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MITA Gateway 5010 Overview

MITA Gateway 5010 Overview. 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 Connectivity - CORE Service Eligibility Adapter

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MITA Gateway 5010 Overview

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  1. MITA Gateway 5010 Overview May 18th 2009

  2. 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 Steps

  3. 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 concepts

  4. 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 …….

  5. Gateway 5010 Overview PowerPoint has new layouts that give you more ways to present your words, images and media. Gateway 5010 Architecture

  6. Gateway 5010 – Deliverables • Publish recommendations to the TARB on details of the MITA technical architecture • Deliver solution 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 systems

  7. 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 • Authorization • Auditing

  8. Gateway 5010 – Architecture

  9. Gateway 5010 – Architecture

  10. 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 definition • Developing standard WSDL to be used by all implementers

  11. Inquire Member Eligibility – Data Model

  12. Inquire Member Eligibility – Overview

  13. 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 authentication • One option for the MIME Multipart implementation • S2M4 – Uses username and password

  14. CORE Service – Real Time Model

  15. CORE Service – Batch Model

  16. 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 systems

  17. IME Adapter – Model

  18. 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 works

  19. 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 Service • The Eligibility Service retrieves that data from the eligibility database or legacy system.

  20. IME Activity Diagram

  21. 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 2009

  22. Gateway 5010 - Questions

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