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SoftCare “Best Practices” Implementation Example

SoftCare “Best Practices” Implementation Example. TradeLink Integration HealthCare Eligibility EDI 270/271 January 2010. Integration Best Practices. TradeLink and SoftCare “Best Practices” Implementation Example EDI 270 and 271

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SoftCare “Best Practices” Implementation Example

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  1. SoftCare “Best Practices” Implementation Example TradeLink Integration HealthCare Eligibility EDI 270/271 January 2010

  2. Integration Best Practices TradeLink and SoftCare“Best Practices” Implementation Example EDI 270 and 271 Software, Services and Business Process to Meet the Needs of Business SoftCare HealthCare Solutions www.SoftCareHealthCare.cominfo@softcare.com : 1-888-763-8227

  3. Integration Best Practices - Steps TradeLink “Best Practices” Implementation Example Provider Sending EDI Healthcare Claims (004010 837 P) to Medicare • Step One – Design / Create Business Requirements • Step Two – Define Source, Target and Cross Reference File Formats • Step Three – Create Transformations • Step Four – Create and Test Conversions (Maps) • Step Five – Define / Schedule Automatic Processing in TradeLink • Result – Fully integrated, automated, audited and Visible EDI HealthCare Professional Claim (837P) to Medicare (CMS)

  4. Integration Methodology • Project Definition/Discovery • Define Pilot Trading Partner Requirements (Client, Partner, SoftCare) • Documents to be exchanged, • Information requirements, • Business issues to be addressed • Communications requirements • Define Client Requirements (Client, SoftCare) • Business information requirements • Information sources and requirements • Integration points • Business Processes required for implementation • Software configuration

  5. Integration Best Practices - Steps • Project Implementation • Install Software (SoftCare) • Integration Seminar (SoftCare, Client) • Design Integration • Map Integration • Internal Testing • System Setup Seminar (Client, SoftCare) • Partner Setups • Design, Create, Schedule and Test Business Process • Day to Day Operational Training • Integration / Mapping Knowledge Transfer • Pilot Trading Partner Testing (Client, Trading Partner, SoftCare) • Connectivity • Document Testing, • Production Cutover

  6. Step 1 Define Business Requirement • SoftCare led Seminar to define Business Requirements • Pilot Trading Partner • Documents to be exchanged, • Business issues to be addressed • Business information requirements • Information sources and requirements • File structures and if they are conducive to EDI • Integration points • Business Processes required for implementation

  7. Step 1 Define Business RequirementTradeLink’s Partner Specific WorksheetsDocument Processing Rules/Issues

  8. Step 1 Define Business RequirementTradeLink’s File Support OverviewDocument Processing Rules/Issues CSV CSV CSV CSV CSV Transformer CSV Transformer Variable Length File Transformer V.L. Flat File V.L. Flat File V.L. Flat File V.L. Flat File Variable Length File Transformer EDI EDI EDI EDI XML XML EDI Transformer EDI Transformer Database Database Database Database Transformer Database Transformer Database F.L. Flat File F.L. Flat File F.L. Flat File F.L. Flat File Fixed Length File Transformer Fixed Length File Transformer Special XMAPPER Transformers are used to convert native source and target files to XML and then use the GUI editor to Create “Any to Any” transformations XML XML XML

  9. Step Two – Define File Formats - Source File Variable Length HealthCare Claim Example

  10. Integration Best Practices - Steps

  11. Integration Best Practices - Steps

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