2010 MMIS Conference Interoperability Showcase Presented by the Technical Architecture Committee (TAC)

1. 2010 MMIS ConferenceInteroperability ShowcasePresented by the Technical Architecture Committee (TAC)

2. Watch the Transaction Flow for MITA Inquire Member Eligibility PROVIDER DESKTOP Direct Internet Connection Schedule Appointment Standalone Eligibility MITA-Based MMIS PMS Operations Management Program Management CAQH CORE II Adapter Program Integrity Management Contractor Management Care Management Business Relationship Management Internet CORE with NHIN SAML Adapter Provider Management Member Management PROVIDER EMR HIE/NHIN Connection Integrated Eligibility Verification Standalone Eligibility IME Medicaid-NHIN CONNECT Gateway EMR Administrative NHIN Service CHIC (MN) - NHIN CONNECT Gateway Administrative NHIN Service PROVIDER EMR HIE/NHIN Connection Integrated Eligibility Verification Standalone Eligibility EMR

3. Watch the Transaction Flow for MITA Authorization Service Incorporating Clinical Data from NHIN PROVIDER DESKTOP Direct Internet Connection Schedule Appointment Standalone Eligibility Prior Authorization Process MITA-Based MMIS Prior Auth PMS Operations Management Program Management CAQH CORE II Adapter Program Integrity Management Contractor Management Care Management Business Relationship Management Internet CORE with NHIN SAML Adapter Provider Management Member Management PROVIDER EMR HIE/NHIN Connection Integrated Eligibility Verification Standalone Eligibility Prior Authorization Process Medicaid-NHIN CONNECT Gateway EMR Administrative NHIN Service CHIC (MN) - NHIN CONNECT Gateway Administrative NHIN Service PROVIDER EMR HIE/NHIN Connection Integrated Eligibility Verification Standalone Eligibility Prior Authorization Process EMR

4. MITA Authorization Service – MITA Business Service Details MITA-Based MMIS Internet Member Management Program Management 278 5010 EDI Program Integrity Management Contractor Management Operations Management Prior Auth Business Process • incorporate clinical data • review of clinical documents Care Management Business Relationship Management Provider Management Note: Requires support for long running transactions Medicaid-NHIN CONNECT Gateway Medicaid-NHIN CONNECT Gateway Clinical NHIN Services Clinical NHIN Services EMR

5. PA Flow Diagram Authentication Service Provider Desktop PA Adapter (EDI to XML) Perform Auditing SAML Assertion Transform Request User Token Data CAQH CORE 278 Request (w/ User Security Header or X 509 Transport) Perform Authorization Internet 278 Request / 278 ACK Response CAQH CORE Connectivity Orchestrator Perform Auditing PA Service Invoke Business Service (XML, Input/Output) 278/278 (w/ SAML Header) Perform Authorization Submit Request Perform Auditing Requires Manual Review? NHIN Gateway Perform Auditing PA Adapter (XML to EDI) Perform Auditing Perform Authorization NHIN Administrative Request (w/ CAQH CORE 278 Request) Transform Request No (service returns response) OR Perform Authorization Perform Authorization NHIN Gateway Yes (service returns ACK) Convert Approval Data To 278 XML Response Workflow Engine NHIN Administrative Request (w/ CAQH CORE 278 Request) NHIN Clinical Query (Patient Discovery, Document Query, Document Maintenance) Notification (Client Polling, Web Device Callback, Email, etc…) Perform Auditing Audit Response (Options) SAML Assertion HIE System Response Audit Service Authorization Service Manual Review Database, CEF Flat File, etc… Database, LDAP Flat File, etc… Approve/Deny HIE Desktop Approval Application

6. The TAC welcomes participation from all states, vendors and individuals. Please let us know of your interest, especially if you would be interested in helping to define and deploy services that are consistent with the goals of the TAC. Please contact Dave Walsh at dwalsh@esrv.com, Kimberly Ellison-Taylor at kimberly.ellison-taylor@oracle.com or Julie Walsh at julie.walsh@MolinaHealthCare.com.