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National Member Out of Pocket (NMOP)

National Member Out of Pocket (NMOP). Technical Overview March 15, 2013. Overview. Overview System Function and Responsibilities Conceptual Architecture NMOP Web Service System Configuration Quality Attributes Q & A. Overview. Purpose of this document

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National Member Out of Pocket (NMOP)

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  1. National Member Out of Pocket (NMOP) Technical Overview March 15, 2013

  2. Overview • Overview • System Function and Responsibilities • Conceptual Architecture • NMOP Web Service • System Configuration • Quality Attributes • Q & A

  3. Overview • Purpose of this document • This document provides a description of the technical environment for the National Member Out of Pocket (NMOP) system. • National Member Out of Pocket (NMOP) • Enables members to obtain information on estimated out of pocket cost for a specific treatment category based on a provider. This cost data includes the low, mid and high range of expected costs. • Has the flexibility for use the Plan’s national accounts, local business and/or appointed vendors.

  4. System Functions and Responsibilities • BCBSA Responsibilities • Web Service – Accepts inquiries from Plans/vendors and provides MOP cost estimates pertaining to a specific treatment category and a provider. The provider should have the cost reported in the NCCT tool for a given treatment category. • Integration - Retrieve cost information and real-time member benefits information from the appropriate BCBSA systems • Reference Data – Provide required reference data to the Plans, i.e. treatment category

  5. System Function and Responsibilities (Continued…) • Plan Responsibilities • User Interface – Participating Plans can develop their own User Interface to accommodate the MOP display functionalities. • Standards – Abide by BCBSA standards in terms of reference data i.e.

  6. Conceptual Architecture

  7. Conceptual Architecture • MOP Service controller will interact with necessary systems to pull the real-time member benefits, cost information and MOP cost • BCBSA Web Service will be used by the Plans/vendors to retrieve the aggregated MOP cost and the breakdowns. • A pre-approval process provides a Web Service Passcode that must be used for all Web Services inquiries. • BluesNet must be used to communicate to the Web services.

  8. NMOP Web Services Functionality • NMOP Web Service is used to retrieve MOP cost data including the breakdowns. • The NMOP web services are “classic” web services because they: • Are self-describing via their own WSDL documents. • Communicate with clients via SOAP over HTTPS. • Retrieving the WSDL • NCCT WSDL must be retrieved directly from the web services.

  9. NMOP Web Services - findMOPCostForProvider • This operation is provided by NMOP Cost Web Service. The consumer must be authenticated and have the appropriate authority for this operation. • The Web Service Passcode establishes identity (authentication) and access control (authorization) • There is a single operation available in the web service • findMOPCostForProvider

  10. System Configuration • The Web Service Pass code obtained from the manual pre-authorization process must be used in the NMOP Web Service Request. • WSDL is the ultimate authority on the specifics of data input and output. • For a tabular view, please refer to the NMOP_Technical_Guide • BCBSA has published a list of treatment categories to the Plans. These are the treatment categories that could be chosen by the end user.

  11. High Availability, Scalability, Extensibility • Multiple independent servers will support the NMOP application • Any single server can go offline with clients directed to another • Servers can be added at any time as Plan utilization increases • Each server will support the current and immediately prior web service interface • Optimize database structure for read-mostly access • Cache database tables in each server in the cluster

  12. Appendix - Definitions • NMOP – National Member Out of Pocket • NCCT – National Consumer Cost Tool • WSDL – Web Service Description Language • Subscriber – Primary member of the Insurance plan • Dependent – Dependent for a Primary member who is covered under the insurance plan.

  13. Feedback • Questions

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