Tanden Care Provider Interfaces Reverse Claim v1

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1 Integrationskrav.dot PB3 Tanden Care Provider Interfaces Integrationskrav ICC

2 2 (18) Attachment- and reference list Number Title, document ID, search path 1 ZT_I_028_ZSubmit.doc PA3 2 TandenTypes.xsd SHS_JMS_Interface Tanden.doc PA _01_01_E-308AutomaticFullReversalCorrections.DOC PA2 2(18)

3 3 (18) Table of contents 1. INTRODUCTION INTEGRATIONS INTEGRATION REVERSE CLAIM REQUEST... 7 Message and translation... 7 Sample XML... 9 RECEIPT Message and translation Sample XML REVERSE CLAIM RESPONSE (SYNCHRONOUS FROM ) Message and translation Sample XML ERROR MESSAGE Message and translation Possible Error Response Codes INTEGRATION REVERSE CLAIM RESPONSE (ASYNCHRONOUS FROM ) Message and translation Sample XML VOLUMES (18)

4 4 (18) 1. Introduction The main information is this document is the tables which contain all parameters and their translation between XML and BAPI parameters. There is some color codes used in the tables: Color Description Cells are changed or added in this version. Parameters are removed in this version. Parameter is not translated between XML and BAPI. Grouping element which does not contain a single value, but several parameters. Table 1 Overview over color codes used in the message parameter and translation tables. 2. Integrations The Care Provider Interface Reverse Claim makes use of two interfaces at the ESB level: No Description 1 An integration used to allow the dental system to send a reverse claim request to SAP which would be evaluated. 2 SAP pushes an evaluated response back to the dental system via ESB and SHS. If the reverse claim request is sent to manual handling, a preliminary response is sent using the same interface and message as the final response. The message request will be sent in a synchronous fashion via JMS queues from the SHS System to JCAPS. The message flow for a correction request is depicted in Figure 1. 4(18)

5 5 (18) Dental System SHS JMS ESB Rule Burst Engine 1. Reverse Claim Request 2. Reverse Claim Request Receipt Response 13. Get Message Request Get Message Request 14. Get Message Response Reverse Claim Response 19. Get Message Request Get Message Request 3. Request Delivery Reverse Claim Request 11. Dequeue Query 12. Dequeue Response Reverse Claim Response 17. Dequeue Query 18. Dequeue Response Reverse Claim Response 4. Request Delivery Reverse Claim Request 10. Manual Handling Notification Reverse Claim Response 16. Reverse Claim Response Reverse Claim Response 5. Z_REVERSE_ CLAIM_REQUEST 6. RFC Response 9. ZBAPISUB_ REVERSE_CLAIM_ RESPONSE 15. ZBAPISUB_ REVERSE_CLAIM_ RESPONSE 7. Evaluate Rules 8. Evaluate Rules Response 20. Get Message Response Reverse Claim Response Figure 1 Sequence diagram for a Reverse Claim request call. 5(18)

6 6 (18) Architecturally, the messages will flow in the following manner: Figure 2 Architectural overview over a Reverse Claim request call. In the case of an error, The JCAPS system should place the inbound message back into the processing queue to retry later. 6(18)

7 7 (18) 3. Integration 1 The interface is invoked by the dental system which sends a request and receives a synchronous response back. The second integration which describes the asynchronous response sent back to the dental system mailbox is described in the next chapter. Reverse Claim Request The Reverse Claim request message is used as an input message to the Reverse Claim interface. It contains all of the details that must be provided in order for a correction to be processed by the Försäkringskassan system. The SAP function module to call via RFC is Z_REVERSE_CLAIM_V1. Message and translation The following section describes how to translate the incoming request parameters and attributes from the XML message (i.e. a Correction message) received at the JCAPS Enterprise Service Bus into the request that must be sent to the SAP system through RFC. Any BAPI parameters that are not mentioned in the table below are optional and will not need to be sent in. Name shs-invokedinterface XML BAPI Transformation info Comments Element / Attribute Optional Data type Parameters Comp. Transformation Description Comments char (36) request-id Attribute char (36) I_REQUEST_ID No No ID used to link the request with the response. The request id is sent to the BAPI in order to be able to link the request with the asynchronous response. 7(18)

8 8 (18) XML BAPI Transformation info Comments Name Element / Attribute Optional Data type Parameters Comp. Transformation Description Comments vendor-name Attribute X char (60) N/A This attribute may be ignored. It is not sent to the BAPI product-name Attribute X char (60) N/A This attribute may be ignored. It is not sent to the BAPI version-number Attribute X char (15) N/A This attribute may be ignored. It is not sent to the BAPI organizationnumber Attribute X int (10) I_ORG_NUM No No The organizational number of the care provider. user-id Attribute int (12) I_USER_ID No No User sending the request. clinic-id Element int (8) I_CLINIC_ID No No The id that the clinic has been assigned by FK. claim-id Element int (10) I_CLAIM_ID No No The claim that is requested to be reversed by using a correction case. Table 2 Overview over parameters and their translation for the Reverse Claim Request. This parameter is sent in to be able to attach the correct organization number to the asynchronous response. 8(18)

9 9 (18) Sample XML Figure 3 Sample XML for a ReverseClaimRequest message. 9(18)

10 10 (18) Receipt A receipt is sent back to the user when the request has been received correctly. The receipt does not contain any specific parameters, just the request id and organization number in order to match the response with the request. Message and translation The parameters and translation is shown in the table below: BAPI XML Transformation info Comments Parameter Name Element / Attribute Optional Data type Comp. Transformation Description Comments N/A request-id Attribute char (36) N/A ID used to link the response with the request. N/A organizationnumber Attribute int (10) N/A Used to place the message in the right mailbox in in SHS. Table 3 Overview over the parameters and their translation for a ReceiptResponse. This value must be copied from the request-id message on the inbound request XML message. This value will also be set as a JMS property. 10(18)

11 11 (18) Sample XML The following sample demonstrates a possible response returned synchronously: Figure 4 Sample XML for the ReceiptResponse message. Reverse Claim Response (Synchronous from ) SAP will always return a synchronous response to the correction. This response will indicate if the correction was approved automatically, denied automatically or sent to manual handling. The end-user will not receive the response synchronously since a receipt was already returned but the response will be sent to the clinics mailbox inside a GetMessage container message. Message and translation BAPI XML Transformation info Comments Element Parameter Name / Attribute Optional Data type Comp. Transformation Description Comments E_STATUS Thie field will be populated with an E in case of an error and S if the call was successful. When sent as S this ReverseClaimResponse structure 11(18)

12 12 (18) N/A request-id Attribute char (36) N/A organizationnumber Attribute int (10) should be mapped. This attribute should be taken from the REQUEST-ID JMS property, specified within the UserProperties section of the message. This attribute should be taken from the <environment_prefix>_sender JMS property, specified within the UserProperties section of the message. N/A (clinic-id) N/A This attribute should be taken from the <environment_prefix>_sender JMS property, specified within the UserProperties section of the request message. E_CLAIM_STATUS status Element char (1) No No Indicating the status of the correction case for reversing the specified claim. E_CORRECTION_CASE_ID correctioncase-id Element X int (10) No No This field corresponds to the Service Order ID created in SAP Table 4 Overview over the parameters and their translation for the synchronous Reverse Claim Response. This attribute should be taken from the <environment_prefix>_sender JMS property, specified within the UserProperties section of the request message. Valid values: A = Approved M = Manual Handling D = Declined 12(18)

13 13 (18) Sample XML The following sample message demonstrates a typical response where the correction request was sent to manual approval: Figure 5 Sample XML for a synchronous ReverseClaimResponse message. Error Message An error response is sent if there is a technical problem or if the header validation fails. Technical errors could be sent directly from the ESB, but header validation errors are sent from SAP. In the case where the inbound message from SHS is corrupted or there is an issue sending the request to SAP, JCAPS will generate an error response and send it to the clinic mailbox. In the situation where the message cannot be read, values such as the RequestId and Organisation number will not be accessible, so in order to send a correct error response, in all cases details need to be retrieved from user defined JMS properties associated with the inbound message. Error messages are sent back synchronously from SAP, but asynchronously from the dental journal systems point of view. 13(18)

14 14 (18) Message and translation BAPI XML Transformation info Comments Element Parameter Name / Attribute Optional Data type Comp. Transformation Description Comments N/A request-id Attribute char (36) N/A Attribute int (10) This attribute should be taken from the <environment_prefix>_correlation_id JMS property, specified within the UserProperties section of the message. This attribute should be taken from the <environment_prefix>_sender JMS property, specified within the UserProperties section of the message. E_STATUS N/A This field is will be populated with an E. N/A error N/A E_ZCLAIM_MESSAGE\ E_ERROR_NUMBER E_ZCLAIM_MESSAGE\ E_ERROR_MESSAGE E_ZCLAIM_MESSAGE\ E_ERROR_DETAIL organizationnumber error/errorcode error/errortext error/errordetails Element Element int (3) char (255) Element X char (255) No No The unique code for the type of error that has occurred No No The header/short description of the error No No A more detailed description of the error. Table 5 Overview over the parameters and their translation for the Error Message response. 14(18)

15 15 (18) Possible Error Response Codes Code Text Source English Translation 001 Connection Error Any Connection Error 002 Technical Error Any Technical Error 003 Invalid XML SHS Invalid XML 004 Vi har just nu tekniska problem. Du ska inte skicka om din begäran utan vi kommer att hantera denna när våra problem är lösta. 901 Obligatoriska parametern <parameter> saknades 902 Otillåtna parametern <parameter> skickades in 903 Besöket kan inte registreras för tillfället, var god försök igen senare SHS - Missing parameter: <parameter> Invalid parameter: <parameter> Visit can not be registered at the moment, please try again later. (Patient locked) 910 Användaren kunde inte hittas The user could not be found in the system 911 Vårdgivar-ID kunde inte hittas The care provider could not be found in the system 912 Mottagnings-ID kunde inte hittas The clinic could not be found in the system 913 Relationen mellan vårdgivare och mottagning kunde inte hittas The relation between care provider and clinic could not be found in the system 914 Besöket kunde inte hittas The visit could not be found in the system 929 Besöket är inte godkänt/delvis avslag och kan inte korrigeras 930 Angiven klinik är inte den klinik som sänt in det ursprungliga besöket 931 Ärendet handläggs manuellt då besök inte är det senast godkända 932 Ärendet handläggs manuellt då besöket skedde för mer än 14 dagar sedan 933 Det finns en efterhandskontroll på besöket och kan inte korrigeras 934 Det finns redan en korrigering på detta besök 935 Mottagningen kan inte skicka in automatkorrigeringar The visit is not approved/partially approved and full reversal is not possible Specified clinic is not the same as the one that submitted the original visit The correction will be assessed manually since it is not the last approved visit The correction will be assessed manually since it occurred more than 14 days ago There is control case on the reimbursement visit and full reversal is not possible There is already a correction case on the specified visit The clinic can not send in automatic corrections Table 6 List of possible error messages when sending a ReverseClaimRequest. 15(18)

16 16 (18) 4. Integration 2 The interface is invoked by SAP when a claim has been processed. The initial status could be one of the following: A: Approved M: Manual Handling If the claim status is Manual Handling it means that no final decision about the claim has been taken yet. The claim request will then be handled manually after which a second response is sent with one of the following statuses: A: Approved D: Declined 16(18)

17 17 (18) Reverse Claim Response (Asynchronous from ) If the ReverseClaimRequest validates correctly after manual handling, SAP will return a ReverseClaimResponse message through the push interface. The name of the BAPI in that the ESB will use to define the structure is ZBAPIREVCLAIM_V1 The program ID that the ESB will register in SAP is ICC-REVERSE-V1 Message and translation BAPI XML Transformation info Comments Parameter Name Element / Attribute Optional Data type Comp. Transformation Description Comments E_REQUEST_ID request-id Attribute char (36) No No ID used to link the response with the request. E_ORG_NUM organizationnumber Attribute int (10) No No The organizational number of the care provider. E_CLINIC_ID N/A The id that the clinic has been assigned by FK. E_CLAIM_STATUS status Element char (1) No No Indicating the status of the correction case for reversing the specified claim. E_CORRECTION_CASE_ID correction-caseid Element X int (10) No No This field corresponds to the Service Order ID created in SAP Table 7 Overview over the parameters and their translation for the asynchronous Reverse Claim Response. Used to be able to link the request with the response sent back asynchronously The clinic id returned by SAP in order to place the message in the right mailbox. The JMS property <environment_prefix>_endrecipient will need to be populated with the value returned from SAP. Valid values: A = Approved D = Declined 17(18)

18 18 (18) Sample XML The following sample message demonstrates a typical response where the correction request validated correctly: Figure 6 Sample XML for an asynchronous ReverseClaimResponse message. 5. Volumes Number of messages: 6136 per year Mont Da Busy hour h 511 y 17 Distribution to be spread throughout the day, but likely to be more load during the workday hours Size of message: ~0.5kb Table 8 Preliminary forecast for the volumes of ReverseClaimRequest messages. 18(18)

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