh6i0m!r6e86EMS 0ueue mana!er and uses the information to ma;e an H33P connection to ,3FS and transfer data usin! standard H33P methods. 3he retrieved data is in turn pu)lished to the ,- Mana!er from where it is pic;ed for further processin!. 3he eFay connection acts as the !ateway to the ,3FS and can )e confi!ured e*clusive of the data processin! functions within the colla)oration rule itself. MM/ will retrieve the et6DMH6H33P6&/- messa!es from the ,- Mana!er dmh6i0m!r6e86EMS: and will !enerate the appropriate H33P methods to retrieve a new file. 3he MM/ will pu)lish an et6DMH6H33P6 $,/G3 messa!e: which is a See+eyond standard messa!e type to the ewc6dmh6,3FS eFay onnection. ewc6dmh6,3FS will retrieve the necessary certificates from a specified 3rust Store and esta)lish H33PS communication with ,3FS. MM/ ew6DMH6e86Https64rom63P will retrieve the data and pu)lish it as a !eneric messa!e of the type et6DMH6H33PS64&OM63P to the ,- Mana!er. MM/ will pu)lish an et6DMH6/&&O&6MS= messa!e to the dmh6i0m!r6SHS6EMS 0ueue in case any errors or e*ceptions are encountered.

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System and Process Documentation

$.$

e49DM 9e:9 tt1s9To9TP


DMH 3rust Store Fe) ertificates

Messa!e to )e sent to 3radin! Partners via ,3FS e49DM 9e:9 tt1s9To9TP et6DMH6H33PS63O63P dmh6i0m!r6e86EM S col6DMH6e86Https63o63P cr6DMH6e86Https63o63P

4iles sent to ,3FS via H33PS SS$ et6DMH6H33P6 $,/G ,nformation 3 ewc6https6DMH6,3 FS &esponse Messa!e received from ,3FS et6DMH6H33P6 $,/G3

i06DMH6e863radin !6Port6-ueue Sends response messa!es to e8chan!e data)ase e86to6ePM

col6DMH6e86Https63o6ePM r6DMH6e86Https63o6ePM

,nternal H33P ommunication

,3FS /rrors and9or /*ceptions if any et6DMH6/&&O&6MS= dmh6i0m!r6SHS6EM S

.o''aboration .o''aboration 2u'e 3ub&cri-tion In&tance e1F-tandE/ent $ub'ication In&tance et $6FE55;5F$-E e1FtoFeP$F-td 6tt%2#ient .o''aboration .o''aboration 2u'e 3ub&cri-tion In&tance $ub'ication In&tance

co#F $6Fe1F6tt%sFToFTP crF $6Fe1F6tt%sFToFTP ,vent %y-e etF $6F6TTP-FT;FTP ,vent %y-e etF $6FE55;5F$-E e1FtoFeP$ e1F6tt%2#ient co#F $6Fe1F6tt%sFToFeP$ crF $6Fe1F6tt%sFToFeP$ ,vent %y-e e1FE*terna#FE/t (5eAuired! ,vent %y-e e1FtoFeP$ 3ource e,cFdmhFiAmgrFe1FI$!e&tination e,cFdmhFiAmgrF-8-FI$iAF $6Fe1FTradingFPortFGueue e,cFdmhFIT'-

3ource K)98L !e&tination iAF $6Fe1FTradingFPortFGueue

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$.'

e49DM 9Poll9Re-e.3e9 tt1s


e49DM 9e:9Poll9Re-e.3e9 tt1s col6DMH6e86Poll6&eceive6Https cr6DMH6e86Poll6&eceive6Https Sends a H33PS &e0uest with the D&$ of the new file to )e pic;ed up et6DMH6H33P6&/dmh6i0m!r6e86EMS

Polls the 3ri!!er 3a)le for new filename entries et6DMH6S-$6PO$$

&eceives the new fileBs D&$ from the 3ri!!er 3a)le et6DMH6S-$6PO$$ 3ri!!er 3a)le on Pass'throu!h Data)ase

ewc6dmh6S-$

,nternal ED+ ommunication

.o''aboration .o''aboration 2u'e 3ub&cri-tion In&tance et $6F-G>FP;>> $ub'ication In&tance et $6F6TTPF5EG4E-T

co#F $6Fe1FPo##F5ecei/eF6tt%s crF $6Fe1FPo##F5ecei/eF6tt%s ,vent %y-e etF $6F-G>FP;>> ,vent %y-e etF $6F6TTPF5EG 3ource e,cFdmhF-G> !e&tination e,cFdmhFiAmgrFe1FI$-

3he multi'mode eFay @MM/A ew6DMH6e86Poll6&eceive6Https polls the 3ri!!er 3a)le: which is a part of the Pass'throu!h data)ase: for new entries. /ntries in the ta)le consist of the D&$ and details such as the /ntity ode and Su)mission Date. However: only the D&$ of the new file is retrieved from the ta)le and a re0uest messa!e is sent to the ew6DMH6e86Https64rom63P eFay via the dmh6i0m!r6e86EMS 0ueue. 3his eFay performs the followin! se0uence of operations? MM/ will pu)lish an et6DMH6S-$ event to the S-$ Server eFay onnection ewc6dmh6S-$: to 0uery the data)ase for new entries )ased on the I,sProcessedB fla! that determines whether the translator has processed a file or not. MM/ will !enerate an H33P re0uest messa!e of the et6DMH6H33P6&/- type and pu)lish it to the ,- Mana!er dmh6i0m!r6e86EMS.

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$.#

e49DM 9e:9Ro,te*
e49DM 9e:9Ro,te* 1.a &eceiv es the messa!e col6DMH6e86&outer6,n)ound containin! the new data et6DMH6H33PS64&OM63P cr6DMH6e86&outer6,n)ound dmh6i0m!r6e86EMS 2a. /O+ 4iles are sent f or translation et6DMH6SDM 6/O+ dmh6i0m!r6EMS

2a. 23.P and 23., 4iles are sent to e8chan!e f or v alidation e86f rom63radin!6Partner

col6DMH6e86&outer6Out)ound 2). Sends a !eneric messa!e to 3radin! Partner et6DMH6H33PS63O63P cr6DMH6e86&outer6Out)ound i06DMH6e863radin!6Port6-ueue 1). 23%: 55. and 311 messa!es are receiv ed f rom e8chan!e e86H33P: e86H33PS

/rrors and9or /*ceptions if any et6DMH6/&&O&6MS= Sy stem &eports et6DMH6&/PO&36MS= dmh6i0m!r6SH S6EMS

Dpdates the tri!!er ta)le et6DMH6S-$6PO$$ ED+ communication ewc6dmh6S-$ 3ri!!er 3a)le on Pass'throu!h Data)ase

.o''aboration .o''aboration 2u'e 3ub&cri-tion In&tance et $6F"romFTP $ub'ication In&tance et $6F5EP;5TF$-E et $6F-G>FP;>> et $6FE1F"5;$FTP et $6F- $2FE;7 et $6FE55;5F$-E .o''aboration .o''aboration 2u'e 3ub&cri-tion In&tance et $6FE1FT;FTP et $6FE1FT;FTP et $6FE1FT;FTP et $6FE1FT;FTP $ub'ication In&tance et $6FT;FTP et $6F-G>FP;>>

co#F $6Fe1F5outerFInbound crF $6Fe1F5outerFInbound ,vent %y-e etF $6F6TTP-F"romFTP ,vent %y-e EtF $6F5EP;5TF$-E etF $6F-G>FP;>> e1FfromFTradingFPartner etF $6F- $2FE;7 etF $6FE55;5F$-E co#F $6Fe1F5outerF;utbound crF $6Fe1F5outerF;utbound ,vent %y-e e1F6TTP e1F6TTP e1F6TTPe1F6TTP,vent %y-e etF $6F6TTP-FT;FTP EtF $6F-G>FP;>> 3ource e,cFdmhFiAmgrFe1FI$!e&tination e,cFdmhFiAmgrF-8-FI$e,cFdmhF-G> iAF $6Fe1FTradingFPortFGueue e,cFdmhFiAmgrFI$e,cFdmhFiAmgrF-8-FI$-

3ource co#F $6Fe1FfromFeP$ co#F $6Fe1FeP$F7atching co#F $6Fe1FfromFeP$ co#F $6Fe1FeP$F7atching !e&tination e,cFdmhFiAmgrFe1FI$e,cFdmhF-G>

3he MM/ ew6DMH6e86&outer is a router for messa!es to and from e8chan!e. ,t contains two colla)orations that act on in)ound and out)ound messa!es at different instances in the process cycle. 3he routin! functions in the rules transform specific messa!es into !eneric messa!es and vice versa.

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3he ,n)ound colla)oration is the startin! point for in)ound messa!e processin!. 4iles from the ,3FS are received as data chun;s in the form of !eneric messa!es: and need to )e sent to different eFays )ased on whether the file is an 23. or an /O+. 3he MM/ wor;s as follows? 3he MM/ colla)oration col6DMH6e86&outer6,n)ound receives !eneric events et6DMH6H33PS64&OM63P that contain the data from the ,3FS. 3he /O+ is routed to the dmh6i0m!r6EMS ,- Mana!er for translation to 23% format. 3he 23. data is transformed into +ase(4 format re0uired )y e8chan!e: and statistical information such as the transaction counts are e*tracted: and the tri!!er ta)le is updated. 3he e86from63radin!6Partner event is populated as follows?
Partner 9ame= >ogica# 9ame In"i#e Pa(#oad irection $6FK2ount( 2odeLFInbound The count( codes are e*tracted from the I-)DC fie#d of the 837. The fi#ename from ,here this %articu#ar transaction ,as e*tracted. The 113 message is encoded in 7ase&CB format. I (Inbound!

3he 23. data is associated with a 3radin! Partner +2+ Profile Game and sent to i06DMH6e863radin!6Port6-ueue for validation )y e8chan!e and laredi. System reports are !enerated for )oth the /O+s and the 23.s and are sent to the System &eports Data)ase via the /t6DMH6&/PO&36MS= /vent. 3he out)ound colla)oration wor;s in a similar manner: actin! upon out)ound data from e8chan!e: which is received in the form of 23%s: 55.s and 311s. 3hese messa!es are decoded from their +ase(4 format and assi!ned filenames )efore )ein! sent out to the 3radin! Partners via the ,3FS. 3he colla)oration col6DMH6e86&outer6Out)ound pic;s up e86H33PS messa!es from e8chan!e via the i06DMH6e863radin!6Port6-ueue ,-. 3hese messa!es: which are in the Standard /vent format: are decoded: assi!ned filenames and are sent out to dmh6i0m!r6e86EMS as et6DMH6H33PS63O63P messa!es. 3he tri!!er ta)le is updated with the num)er of transactions ac;nowled!ed and accepted via the et6DMH6S-$6PO$$ event. /rrors and &eports are sent usin! the /t6DMH6&/PO&36MS= event types respectively. et6DMH6/&&O&6MS= and

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$.8

e49DM 9P*o-ess9E**o*s
&eceiv es error messa!es f rom dif f erent eFay s et6DMH6/&&O&6MS= e49DM 9P*o-ess9E**o*s col6DMH6Process6/rrors cr6DMH6Process6/rrors

dmh6i0m!r6SH S6EMS

Sends 4131$ and D&=/G3 error messa!es to email et6DMH6/M1,$6MS=

Sends all error messa!es to /rror 3a)le et6DMH6S-$

SM3P Serv er ,nternalSM3P ommunication

ewc6dmh6/M1,$

ewc6dmh6S-$

,nternalED+ ommunication

/rror 3a)le on Pass' throu!h Data)ase

.o''aboration .o''aboration 2u'e 3ub&cri-tion In&tance et $6FE55;5F$-E $ub'ication In&tance et $6FE$)I>F$-E et $6F-G>

co#F $6FProcessFErrors crF $6FProcessFErrors ,vent %y-e etF $6FE55;5F$-E ,vent %y-e etF $6FE$)I>F$-E etF $6F-G> 3ource e,cFdmhFiAmgrF-8-FI$!e&tination e,cFdmhF-G> e,cFdmhFE$)I>

3he ew6DMH6Process6/rrors plays a very crucial role in the 3ranslator system ena)lin! error reportin! from every component without the need for individual error handlin! methods. /rror reportin! is performed throu!h two channels: throu!h an error ta)le and an email messa!es. 3he col6DMH6Process6/rrors su)scri)es to the et6DMH6/&&O&6MS= event from the dmh6i0m!r6SHS6EMS ,- Mana!er. 3he ,- Mana!er in 0uestion is used )y all components to su)mit error messa!es and reports. +ased on the severity of the error: the colla)oration rule ma;es a decision to send email alerts or >ust lo! them into the error ta)le. 1ll errors are: )y default: lo!!ed into the /rror 3a)le DMH6SHS6/&&O&S with the location as well as the details of the error. /mail messa!es are !enerated only for errors identified as D&=/G3 or 4131$: with the appropriate su)>ect lines and messa!e )odies )ein! !enerated accordin! to the error source and cause. 3he et6DMH6/M1,$6MS= is a See+eyond !eneric event type that encodes all the information needed to !enerate a valid email messa!e. 3his event is sent to the HHSD SM3P server throu!h the ewc6dmh6/M1,$ eFay connection.

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$.1& e49DM 9P*o-ess9Re1o*ts


&eceiv es reportin! data f rom dif f erent eFay s e49DM 9P*o-ess9Re1o*ts et6DMH6&/PO&36MS= col6DMH6Process6&eports dmh6i0m!r6SH S6EMS cr6DMH6Process6&eports

Sends reportin! data to the &eports 3a)le et6DMH6S-$

ewc6dmh6S-$ ,nternalED+ ommunication

&eports 3a)le on Pass'throu!h Data)ase

.o''aboration .o''aboration 2u'e 3ub&cri-tion In&tance et $6F5EP;5TF$-E $ub'ication In&tance et $6F-G>

co#F $6FProcessF5e%orts crF $6FProcessF5e%orts ,vent %y-e etF $6F 5EP;5TF$-E ,vent %y-e etF $6F-G> 3ource e,cFdmhFiAmgrF-8-FI$!e&tination e,cFdmhF-G>

3he ew6DMH6Process6&eports eFay handles all the reportin! data !enerated )y the DMH H,P11 3ranslator. 3he ,- Mana!er dmh6i0m!r6 SHS6EMS acts as a repository for all the reportin! events that are !enerated )y different components in different sta!es of the claims cycle. &eportin! data is useful to o)tain statistics for each 3radin! Partner: such as the num)er of files: transactions: service lines: etc inputted to the system: or re>ected )y different validation procedures. 1 most useful feature of the reports data is that it indicates in amounts: the claims that were re>ected on the )asis of H,P11 errors and those re>ected due to translation errors. 3he colla)oration col6DMH6Process6&eports su)scri)es to the /t6DMH6&/PO&36MS= event that contains fields to hold reportin! data from different components. +ased on the county code: year: and month of translation: the reports are updated in the DMH6SHS6&/PO&3S data)ase ta)le throu!h the et6DMH6S-$ event type. 1 separate record is created for each county per month9year.

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System and Process Documentation

$.11 e49DM 9Ro,te*


1a &eceives validated 23.P: 23., data e86to6e+PM i06DMH6e86e+PM e49DM 9Ro,te* col6DMH6&outer6,n)ound cr6DMH6&outer6,n)ound 2a. #alidated 23.P and 23., sent for translation et6DMH623.P: et6DMH623., dmh6i0m!r6EMS

col6DMH6&outer6Out)ound 2). Sends a +ase(4 encoded 23% data for validation e86to6ePM cr6DMH6&outer6Out)ound 1). 3ranslated 23% sent for validation et6DMH623%

/rrors and9or /*ceptions if any et6DMH6/&&O&6MS= System &eports et6DMH6&/PO&36MS= dmh6i0m!r6SHS6EMS

.o''aboration .o''aboration 2u'e 3ub&cri-tion In&tance et $6FE1FT;FE7P$ $ub'ication In&tance et $6F5EP;5TF$-E et $6FEE9E5I2FEHT .o''aboration .o''aboration 2u'e 3ub&cri-tion In&tance et $6FEE9E5I2FEHT $ub'ication In&tance et $6FE1FT;FEP$

co#F $6F5outerFInbound crF $6F5outerFInbound ,vent %y-e e1FtoFe7P$ ,vent %y-e EtF $6F5EP;5TF$-E etF $6F837P co#F $6F 5outerF;utbound crF $6F5outerF;utbound ,vent %y-e etF $6F83< ,vent %y-e e1FtoFeP$ 3ource co#F $6Fe1FfromFeP$ !e&tination e,cFdmhFiAmgrF-8-FI$e,cFdmhFiAmgrFI$-

3ource e,cFdmhFiAmgrFI$!e&tination iAF $6F e1Fe7P$

$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 3radin! Partners and the )usiness lo!ic of the translator: 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. 3he MM/ has two colla)orations that act on in)ound and out)ound data at different sta!es of the translator cycle. 3he col6DMH6&outer6,n)ound acts on messa!es comin! from the e8chan!e component after validation. ,t performs the followin! se0uence of steps? 3he in)ound 23. data is parsed to e*tract the =S72 field value. 3his value is then used to determine if the incomin! 23. is whether a professional or institutional claim. 3he in)ound 23. data is decoded from its +ase (4 format in the e86to6e+PM messa!e structure to the et6DMH623.P or et6DMH623., messa!e @dependin! on the =S72 valueA. 1 report messa!e: /t6DMH6&/PO&36MS=: is !enerated indicatin! the details a)out the claims includin! valid num)er transactions: services: amount: etc. that can )e used later to !au!e the 0uality of a 3radin! PartnerBs data.

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Department of Mental Health

System and Process Documentation

3he col6DMH6&outer6Out)ound performs a similar process in the reverse direction: operatin! on 23% messa!es. 3he et6DMH623% messa!e: which is a !eneric event that encodes the 23% data in its payload node: is pic;ed up from the dmh6i0m!r6EMS ,- Mana!er. 3he data is +ase (4 encoded and assi!ned an appropriate 3radin! Partner profile lo!ical name )efore )ein! sent to e8chan!e for validation. 3he nodes of the standard event e86to6ePM are populated as follows?
Partner 9ame= >ogica# 9ame "7F49IG4EFI "7F2;49T Pa(#oad irection $6FK2ount( 2odeLF;utbound

The fi#ename of the in%ut E;7 from ,hich the 83< ,as generated. The number of batches that ,ere %resent in the E;7 and ,ere transformed into transactions of the 83<. The 113 message is encoded in 7ase&CB format. ; (;utbound!

/rrors and e*ceptions encountered in this colla)oration are sent for processin! throu!h the et6DMH6/&&O&6MS= type.

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System and Process Documentation

$.12 e49DM 9SDMC9EOB9A11en+


&etriev es the /O+ data receiv ed f rom ,3FS et6DMH6SDM 6/O+ dmh6i0m!r6EMS e49DM 9SDMC9EOB9A11en+ col6DMH6SDM 6/O+61ppend cr6DMH6SDM 6/O+61ppend dmh6i0m!r6EMS 1ppends some pass'throu!h inf ormation to the /O+ and sends it f or f urther processin! et6DMH6SDM 6/O+6/*t

/rrors and9or /*ceptions if any et6DMH6/&&O&6MS= Sy stem &eports et6DMH6&/PO&36MS=

&e0uests f or the pass'throu!h records f or /O+s et6DMH6S-$

&etriev es the /O+s pass' throu!h records f rom data)ase et6DMH6S-$

dmh6i0m!r6SH S6EMS

ewc6dmh6S-$ ,nternalED+ ommunication

Pass'throu!h 3a)le

.o''aboration .o''aboration 2u'e 3ub&cri-tion In&tance et $6F-G> et $6F- $2FE;7 $ub'ication In&tance et $6F- $2FE;7FE*t et $6FE55;5F$-E et $6F5EP;5TF$-E

co#F $6F - $2FE;7F)%%end crF $6F - $2FE;7F)%%end ,vent %y-e etF $6F-G> etF $6F - $2FE;7 ,vent %y-e etF $6F- $2FE;7FE1T etF $6F E55;5F$-E etF $6F 5EP;5TF$-E 3ource e,cFdmhF-G> e,cFdmhFiAmgrFI$!e&tination e,cFdmhFiAmgrFI$e,cFdmhFiAmgrF-8-FI$e,cFdmhFiAmgrF-8-FI$-

3he ew6DMH6SDM 6/O+61ppend enhances the /O+ record with information from the pass'throu!h ta)le to support the !eneration of 23% transactions with appropriate claim'service line hierarchies that were e*tracted from the 23. transaction. 3he enhanced /O+ structure contains the claim level details allowin! the service lines to )e !rouped appropriately )efore )ein! answered in the form of remittances. 3he MM/ su)scri)es to the et6DMH6SDM 6/O+ event that encapsulates the /O+ data received from the ,3FS. 3he S-$ event type et6DMH6S-$ is used to e*tract the pass'throu!h fields for the correspondin! service lines. ,f the pass'throu!h data is not found: the /O+ is re>ected and an error messa!e is !enerated.

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System and Process Documentation

$.13 e49DM 9SDMC9EOB9So*t


&eceiv es the e*tended /O+s f or sortin! and translation et6DMH6SDM 6/O+6/83 e49DM 9SDMC9EOB9So*t col6DMH6SDM 6/O+6Sort dmh6i0m!r6EMS cr6DMH6SDM 6/O+6Sort dmh6i0m!r6EMS Sends the sorted set of /O+s f or translation et6DMH6SDM 6/O+6/836Sorted

/rrors and9or /*ceptions if any et6DMH6/&&O&6MS= Sy stem &eports et6DMH6&/PO&36MS=

dmh6i0m!r6SH S6EMS

.o''aboration .o''aboration 2u'e 3ub&cri-tion In&tance et $6F- $2FE;7FE*t $ub'ication In&tance et $6F- $2FE;7FE*tF-orted et $6FE55;5F$-E et $6F5EP;5TF$-E

co#F $6F - $2FE;7F-ort crF $6F - $2FE;7F-ort ,vent %y-e etF $6F- $2FE;7FE1T ,vent %y-e etF $6F- $2FE;7FE1TF-orted etF $6F E55;5F$-E etF $6F 5EP;5TF$-E 3ource e,cFdmhFiAmgrFI$!e&tination e,cFdmhFiAmgrFI$e,cFdmhFiAmgrF-8-FI$e,cFdmhFiAmgrF-8-FI$-

3he ew6DMH6SDM 6/O+6Sort eFay sorts the enhanced /O+ records to allow for the !roupin! of service lines into claim remittances. 3he col6DMH6SDM 6/O+6Sort su)scri)es to the et6DMH6SDM 6/O+6/*t event from i0m!r6DMH6EMS: which is the enhanced /O+ file. 3he /O+ records are sorted )ased on the claim level information and sent to the dmh6i0m!r6EMS as et6DMH6SDM 6/O+6/836Sorted events for actual translation. /rrors and e*ceptions in the eFay colla)oration rule are sent as et6DMH6/&&O&6MS= event to the dmh6i0m!r6 SHS6EMS ,- Mana!er for further processin!.

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System and Process Documentation

$.14 e49DM 9SDMC9EOB9To9#3!


&etriev es the sorted /O+s et6DMH6SDM 6/O+6/836Sorted e49DM 9SDMC9EOB9To9#3! col6DMH6SDM 6/O+63o623% dmh6i0m!r6EMS cr6DMH6SDM 6/O+63o623% dmh6i0m!r6EMS Sends the translated 23%s et6DMH623%

/rrors and9or /*ceptions if any et6DMH6/&&O&6MS= Sy stem &eports et6DMH6&/PO&36MS=

-ueries f or the pass'throu!h f ields )ased on primary ;ey et6DMH6S-$

&etriev es the pass'throu!h records et6DMH6S-$

dmh6i0m!r6SH S6EMS

ewc6dmh6S-$

Pass'throu!h 3a)le

.o''aboration .o''aboration 2u'e 3ub&cri-tion In&tance et $6F- $2FE;7FE*tF-orted $ub'ication In&tance et $6F ErrorF$sg et $6F83< et $6F 5e%ortF$sg et $6F-G>

co#F $6F - $2FE;7FToF83< crF $6F - $2FE;7FToF83< ,vent %y-e etF $6F- $2FE;7FE1TF-orted ,vent %y-e etF $6F E55;5F$-E etF $6F83< etF $6F 5EP;5TF$-E etF $6F-G> 3ource e,cFdmhFiAmgrFI$!e&tination e,cFdmhFiAmgrF-8-FI$e,cFdmhFiAmgrFI$e,cFdmhFiAmgrF-8-FI$e,cFdmhF-G>

3he ew6DMH6SDM 6/O+63o623% eFay is the main wor;horse of the /O+ to 23% translations: involvin! numerous steps and su)'procedures to effectively !enerate 23% transactions from the SDM /O+ records. 1n important fact to )e noted at this point is that the SDM /O+ records contain no information a)out the hierarchical structure in which they were initially encoded when they were su)mitted as 23.P transactions. 3he a)sence of any loopin! information ma;es the 23% !eneration a rather cum)ersome procedure involvin! !roupin! structures and runnin! counters to !enerate information for each hierarchical loop. 3he MM/ ew6DMH6SDM 6/O+63o623% su)scri)es to the et6DMH6SDM 6/O+6/836Sorted event: which contains the sorted and enhanced /O+ records. 3he /O+ records are transformed into an 23% transaction and the data is sent as a et6DMH623% event for further H,P11 validation.

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Department of Mental Health

System and Process Documentation

' E**o*

an+l.n5()al.+at.on

3he DMH H,P11 3ranslator modularly handles )oth )usiness and system errors throu!h its internal events and eFays. H,P11 validation is handled )y the e8chan!e component: reportin! errors in the form of 55. and 311 transactions.

'.1

IPAA )al.+at.on

H,P11 #alidation is performed )y the 4aciledi en!ine provided )y laredi orporation as a part of the See+eyond e<=ate ,nte!rator. 3he 4aciledi appliance interacts with the e8chan!e component via H33P and validates all 812 H,P11 transactions and !enerates appropriate responses and ac;nowled!ements. 4or further information: see the followin! document 3/ ' /rror Handlin! Process@1.2A ' DMH.

'.2

B,s.ness an+ S/ste0 E**o*s

1ll 3ranslator errors includin! the )usiness and system errors are handled )y the ew6DMH6Process6/rrors eFay: which lo!s them into the appropriate ta)les and !enerates email messa!es to the specified parties when needed. 1 more detailed description of the error handlin! process is found in Section ( a)ove which descri)es the functionin! of the eFay itself. 4or further information: see the followin! document 3/ ' /rror Handlin! Process@1.2A ' DMH.

# Relate+ Do-,0entat.on
4or related information: see the followin! documents? 21 ' Hi!h $evel H,P11 3ransactions Processin! 1rchitecture @1.3A ' DMH.doc

1 ' +usiness &e0uirements @1.2A ' DMH.doc 2 ' Physical H,P11 3ransactions 1rchitecture Model @1.7A ' DMH.doc 4+ ' 3est Procedures @1.7A ' DMH.doc 23.P H,P11 ,mplementation =uide 23% H,P11 ,mplementation =uide 2D ' 55. and &eportin! Specification @1.1A ' DMH 3/ ' /rror Handlin! Process @1.2A ' DMH 34 'System Production &eports Data)ase @1.7A J DMH 3= ' Data &epository @1.2A ' DMH 41 ' ompanion =uide @1.7A ' DMH

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