Dec 152009

I have been thinking of BizTalk healthcare classes or writing a book for BizTalk in relation to healthcare, viagra adiposity and I thought that I would put the things that I would look for if I was going to pay for a class or heaven forbid; buy a morbid book.

1. The teacher/writer has to have healthcare experience.

2. I want to have a brief understanding of the ‘flow’ of document in a healthcare situation:

     837 (Claims) are submitted to a health plan for payment
     997 (Acknowledgments) are returned to know if they pass Type 1 and Type 2 validation
     824 (Application Notification) can be returned for Type 3 through Type 7 validation, illness depending on the capability of the backend system
     835 (Claim Status) are sent back to notify of Claim status
     270 (Eligibility Request) are sent to health plan to ask for status of patient eligibility for service
     271 (Eligibility Response) are sent from health plan in response to patient eligibility request
     276 (Claim Status Request) are sent to health plan to as for status of claim
     277 (Claim Status Response) are sent from health plan to in response of claim request
     820 (Payment Notification) are sent from the health plan to notify of payment of the claims
     834 (Eligibility) are sent for notification of eligibility

3. I want to map a 837, as that will be the transaction I will most deal with, spend a majority of the the time mapping the 837 transaction if I have to, because that is my biggest pain point.

4. Explain HL7, where it is used

    Provider transactions, largely used in intra department messaging

5. Create a sample ORU^R01 message from a flat file and create a flat file from a ORU^R01 message so I can learn the following HL7 nuances:

    Schema Generation (partner specific schema creation)
    Multipart Messages 
    MSH Segment 
    How to map the flat XML message that the BTAHL7 pipeline (DASM) creates / (ASM) expects 
    Explain MLLP, integrate it into one of the ORU labs

Things I want to briefly want to learn:

    (I need to know what they are, but it should not be the focus of a the class/book)

Things I don’t want to learn:

BAM: BizTalk in a Healthcare Scenario should never be the system of record, the Claim Payment application should be, the out-of-the-box EDI reporting functionality that comes with BizTalk accounts for 99% of what I need
BRE: BizTalk would not be used for message modification/routing/anything else the BRE can be used for, as there are entire workflows designed in every claim payment processing system that deals with changing business rules
AS2: It is too big of a beast to teach along with all of the things that I listed above, and second: NO HEALTHCARE COMPANY TRANSMITS DATA USING AS2
Purchase Orders, Invoices, Advanced Shipment Notifications: I can look at a whole plethora of examples that Microsoft publish. Maybe a MCO deals with ordering supplies for an office, but by in large, I want to know about HIPAA transactions; not transactions I would never see at work.

Anything that I missed? I am thinking of putting together an online class (or via CD) or a book, what would you like to see? Is there any interest in a BizTalk/Healthcare book?

Tell me your experiences!

  • Sree J

    This would be a really good book/class and something I have been looking for a long time. I will check back to see how this turns out

  • Jay


    It sounds like a wonderful idea to have a book on BizTalk’s optimal usage with healthcare solutions. Please keep us posted if you happen to move in that direction.

  • Focussing on claims is a very U.S.A centric scenario. The Australian and NZ health systems are free so there are no claims. ( For that matter I suspect the UK systems are similar). I find that most health software systems focus on claims which is of no use in our part of the world. What we are really interested in is flow of clinical and patient data to many different systems that avoid double entry.P.S. It looks like I will be going back to HL7 messaging project soon so I look at for your book… and I will buy a copy.

  • Mark,
    I understand your statement, but just because you don’t pay for the service, someone/something does!
    Hopefully there is enough interest in a book.

  • Ian jolly

    I’d really appreciate such a book / class. I know it’s not healthcare specific but would love to see an advanced SQL adapter sections e.g. calling multiple SP per record.

  • JJ Sonderman

    Greetings Eric,

    I’m a Biztalk Newbie tasked to implement the HIPAA transaction set. The healthcare industry has several mandates that will draw the attention of BT developers new and old.
    1) Conversion of HIPAA transactions from 4010 to 5010.
    2) Conversion of Provider Specialties to Taxonomy codes
    3) Conversion of ICD9 to ICD10
    I would also consider topics like: Security of Realtime transactions, Member/Provider lookup strategies, Backup Strategies, Rejected Claims and Troubleshooting Biztalk 2009.

    Kind Regards,

  • I had come to rely on your blog from the very beginning of my BizTalk adventure. Now as an MCTS, I still find that many of my “Bing|Google’s” searches still find you time and again. There are very few people who have your talent in this sphere.

    I will definitely purchase your book.

  • Chris

    In the past we have done everything very batch like. Now I am tasked at learning and leveraging Biztalk. So what is ahead of me: We have to split 835’s for two hospitals, and a practice. Mostly this is done with the NPI, however there is an 835 that is created based on what is in clp segment. So I create lots of 835s from 835s. within that I need to change reciever id in the ISA so that the new 835 flows into one of the many billing systems here. — I create lots or reports. I envision sending lots of data into a database. And the reports whould be generated from there. — One of our systems does not read CAS segments easily. Oh, it reads the first CAS segment. but not the second. So I have to consolidate multiple CAS segments into at least one. This may be hard for me to explain. — anyway you get the idea, I do all of my work in vb 6, and a componet called symphonia. In the future we want this all to be biztalk. And I am going to need to do this all this year:) I think I have a huge learning curve ahead of me.

  • Aniruddha

    Greetings Eric,

    Late in commenting. But your idea is excellent. We all working in the industry should have a methodical knowledge. As what we are doing and why we are doing?

    I really appreciate your idea.