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Über dieses Buch

Building a successful health care claims processing EDI implementation in BizTalk Server can be complex. Decisions must be made around how to extract and publish data, how to map to the 837 EDI standard, and how to appropriately batch and deliver data. If architected properly, your BizTalk solution can be highly efficient, simple, and something that can be managed and extended for years to come.

The topics in this book include building complete inbound and outbound solutions for 837 Institutional and Professional EDI document types. In addition, topics around 997/999 acknowledgements and related document types are included. Covering mapping, trading partner configuration, AS2, SFTP, data extraction, data routing, and batching, you will find this to be a goldmine of information to aid you in a successful implementation.

Inhaltsverzeichnis

Frontmatter

Chapter 1. Architectural Patterns

Abstract
BizTalk is a development platform that lends itself to a variety of implementation styles. After you’ve worked with the platform on a number of projects, however, you will find that there are really only a few patterns that meet the critical requirements of a well-developed solution. In this chapter you look at some of the most appropriate architectural patterns for health care implementations, centered on the specific requirements of the Professional Health Care Claim in the 837P 5010 format.
Mark Beckner

Chapter 2. Solution: Receiving 837P Data

Abstract
In this chapter you walk through a complete end-to-end solution on how to build out BizTalk to receive 837P documents from an external trading partner and send an acknowledgement back. The data is received via an SFTP adapter, archived using a .NET assembly, processed by an orchestration, and written to a flat file in the ECSIF format. You are introduced to many of the key concepts required in virtually any environment that you may find yourself having to develop within. The overview of this specific solution is shown in Figure 2-1.
Mark Beckner

Chapter 3. Solution: Sending 837P Data

Abstract
In the previous chapter you looked at inbound 837P data—this chapter you will look at outbound 837P data. It introduces how to pull data from a source SQL Server database, map that data to an outbound 837P document, and batch the results into one file with multiple claims per ST/SE. There is important information presented about how best to interact with SQL from BizTalk, how to structure the source data you’ll be mapping from, and how to batch the data using configurations available in the BizTalk Party Agreement. The architectural overview of this solution is shown in Figure 3-1.
Mark Beckner

Chapter 4. Mapping Data

Abstract
Constructing and deconstructing the data in the various EDI formats associated with health care is a task that requires both analysis and development skills. There are people within claims management who specialize in working with data as it is defined in the various formats, and someone acting as an EDI analyst will be critical during initial inbound and outbound BizTalk map implementations.
Mark Beckner

Chapter 5. Ports, AS2 and Acknowledgements

Abstract
The actual receipt and delivery of files is central to any solution. The most common approaches to receiving and sending data within the EDI Health Care space include SFTP, encrypted data over standard FTP, and secure communications over AS2. SFTP is a simple custom adapter setup and configuration. Dealing with encrypting and decrypting data over FTP requires custom code. Configuring AS2 for direct party-to-party communication requires certificates and complex configurations within BizTalk. This chapter details the set up and configuration for each of these methods, as well as how to successfully deliver various forms of EDI acknowledgements.
Mark Beckner

Backmatter

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