Medical Claims Electronic Data Transfer DataLink Questions and Answers

Transcription

1 Medical Claims Electronic Data Transfer DataLink Questions and Answers 1.0 General Questions 1.1 Q. What are the changes and/or improvements in the new Medical Claims Electronic Data Transfer (MC EDT) service? A. Improvements in the new MC EDT service include: Enhanced security features; Ability to process large files of any format and content; Ability to designate 3 rd parties to act on behalf of a Health Care Provider (HCP); Internet availability through an existing broadband connection. No need for specialized modems and outdated protocols; Provision of a web based user interface for practices that do not have a suitable Electronic Medical Records (EMR) system; Provision of a web services interface to allow EMR systems to provide automated interfaces. 1.2 Q. What security improvements does the new MC EDT service have? A. The new MC EDT service utilizes a robust Identity and Access Management system to manage and support user authentication. In addition, all traffic to and from MC EDT is encrypted with server side using SSL transport layer security (256 Bit AES). Any system wishing to communicate with the MC EDT service must be able to support this algorithm and key strength. 1.3 Q. What is e-access? A. e-access is the name given to the framework which supports consumption of a set of business services provided by MOH using a common technology platform. Health Card Validation (HCV) and MC EDT are among the first services being provided under this e-access framework. All e-access services will be delivered with a consistent set of technologies and interfaces. July 6, 2011 Page 1 of 9

2 1.4 Q. Is there still a mailbox in the MC EDT service? A. In the MC EDT service the idea of the mailbox is still present. A mailbox is essentially associated with each CSN/Billing Number. However, unlike the current EDT Service, a user/account may have access to any number of mailboxes (at least one for each billing number) for which they have been given access through the designate process. 1.5 Q. Can software vendors provide a downstream service based on the e-access MC EDT web service? A. Yes. Software vendors are free to provide value added services for their clients and functionality consistent with the relevant security standards by developing to the web services interface. 1.6 Q. The current EDT has a function to send a file from one user to another. Is this function still provided? A. No. The user to user functionality will not be available in the new service. 1.7 Q. Can I use the old EDT and the new MC EDT service at the same time? A. All files that are currently sent to the old EDT service will be sent to the MC EDT service as well. Once the existing EDT user migrates to the new MC EDT service, access to the old EDT service will be suspended. 1.8 Q. What kind of Internet Service Provider (ISP) should I choose? A. Any ISP is acceptable to the ministry. 2.0 Development Questions 2.1 Q. Will a user interface be provided? A. Yes. A simple web user interface will be provided for those end users that do not have an automated/integrated system. This interface will provide the basic functions to upload, download, submit and list content very similar to the functionality provided today with the current EDT service. July 6, 2011 Page 2 of 9

3 2.2 Q. Can software vendors build upon the user interface? A. No. Software vendors must use the web services interface. Screen scraping or utilizing the HTML/HTTP interface may not be used by automated systems. 2.3 Q. Are there any changes to existing file formats? A. No. Only the filename conventions have changed. Users and software vendors may use any convention they wish for naming local files (if necessary). 2.4 Q. What are the file name conventions? A. Software vendors/users may choose any file naming convention they wish consistent with their operating system standards. In some cases, file names may no longer be relevant as vendors may choose not to generate intermediate files. 2.5 Q. How do I know what files remain to be downloaded? A. All downloads will be tracked on a user by user (logged in account) basis. Functions will be provided within the user interface and web services interface to LIST documents based on search criteria such. Detailed information will be provided at a later date. 2.6 Q. What kind of search criteria will I have on listing documents? A. This information will be provided at a later date. 2.7 Q. What kind of support can I expect during development? A. Support is available for questions regarding technical specifications. Support will not be provided to assist in troubleshooting or issue resolution for systems external to the ministry. 2.8 Q. Will a REST interface also be provided in addition to the SOAP web service interface? A. No. Currently SOAP 1.2 is the OPS standard. July 6, 2011 Page 3 of 9

4 2.9 Q. How many documents can I upload/download at one time? A. The interface is synchronous and therefore documents can only be sent or retrieved one at a time. However, software vendors may initiate multiple connections in order to initiate multiple concurrent download/uploads. Further details on this will be provided at a later date as part of the detailed specifications Q. Will I be required to encrypt the payload or is SSL/TLS sufficient? A. SSL/TLS is expected to be sufficient. This is being reviewed as part of our internal Threat Risk Assessment/Privacy Impact Assessment process. The full requirements for encryption will be provided at a later date as part of the detailed specifications Q. When I upload and submit a file to OBEC or Claims Processing, where will the file be stored? A. Files are stored based on the owner of the content that is being uploaded. Only Health Care Providers (HCP) can be owners. When a designate upload/submits on behalf of an HCP the content is stored within an area owned by the HCP and for the specific billing numbers used by the HCP Q. Can the MC EDT service be utilized as a mechanism for general storage of content? A. No. Only relevant material specific to the ministry may be uploaded Q. My software already requires the HCP to obtain and/or provide a certificate. Can we use that certificate for authentication instead of an Enterprise Identity Athentication Management (EIAM) account? A. No, not at the present time. This ability may be provided in the future 2.14 Q. What kind of network access will our HCP s require? A. Any broadband internet connection or access via ehealth Ontario with DSL speeds will be sufficient. A user may choose any technology including DSL, T1, Dialup TCP/IP, Satellite and WiMAX as long as it meets the security standards required by the Government of Ontario Information Technology Standards (GO ITS). July 6, 2011 Page 4 of 9

5 2.15 Q. Will files/documents be compressed on download? A. Yes, if requested. There is an option for compression. The actual method and technology are still under investigation and will be provided at a later date. 3.0 Functionality Terminology Questions 3.1 Q. What is a document? A. A document is the term used to describe any content that is uploaded or downloaded using MC EDT. As an example, it may be a claim file, an OBEC request, a Remittance Advice or Primary Care Report. Documents may be downloaded with any file name. All documents within the MC EDT service are provided a global unique identifier. This identifier is used for all actions within the MC EDT service. The original filename and a LOCAL ID attribute and description are stored with the Document by MC EDT to assist users and software vendors with relating an internally generated file with the file/document on MC EDT. 3.2 Q. What is the difference between uploading and submitting a document? A. Uploading a document only transfers its content to the MC EDT system. In order to have that document sent to Claims Processing or OBEC (as an example) it must be submitted. A document is always uploaded and associated with the Health Care Provider and a specific billing number (even if it is uploaded by a designate). 3.3 Q. What is a Claims Submission Number (CSN)? A. The CSN is more commonly referred to as a billing number and is a six character field assigned to a Health Care Provider by the ministry for the purposes of submitting medical claims. 3.4 Q. What is a Group Number? A. The Group Number is a four character field that is assigned to a group of Health Care Providers and is used with the CSN for billing purposes. July 6, 2011 Page 5 of 9

6 3.5 Q. What is a Stakeholder Number (SN)? A. A SN is a unique ten character number assigned by the ministry to every Health Care Provider or agent who is registered on the Corporate Provider Database. This number is for internal use and should not be shared. 3.6 Q. What is a designate? A. A designate is third party to whom a Health Care Provider has delegated some level of privilege to act on their behalf. A Designate could be a member of the Health Care Provider s staff, a billing agent or another health care provider. 3.7 Q. Can a designate be a designate for multiple Health Care Providers? A. Yes. A person with one account from EIAM can be a designate for any number of Health Care Providers. 3.8 Q. Can a designate have different privileges for each designation? A. Yes. A person may have download only capability for certain document types for Health Care Provider A, and have completely different capabilities for Health Care Provider B. 3.9 Q. Can another Health Care Provider be a designate? A. Yes. Anyone with a valid account from EIAM and who is enrolled to e- Access/EDT can be a designate Q. Will there be an Application Program Interface (API) for handling of designates or the self service account management functions from EIAM? A. No. This function is being provided though a Web User Interface provided by EIAM Q. What is a Service User? A. A Service User is the term used to identify the authorized user (Health Care Provider) of a service through e-access and may also be referred to as a Primary Account Holder. July 6, 2011 Page 6 of 9

7 3.12 Q. What is an End User? A. An End User is the person actually using the service and may be the same as the Service User or may be a designate. 4.0 User Accounts and Designate Access Questions 4.1 Q. Will the current EDT accounts be used for the new EDT system? A. No. MC EDT users will be required to set up a new account using Enterprise Identity and Access Management (EIAM), a self service system provided by the Ontario Public Service (OPS). 4.2 Q. How will a user obtain an account from the OPS EIAM? A. A web self service mechanism is being provided to allow users to create their own usernames in a similar fashion to that provided by ONe key. To properly assure EIAM that users are authentic, the ministry will communicate the process to current EDT users and new Health Care Providers registering for the first time. Additional details on this process will be provided at a later date. 4.3 Q. How will designates obtain an account from EIAM? A. A workflow self service mechanism will be provided by EIAM to allow HCPs to request designate accounts. Using this process, HCP s staff will be able to create and administer their own accounts. Note that third party service providers, such as billing agents, will register with the ministry and establish their own account. HCPs will be able to designate permissions for claim submission and report retrieval to their Billing Agents, as well as change these designations. 4.4 Q. Can a designate further designate the access they have been given? A. No. A designate does not have the capability to further designate privileges. July 6, 2011 Page 7 of 9

8 4.5 Q. Can a username and password be shared with an HSP staff person? A. No. A user s name and password are for individual use only as per Government of Ontario Information Technology Standards. HSP staff such as Clerical and Accounting persons will be given their own username and password. Through the designate process, an HCP can confer privileges to other accounts to act on behalf of the HCP, including other HCP s. 4.6 Q. What features will this self service account management provide? A. The self service mechanism will allow an HCP and an HCP s associates (designates, Billing Agents) to: Create his/her account based on the shared secret provided by the ministry; Manage that account (change attributes, reset password); and Assign and manage designates. 5.0 Conformance Testing Questions 5.1 Q. Will conformance testing be required? A. Yes, this is now a mandatory requirement. Software vendors are responsible for ensuring that their solution continues to be in conformance with the ministry s published specifications. All submissions using the MC EDT service will be checked to ensure the software has successfully completed conformance testing. 5.2 Q. How do I schedule a conformance test? A. When you have completed your software changes you can contact the Service Support Contact Center (SSContactCentre.MOH@ontario.ca or ). 5.3 Q. What are the tests that need to be passed and the details of those tests? A. Mandatory conformance tests will be determined based on the published business and technical specifications. These documents will be available in the fall/winter of 2011/12. July 6, 2011 Page 8 of 9

9 5.4 Q. What kind of support can I expect for conformance testing? A. The ministry will maintain an environment for conformance testing and will provide support to software vendors during the prearranged conformance testing window. Support will include communicating details of test data available for software vendor use, account set up, confirming test outcomes and assistance with troubleshooting relevant to technical specifications during initial integration testing and formal conformance testing. 5.5 Q. Will a software vendor have the ability to run through the conformance tests prior to actually performing the formal test? A. The ministry will support software vendor integration testing as a preliminary step to confirm the software vendor system s readiness for formal conformance testing. 5.6 Q. How will my software be certified once I have performed and passed conformance testing? A. Software vendors who pass certification will be provided with a conformance key that must be inserted into the web service call as part of the request. Web service calls will be rejected without a valid conformance key. Details will be provided as part of detailed specification at a later date. 5.7 Q. If I make enhancements or changes to my software do I have to go through conformance testing again? A. Software vendors must ensure that their solution continues to be in conformance with the ministry s published specifications and must submit any changes to their application for conformance testing. The ministry is not responsible for interruptions to Health Care Providers ability to upload / download / submit files caused by changes to software vendor systems. 5.8 Q. If my system has been certified through conformance testing and I haven t made any changes to it, will I have to conformance test again for any reason? A. The ministry may require software vendors to reconfirm their system s conformance as a result of changes to the ministry s service. In this case, the requirement will be communicated well in advance. July 6, 2011 Page 9 of 9