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!

Dec 102008

A friend recently asked me about retrieving the policy number and returning it to the orchestration.

Here is the official response:

The Policy() object has properties MajorVersion and MinorVersion. However, rx remedy the Policy object is not exposed by the CallRules shape, so you would have to write some code in order to get it.