WebSphere Transformation Extender
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1 IBM Software Group WebSphere Transformation Extender Healthcare Industry Packs Overview IBM Corporation
2 Agenda WTX Overview Business Value of WTX HC Packs Technical Details of WTX HC Packs Q&A 2
3 What Does IBM WebSphere TX Do? It takes any kinds of data from their native forms ANY Data Processes them together, natively, with NO CODE Many-to-many Integration And outputs them into their native target formats ANY Data Ex. - Hierarchical Data, Binary Data, Packed Data, Tabular Data, Relational Data, Nested Structures, Mixed-Type Data, and on and on 3
4 Delivering Mission Critical Solutions On average, over U.S. $1.6T* in transactions flows through WebSphere TX on a daily basis Major Stock exchanges 9 of 10 Major U.S. Financial Firms 75% of BC/BS claims 6 of 10 Major Insurance Firms 3 of 3 Top U.S. Pharmacy Benefits Providers 6 of 6 Top Global Banks 6 of 10 Top U.S. Banks, 4 of 5 UK Top UK Banks Major Global and National Telecoms and on and on and on. * $1.6T is based on available, tangible measurements. Actual estimates are in excess of this amount. 4
5 Examples of Complex Transformation Challenges Addressed by WebSphere TX Data Enhancement Lookups Data Logic and Routing Data Validation Context Based Data and Usage Rules Many to Many Transformation Single-Transaction, interdependent data sets, conversions and logic Mixed Data and Source/Target Types Dependent Result Sets, Nested Structure Dependencies Complex Data Transformation Nested, Semi-structured And Hierachical Data Types Dependent Inputs And Outputs Binary, Packed, EBCDIC, ASCII, Mixed Character Data 5
6 The Components of a WebSphere TX Solution Adapter Type Tree Type Tree Adapter Adapter Adapter Type Tree Type Tree Rules Type Tree Adapter Sources Mapping Destinations An adapter is a technical connector which can be plugged into a source or destination - without parsing! A Type Tree is a graphical representation of meta-data Map rules define how a Source structure is transformed to a Destination structure A Map can perform many tasks : Validation Enrichment, Content Based Routing etc. SOURCE FILE CROSS-REFERENCE TABLE DATABASE UPDATE TRANSFORMED MESSAGE ON OUTPUT 6
7 Describe the Data... IBM WebSphere TX Type Trees The Type Trees defines the structure of the data to be handled in IBM WebSphere TX Validation Item / Field Restrictions (Enumerations, Exclusions, Pattern, Range) Cross-field validation (Ex. HIPAA Date qualifier & date field...d8 / RD8) Cross-record validation (Ex. GS Count must equal # of transaction sets) Occurance restrictions (Ex. Mandatory / Optional / Situational ) 7
8 Map Designer - Creating transformation rules 8
9 Healthcare Industry Trends and Futures Increasing Pressure to Control Costs Improving Productivity and Processes Focus on Improving Quality of Care Business Value of WTX Healthcare Packs Clinical Collaboration Virtualization of IT in healthcare Security and compliance Medical Banking Consumer Directed Healthcare Electronic Medical Records 9
10 NPI National Provider Identifier ICD-10- and ICD-10-PCS International Classification of Diseases (Standard Diagnostics), Procedure Coding System New HIPAA e-prescribing /NCPDP & Scripts Medical Banking: 24-hr electronic fund transfer payments on claims HSA Healthcare Savings Accounts Electronic Claims Attachments with CDA (Clinical Data Architecture) standard CMR (Computerized Medical Records), EHR (Electronic Health Records), PHR RHIO Regional Healthcare Information Organization Infrastructure, Community Health Consortiums Consolidated Health Informatics CHI Adopted Standards: LOINC (Lab Result names), HL7(scheduling,medical record/image, observation report messaging), NCPDP (retail pharmacy transactions), DICOM (image information to workstation) 10
11 Claims processing requires robust EDI Gateway EDI Document (837D, 837P, 837I) Healthcare HUB Integrate Administration & Financials EDI Document (997, 277, 824, 835) WebSphere TX HIPAA & EDI Pack Load ODS Retrieve original Claim Data Update Claims System Claims Adjudication System Return Result Route Dental Claims Dental Adjudication System 11
12 Capitol Blue Cross Empire Blue Cross Premera Blue Cross Blue Shield Trigon Blue Cross Blue Shield Kentucky Montana Tennessee Kansas City Georgia NJ - Horizon Independence Blue Cross Regence WllMark IBM Software Group WebSphere software IBM WebSphere Integration Solutions Blue Cross/Blue Shield customers Anthem Blue Cross Blue Shield - Administar Federal Alabama Cahaba GBH Blue Cross and Blue Shield of NE PA - Veratus Western PA - Highmark Missouri - Alliance Hawaii - HMSA Florida - First Coast Service Options Puerto Rico Triple S Rhode Island Arkansas HCSC BC/BS of Illinois BC/BS of Texas BC/BS of Oklahoma Over 70% of all Blue Cross/Blue Shields have IBM Information Integration Software and over 40% use it for HIPAA compliance 12
13 WTX Pack for HIPAA EDI 4.3 Type Trees X12N Documents All Mandated Documents (V4010, V4010A, V5010) Claim Status/Patient Information (V /276) All Draft Standards (V5010) Technical Details of WTX Healthcare Packs Legacy Data Formats CMS NSF (V3.0.1) HIPAA HL7 NCPDP UB92 (V5.0, V6.0) WTX Maps Over 25 HIPAA Legacy Format Sample Transformations Sample Data 50 Sample Data Files All X12N Documents Plus CMS, UB92 and NSF 13
14 HIPAA and Related Transactions Supported 837 Health Care Claim: Professional, Institutional, Dental 277 / 275 Health Care Claim Request for addt l info / Claim Attachment 270 Eligibility, Coverage or Benefit Inquiry 271 Eligibility, Coverage or Benefit Information 834 Benefit Enrollment and Maintenance 835 Health Care Claim Payment/Advice 276 Health Care Claim Status Request 277 Health Care Claim Status Notification 278 Health Care Services Review Information Request for Review 278 Health Care Services Review Information Response to Request 820 Payment Order/Remittance Advice 14
15 WTX Pack for HIPAA EDI 4.3 Validation And Acknowledgement SNIP/WEDI Validation Types 1-4 out-of-the-box Examples of Types 5-7 (codeset) validation Includes Validation of Embedded XML (CDA) All Types of Functional Acknowledgments Simple FA (997) HIPAA FA (999) Application Advice (824) Undeliverable (TA1) Simple English Acknowledgments (html)!! Callable, Configurable Compliance Checking!! 15
16 HL7 (Health Level 7) The HL7 Business Problem International Scope Exchange of Information Related To Patient Care Patient Administration (Admissions, Discharges, etc.) Clinical Orders (Requests for Testing) Scheduling (Appointments) Observation Reporting (Care Notes) Laboratory Results (Test Data) Designed to be Extended Two Categories of Messages Version 2.x (EDI-Style) Version 3.x (XML) 16
17 WTX Pack for HL7 V4.3 Type Trees Versions 2.1 through 2.6 The validation rules check for the following: valid segments segment order maximum segment and loop occurrences element attributes (for example, size and data type) adherence to HL7 syntax rules as defined in the HL7 standard HL7 Version 3.x Data Does Not Require Pack for HL7 Use the Built-In XML Importer or Map Directly to Schema (V8.2) 17
18 HL7 Pack Components Message types and their corresponding message events 18
19 WTX Pack for NCPDP The NCPDP Business Problem Submission of Pharmaceutical Claims Specific to U.S. Also Mandated By U.S. Government Part of HIPAA Limited to Retail Pharmacy Designed for Request/Reply Architecture 19
20 NCPDP Data B1OKAT AM04C2M628899C302C90 AM01C52CACLARACBMATAL AM07EM1D E103D D300 D5090D80E AM11DU FBE { AM03DB EZ05 20
21 WTX Pack for NCPDP V4.2 Type Trees V3.2 and V5.1 Only Includes HIPAA Mandated Documents Maps Sample Maps To Create Reports From Requests and Replies Sample Data Eligibility Request/Response Rebill Request/Response Reversal Request/Response Claim Request/Response 21
22 Position WTX Healthcare Pack In Any Architecture Communications Reporting Partner Management Security/ Encryption WPS/WMB/WESB Validation/ Acknowledgement Transformation Orchestration Community Management WebSphere TX With Healthcare Industry Pack 22
23 Summary What WebSphere TX Provides Interoperability Connect applications, databases, processes within the enterprise Partners, processes across enterprises Powerful transformation and routing Speed Easy design and implementation No re-training Fast maintenance without coding Rapid adaptation to change Simplified Complexity Graphical integration views Consistent approach to multiple types of integration Reusable objects Adaptability Leverage your proven IT infrastructure Fully support your choice of IT investments (i.e. messaging middleware ) Non-invasive integration Snappable modules 23
24 Q & A 24
25 Grazie Italian Thai Traditional Chinese Russian Gracias Spanish Obrigado Brazilian Portuguese Danke German Merci French Arabic Simplified Chinese Japanese 25
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