MITA Gateway 5010 Overview

May 18th 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 Authentication & Authorization Auditing

Prototype Next Steps

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

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 …….

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Gateway 5010 Architecture

Gateway 5010 Overview

CORE Service – S2M1• Provides connectivity

and specifies protocols

Adapter – S3M3• Transforms data into the

MITA compliant format

MITA Service – S1M3• MITA business service

performs the functional-ity

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

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

Gateway 5010 – Architecture

Gateway 5010 – Architecture

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 ob-

jects 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 defi-

nition Developing standard WSDL to be used by all im-

plementers

Inquire Member Eligibility – Data Model

Inquire Member Eligibility – Overview

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 Mul-

tipart 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

CORE Service – Real Time Model

CORE Service – Batch Model

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

IME Adapter – Model

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

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.

IME Activity Diagram

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

Gateway 5010 - Questions