National Member Out of Pocket (NMOP)

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