2010 mmis conference interoperability showcase presented by the technical architecture committee...
TRANSCRIPT
2010 MMIS Conference
Interoperability Showcase
Presented by the Technical Architecture Committee (TAC)
PROVIDER DESKTOPDirect Internet Connection
Schedule AppointmentStandalone Eligibility
PMS
PROVIDER EMRHIE/NHIN Connection
Integrated Eligibility VerificationStandalone Eligibility
EMR
PROVIDER EMRHIE/NHIN Connection
Integrated Eligibility VerificationStandalone Eligibility
EMR
CHIC (MN) - NHINCONNECT Gateway
Administrative NHIN Service
InternetProvider
Management
ContractorManagement
Operations Management
ProgramManagement
BusinessRelationship
Management
ProgramIntegrity
Management
CareManagement
Member Management
MITA-Based MMIS
IME
CORE with NHIN SAML Adapter
CAQH CORE IIAdapter
Medicaid-NHINCONNECT Gateway
Administrative NHIN Service
Watch the Transaction Flow forMITA Inquire Member Eligibility
PROVIDER DESKTOPDirect Internet Connection
Schedule AppointmentStandalone Eligibility
Prior Authorization Process
PMS
PROVIDER EMRHIE/NHIN Connection
Integrated Eligibility VerificationStandalone Eligibility
Prior Authorization Process
EMR
PROVIDER EMRHIE/NHIN Connection
Integrated Eligibility VerificationStandalone Eligibility
Prior Authorization Process
EMR
CHIC (MN) - NHINCONNECT Gateway
Administrative NHIN Service
InternetProvider
Management
ContractorManagement
Operations Management
ProgramManagement
BusinessRelationship
Management
ProgramIntegrity
Management
CareManagement
Member Management
MITA-Based MMISPrior Auth
CORE with NHIN SAML Adapter
CAQH CORE IIAdapter
Medicaid-NHINCONNECT Gateway
Administrative NHIN Service
Watch the Transaction Flow forMITA Authorization Service
Incorporating Clinical Data from NHIN
EMR
ProviderManagement
ContractorManagement
MemberManagement
ProgramManagement
BusinessRelationship
Management
ProgramIntegrity
Management
CareManagement
OperationsManagement
MITA-Based MMIS
- incorporate clinical data- review of clinical documents
Internet
Medicaid-NHIN CONNECT Gateway
Clinical NHIN Services
MITA Authorization Service – MITA Business Service Details
Medicaid-NHIN CONNECT Gateway
Clinical NHIN Services
278 5010 EDI
Note: Requires support for long running transactions
Prior Auth Business Process
No (service returns
response)
PA Flow DiagramProvider Desktop
NHIN Gateway
HIE System
HIE Desktop
Authentication Service
CAQH CORE
ConnectivityOrchestrator
PA Adapter(EDI to XML)
PA Service
Requires Manual
Review?
Convert Approval Data To 278 XML Response
Notification (Client Polling, Web Device
Callback, Email, etc…)
Workflow Engine
NHIN Clinical Query (Patient Discovery, Document Query,
Document Maintenance)
Approval Application
Audit Service
Authorization Service
NHIN Administrative Request (w/ CAQH CORE 278 Request)
NHIN Administrative Request (w/ CAQH CORE 278 Request)
CAQH CORE 278 Request (w/ User Security Header or X 509 Transport)
Internet
278 Request / 278 ACK Response
278/278 (w/ SAML Header)
User Token Data
SAML Assertion
Perform AuditingNHIN
Gateway
Perform Authorization
Perform Auditing
Audit Response (Options)
SAML Assertion Response
Database, CEF Flat File, etc…
Database, LDAP Flat File, etc…
Perform Auditing
Perform Authorization
Transform Request
Transform Request
Perform Auditing
Perform Authorization
Perform Auditing
Perform Authorization
Invoke Business Service (XML, Input/Output)
Perform Auditing
Perform Authorization
PA Adapter (XML to EDI)
Submit Request
Yes (service returns ACK)
Manual Review
Approve/Deny
OR
The TAC welcomes participation from all states, vendors and individuals. Please let us know of your interest, especially if you would be interested in helping to define and deploy services that are consistent with the goals of the TAC. Please contact Dave Walsh at [email protected], Kimberly Ellison-Taylor at [email protected] or Julie Walsh at [email protected].