e-referral initiative · 2014-11-10 · referral. the initiative will facilitate better control on...
TRANSCRIPT
e-Referral Initiative Technical Specifications Version 1.0
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Table of Contents
OVERVIEW 2
SCOPE 2
WHY E-REFERRAL 2
ABBREVIATIONS 2
EREFERRAL INITIATIVE CYCLE 3
INVOLVED TRANSACTION 3
EREFERRAL TRANSACTIONS 3
EREFERRAL CYCLE 4
EREFERRAL TRANSACTION STATUS 4
EREFERRAL ACCESS 5
CONNECTING TO EREFERRALHUB 5
CREDENTIALS TO UTILIZE EREFERRALHUB 5
EREFERRAL BUSINESS PROCESS 6
PROCESS 1: UPLOAD EREFERRAL 6
PROCESS 2: CANCEL EREFERRAL 9
PROCESS 3: DOWNLOAD AND DISPENSE EREFERRAL 10
PROCESS 4: RELEASE EREFERRAL 11
PROCESS 5: DISCHARGE EREFERRAL 11
EREFERRAL SCENARIO EXCEPTIONS 12
REFERRAL FROM CLINICIANS OUTSIDE DUBAI 12
REFERRAL TO CLINICIANS OUTSIDE DUBAI 12
EREFERRAL TRANSACTION TRACKING 12
EREFERRAL STATUS UPDATES 13
REFERRING CLINICIAN 13
DOWNLOADING CLINICIAN 13
EREFERRAL WEB SERVICE DOCUMENTATION 14
UPLOAD EREFERRAL (PROVIDER) 14
GET MISSING EREFERRAL REFERENCE NO. (PROVIDER) 15
GET REFERRAL DETAILS (PROVIDER) 16
DOWNLOAD EREFERRAL FILE (PROVIDER & PAYER) 17
LOCK EREFERRAL (PROVIDER) 18
RELEASE EREFERRAL (PROVIDER) 19
DISCHARGE EREFERRAL (PROVIDER) 20
GET NEW EREFERRAL (PAYER) 21
SEARCH EREFERRAL HISTORY (PROVIDER & PAYER) 22
SET EREFERRAL AS DOWNLOADED (PAYER) 24
WEB SERVICES RETURNED VALUES 25
EREFERRAL WEB SERVICES ADDRESS \ WSDL 25
WEB SERVICES WSDL 25
EREFERRAL INITIATIVE IMPLEMENTATION ERROR! BOOKMARK NOT DEFINED.
IMPLEMENTATION IN DUBAI ERROR! BOOKMARK NOT DEFINED.
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Overview
Scope As the insurance sector in the emirate of Dubai is expanding rapidly with the introduction of the new
mandatory insurance law, the Dubai Health Authority is introducing a new gate keeping initiative called e-
Referral. The initiative will facilitate better control on the insurance spending towards a more cost effective
insurance market.
eReferral initiative is a computer based referral system between General and specialist clinicians within the
same as well as different healthcare facilities. The system will enable a clinician to transfer a patient to a
different clinician based on their specialty or specialty group through the eReferralHub (Part of the DHPO).
eReferral will provide insurance companies with tracking evidence of the referral rout taken by the patient.
Dubai is the first to implement such an electronic gate keeping solution in the region.
This document will discuss and outline the business and processing aspects of the eReferral initiative to
help all involved parties configure the technical connections and establish the business requirements
through the involved transactions’ schemas.
Why e-Referral Dubai Mandatory Insurance Law (11) is anticipated to increase the insured population in the emirate of
Dubai up to three folds the existing market size by the end of 2016. Dubai Health Authority is keen on
introducing smart electronic systems to facilitate easy transactions, gain visibility and maintain controls to
guarantee a cost effective Healthcare Insurance sector. Moreover, it is being a supportive decision-making
tool by making patient transfer history available now of referring the patient from the clinician side, as well
as adjudicating the claim on the payer side.
eReferral will play an important role in enabling the DHA to achieve the goals mentioned below:
Track patient referrals and transfers form one clinician to another.
Implement a Cost Containment model through a gate keeping routing process for clinician visits.
Reduce doctor-shopping habits performed by patients.
Abbreviations Below is a list of the abbreviations that may be used within the document body:
Abbreviation Description
DHA Dubai Health Authority
eReferral Electronic Referral Transaction
DHD Dubai Health DataDictrionary
DHPO Dubai Health Post Office
eReferralHub Component of the DHPO managing the eReferral transactions
Payer Healthcare Service Payer
Provider Healthcare Service Provider
Receiver Transaction receiver
Referring Clinician Clinician that is referring the patient to a given specialty
Specialty Clinician’s specialty as provided by the licensing authority
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eReferral Initiative Cycle Below is a diagram representing the high-level cycle covered within the eReferral initiative.
Figure 1: eReferral Cycle
Involved Transaction
eReferral Transactions eReferral cycle consists of the transactions shown below:
Transaction Description
Upload eReferral Transaction of submitting an eReferral from the referring clinician to the eReferral Hub
Download eReferral Summary Transaction of downloading an eReferral Summary by the Healthcare Facility from the eReferralHub.
Download eReferral File Transaction of downloading the full eReferral details by the Clinician from the eReferralHub.
Lock eReferral Transaction of setting the eReferral as Locked. The transaction can’t be downloaded by another clinician any more.
Release eReferral Transaction of releasing an eReferral transaction if it is not used by the downloading clinician.
Cancel eReferral Transaction of cancelling an eReferral transaction by the referring clinician.
Forward eReferral Transaction of forwarding a downloaded eReferral to another specialty. (Same as upload eReferral)
Discharge eReferral Transaction of discharging a patient once the referral cycle is completed by the downloading clinician.
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eReferral Cycle
Below is a transaction flow for the eReferral cycle performed on the system. Each line provides the
transaction source, destination, name, content and status as per the cycle diagram provided above.
No. Source Destination Action Input DHPO output
1 Referring Clinician
eReferralHub Upload eReferral
eReferral XML file Upload Result; eReferral Reference No.; Error Report;
2 eReferralHub Downloading Clinician
Download eReferral Summary
eReferral reference No. Member ID
eReferral General Info; Error Report;
3 eReferralHub Downloading Clinician
Download eReferral Full
eReferral reference No. Member ID
eReferral XML File; Error Report;
4 Downloading Clinician
eReferralHub Lock eReferral
eReferral reference No. Member ID
Lock Result; Error Report;
5 Downloading Clinician
eReferralHub Release eReferral
eReferral reference No. Member ID
Release Result; Error Report;
6 Referring Clinician
eReferralHub (Forward) Upload eReferral
eReferral XML file Upload Result; eReferral Reference No.; Error Report;
7 Downloading Clinician
eReferralHub Discharge eReferral
eReferral reference No. Member ID
Discharge Result; Error Report;
eReferral Transaction Status eReferral transaction will undergo several different statuses throughout its journey in the eReferral system
as shown below (Status list below is related to the eClaimLink eReferral System and may not apply to
other legacy systems developed by providers):
No. Transaction Status Description
1 Upload eReferral Posted eReferral is uploaded and available for download.
2 Cancel eReferral Canceled eReferral is cancelled and cannot be downloaded anymore.
3 Lock eReferral Locked eReferral is downloaded and locked from the eReferralHub. Transaction cannot be downloaded anymore.
4 Release eReferral Released eReferral is available for download
5 Forward eReferral Forwarded eReferral is forwarded\uploaded and available for download.
6 eReferral Expired (internal)
Expired eReferral is expired after passing the period defined by the DHA (1 month), without being downloaded by any clinician.
7 eReferral Discharged
Discharged eReferral is discharged after the last visit at the specialist.
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eReferral Access As eReferralHub will be managing the eReferral transactions, certain access and rules need to be set to manage the cycle.
Connecting to eReferralHub eClaimLink solution provides two channels for connecting to the eReferralHub:
An online portal for all the licensed Clinicians utilizing the eClaimLink portal in order to serve the Dubai population, to submit and download electronic referrals through the regulatory eReferralHub under their registered facilities.
A direct link to the eReferralHub though web services. (Details provided later in this document)
Credentials to utilize eReferralHub eReferralHub will manage eReferrals based on the Facility Credentials.
Access will be granted for all facilities registered on eClaimLink.
eReferrals will be allowed only for Clinicians that are listed under a given facility through the Settings Page.
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eReferral Business Process Below is a business process description of the eReferral processes:
Process 1: Upload eReferral
Uploading an eReferral by the referring Clinician to the eReferralHub will be utilized in two cases: 1.
Uploading a new eReferral Transaction, 2. Forwarding a downloaded eReferral Transaction.
Figure 2: Upload eReferral
1. Fill in eReferral Details: A minimum set of mandatory fields are requested to complete the transaction (defined the table below). Providing additional information will facilitate higher quality services and record keeping for the patient. Provider\Clinician has the option to utilize their internal HIS systems to communicate directly to the DHPO through web services, or to utilize the free of charge eReferral System provided by the DHA through the eClaimLink system.
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Table 2.2 eReferral Data Elements
A full list of elements with their definitions, types and restrictions is available at the DHD \ Schema section
on the eClaimLink Portal (Direct Link)
No. Element Description Mandatory
1 Header Header element of the eReferral transaction Yes
1.1 SenderID ID of the facility sending the eReferral Yes
1.2 ReceiverID ID of the facility receiving the eReferral Yes
1.3 TransactionDate Date of the transaction Possible values: DD/MM/YYYY
Yes
1.4 DispositionFlag To indicate the file type (TEST or PRODUCTION) Yes
2 Referral Prescription element of the eReferral transaction Yes
2.1 ID Unique Identifier to track the eReferral Yes
2.2 Type Type of the Electronic.Referral being submitted Possible values: Referral, Cancellation, Discharge
Yes
2.3 PayerID Represents the ID of the eReferral payer Possible values: Insurance License, SelfPay (cash patient)
Yes
2.4 Start Referral start date and time Possible values: dd/mm/yyyy HH:MM
Yes
2.5 End Referral end date and time Possible values: dd/mm/yyyy HH:MM
Yes
2.6 Clinician eClaimLink ID of the referring clinician Yes
2.7 Specialty eClaimLink ID of the destination specialty of the eReferral Yes
2.8 PreviousReferral ReferenceID
Reference Number of the pervious eReferral in the case of the transaction being a second referral
No
2.9 Member Member element of the eReferral transaction Yes
2.9.1 MemberID Unique reference ID of the patient receiving the eReferral Possible Values: Insurance Member ID, or other unique identifier of the member.
Yes
2.9.2 EmiratesIDNumber Number of the patient’s Emirates ID Possible values: Emirates ID Number, or Default values for members that do not have an ID.
Yes
2.9.3 DateOfBirth Birth Date of the patient Possible values: DD/MM/YYYY
No
2.9.4 Email Valid patient email account No
2.10 Diagnosis Diagnosis element of the Electronic.Referral Yes
2.10.1 Type Principal, Secondary, Admitting Yes
2.10.2 Code ICD code of the diagnosis (Predefined list) Yes
2.11.1 Observation Observation element within the Activity Yes
2.11.1 Type Type of the observation Yes
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Possible values: Predefined list
2.11.2 Code
Code of the observation Possible values: Predefined list
If you are using the eClaimLink eReferral system, this field will be auto filled in the background.
Yes
2.11.3 Value
Value of the observation
if you are using the eClaimLink eReferral system this field will be called: o If Type= Text “Reason for Referral” to enter the
referral reason. o If Type= File “file” to upload the needed
document
No
2.11.4 ValueType Type of the detail entered in the value field
If you are using the eClaimLink eReferral system, this field will be auto filled in the background.
No
2. Upload eReferral: Clinician generates and uploads the eReferral to the eReferralHub using the free of charge eReferral System provided by the DHA through the eClaimLink Portal \ Applications. Or utilizing the direct web-services method UploadReferral (documentation provided in a separate section below). Forward eReferral: if the clinician has received the patient through an electronic referral, and would like to further refer this patient to a new clinician specialty for a valid reason then aside from the eReferral details, the clinician should enter the eReferral Reference ID of the original downloaded eReferral within the field (PreviousReferralReferenceID) of the new eReferral. (This link will enable the providers and payers from tracking the chain of referrals). eReferral Transaction Status upon upload
Transaction is valid Status = Posted (available, and can be downloaded)
Transaction is expired Status = Expired (locked, and can’t be downloaded)(validity period to be decided by DHA as part of the Business rules on eClaimLink DHD)
`
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Process 2: Cancel eReferral
Cancellation of the eReferral is utilized in case the referring clinician needs to cancel or modify a successfully
uploaded eReferral. Cancellation is allowed only for posted eReferrals. Expired, Locked, Dispensed and
already cancelled transactions cannot be cancelled another time.
Figure 3: Cancel eReferral
1. Cancel eReferral: the referring clinician can cancel an eReferral in the eReferralHub using the free of charge eReferral System provided by the DHA through the eClaimLink Portal \ Applications. Or utilizing the direct web-services method UploadReferral (documentation provided in a separate section below), with the Referral Type = Cancellation. eReferral Transaction Status
Transaction is cancelled status = Canceled (available, and can be downloaded)
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Process 3: Download and Discharge
Once the eReferral is available at the eReferralHub, facilities and clinicians are able to download and dispense the eReferral (As long as it is valid and not Expired, Locked or Canceled)
Figure 4: Download and Process eReferral
1. Download eReferral Summary: Facility downloads the eReferral summary (only) using the free of charge eReferral System provided by the DHA through the eClaimLink Portal \ Applications. Or by utilizing the direct web-services method GetReferralDetails to validate if the specialty is available at the facility, and then direct the patient to the right clinician. (documentation provided in a separate section below)
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2. Lock eReferral: Facility or clinician confirms accepting the eReferral using the free of charge eReferral System provided by the DHA through the eClaimLink Portal \ Applications. Or by utilizing the direct web-services methods:
DownloadReferralFile to download the eReferral XML file from the eRferralHub.
LockeReferral to lock the eReferral and ensure it is not downloaded by a different facility or clinician.
eReferral Transaction Status
Transaction is Downloaded status = Locked (locked, and can’t be downloaded)
Process 4: Release eReferral
If a clinician evaluates an eReferral transaction after locking it and decides to release it so it can be downloaded by another clinician within the needed specialty:
1. In the case of deciding to reject the eReferral transaction, the clinician must release the eReferral using the free of charge eReferral System provided by the DHA through the eClaimLink Portal \ Applications. Or by utilizing the direct web-services method ReleaseReferral. (documentation provided in a separate section below) eReferral Transaction Status
Transaction is Released status = Released (Posted, and can be downloaded)
Process 5: Discharge eReferral
If a clinician evaluates an eReferral transaction after locking it, completes the needed services and decides to discharge the patient:
1. In the case of deciding to discharge the patient, the clinician must discharge the eReferral using the free of charge eReferral System provided by the DHA through the eClaimLink Portal \ Applications. Or by utilizing the direct web-services method dischargeReferral. (documentation provided in a separate section below) eReferral Transaction Status
Transaction is Discharged status = Discharged (Inactive, and can’t be downloaded)
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eReferral Scenario Exceptions
Referral From Clinicians outside Dubai
DHA advises to have the referring facility and clinician register on the eClaimLink system and send
the eReferral transaction electronically.
In case the referring clinician and facility are not registered on the eClaimLink, then the receiving
facility will submit a ClaimSubmission to the Payer and fill in the reference source using the
Encounter.TransferSource the name and licenses of the referring clinician and facility. (Field details
can be found in the eClaimLink Portal \ Dubai Health Data-Dictionary (DHD) page under the Schema
section).
Referral To Clinicians outside Dubai
Facilities and clinicians utilizing the eReferral system must be registered and activated on the
eClaimLink system.
In case the receiving clinician and facility are not registered on the eClaimLink, then the sending
facility will submit an eReferral transaction on the eReferralHub, and print out an eReferral form to
be provided to the patient in the out of Dubai facility or clinician.
eReferral Transaction Tracking Below is a brief demonstration of the logic and IDs utilized within the eReferral and eClaim process to link the transactions.
No Source Destination Transaction File Link ID
1 Referring Clinician eReferralHub eReferral.Request eReferral.Request ID, eReferral Reference No.
2 eReferralHub Downloading Clinician eReferral.Request eReferral.Request ID, eReferral Reference No.
3 Discharging Clinician
eReferralHub eReferral.Request eReferral Reference No.
3 Claim.Submission DHPO Claim.Submission eReferral Reference No., ClaimID
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eReferral Status Updates
Referring Clinician
Initial Status Action Final Status
Upload eReferral Posted
Posted Download eReferral Summary Posted
Posted Download eReferral XML File Posted
Posted Lock eReferral Locked
Posted Cancel eReferral Cancelled
Posted Edit eReferral Existing eReferral: Cancelled New eReferral: Posted
Posted Request eReferral Again New eReferral: Posted
Posted Expire Expired
Released Cancel eReferral Cancelled
Released Modify Existing eReferral: Cancelled New eReferral: Posted
Released Request Again New eReferral: Posted
Downloading Clinician
Initial Status Action Final Status
Download eReferral Summary Posted
Posted Download eReferral XML File Posted
Posted Lock eReferral Locked
Locked Release eReferral Released
Locked Forward eReferral Posted
Locked Discharge eReferral Discharged
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eReferral Web Service Documentation
Upload eReferral (Provider) Web service method: UploadReferral
Description: Web service method used to upload transaction content in xml format to post office. Validation rules will be applied to make sure that uploaded files are in good shape.
Signature: int UploadReferral (
string facilityLogin, string facilityPwd, string clinicianLogin, string clinicianPwd, base64Binary fileContent, string fileName, out int UploadReferralResult, out string eReferalReferenceNo, out string errorMessage, out base64Binary errorReport)
Element Description
facilityLogin Facility user login name to connect to the DHPO\eReferralHub
facilityPwd Facility user password to connect to the DHPO\eReferralHub
clinicianLogin Clinician user login name to connect to the DHPO\eReferralHub. (Allowed to be Null)
clinicianPwd Clinician user password to connect to the DHPO\eReferralHub (Allowed to be Null)
fileContent content of the file to upload (must be base 64 Binary encoded)
fileName original file name; this file name will be used later to show users the available files for download
UploadReferralResult Result of the upload method. Value Table provided in a separate section below
eReferalReferenceNo Unique Reference Number for the eReferral Generated by the DHPO\eReferralHub for tracking purposes.
errorMessage
output parameter that contains the transaction status: Error: error message if something goes wrong; web service can also send warnings using this parameter; the parameter may be null or empty string if the web service returns zero, otherwise the error message is expected Successful: empty
errorReport output parameter that contains byte array with the content of error report eventually generated by DHPO\eReferralHub Validation during file upload; the parameter may be null
Return value: The web service may return values described in the section Web Services Returned Values.
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Get Missing eReferral Reference No. (Provider) Web service method: GetReferralReferenceNo
Description: web service used to get the most recent eReferral Reference Number on DHPO\eReferralHub for this member.
Signature:
int GetRecentReferralReferenceNo (
string facilityLogin,
string facilityPwd,
string memberID,
out int GetReferralReferenceNoResult,
out string eReferalReferenceNo,
out string errorMessage)
Element Description
facilityLogin user login name to connect to the DHPO\eReferralHub
facilityPwd user password to connect to the DHPO\eReferralHub
memberID ID for a given member (member insurance card number).
GetReferralReferenceNoResult Result of the GetReferralReferenceNo. Value Table provided in a separate section below.
eReferalReferenceNo eReferalReferenceNo of the missing eReferral transaction.
errorMessage
output parameter that contains eventual error message if something goes wrong; web service can also send warnings using this parameter; the parameter may be null or empty string if the web service returns zero, otherwise the error message is expected
Return value: The web service may return values described in the section Web Services Returned Values.
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Get Referral Details (Provider) Web service method: GetReferralDetails
Description: web service used to get a summary of a given eReferral transaction available on the DHPO\eReferralHub. The service returns back an XML containing the Referral transactions details.
Signature:
int GetRreferralDetails (
string facilityLogin,
string facilityPwd,
string eReferalReferenceNo,
string memberID,
out int GetReferralDetailsResult,
out string xmlReferralDetailsMessage,
out string errorMessage)
Element Description
login user login name to connect to the DHPO\eReferralHub
Pwd user password to connect to the DHPO\eReferralHub
eReferalReferenceNo eReferalReferenceNo reference of a given eReferral.
memberID ID for a given member (member insurance card number).
GetReferralDetailsResult Result of the GetReferralDetails. Value Table provided in a separate section below.
xmlReferralDetailsMessage output parameter that contains xml with description of the eReferral details including File ID.
errorMessage
output parameter that contains eventual error message if something goes wrong; web service can also send warnings using this parameter; the parameter may be null or empty string if the web service returns zero, otherwise the error message is expected
Return value: The web service may return values described in the section Web Services Returned Values.
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Download eReferral File (Provider & Payer) Web service method: DownloadReferralFile
Description: web-service used to download the new eReferral requests from the DHPO\eReferralHub.
Signature:
int DownloadReferralFile (
string Login,
string Pwd,
string clinicianLogin,
string clinicianPwd,
string fileId,
out int DownloadReferralFileResult,
out string fileName,
out base64Binary file,
out string errorMessage)
Element Description
Login user login name to connect to the DHPO\eReferralHub
Pwd user password to connect to the DHPO\eReferralHub
clinicianLogin Clinician user login name to connect to the DHPO\eReferralHub. (Allowed to be Null)
clinicianPwd Clinician user password to connect to the DHPO\eReferralHub (Allowed to be Null)
fileId id of the file to receive the downloading link for; this id is received from xml file returned by GetNewReferral web services
DownloadReferralFileResult Result of the DownloadReferralFileResult. Value Table provided in a separate section below.
filename XML file name that is being downloaded
File file content as byte array returned by the web server to the caller
errorMessage
output parameter that contains eventual error message if something goes wrong; web service can also send warnings using this parameter; the parameter may be null or empty string if the web service returns zero, otherwise the error message is expected
Return value: The web service may return values described in the section Web Services Returned Values.
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Lock eReferral (Provider) Web service method: LockeReferral
Description: web service used to get report that an eReferral transaction is locked for a given facility and clinician on the DHPO\eReferralHub.
Signature:
int LockeReferral (
string facilityLogin,
string facilityPwd,
string clinicianLogin,
string clinicianPwd,
string eReferalReferenceNo,
string memberID,
out int LockReferralResult,
out string errorMessage)
Element Description
login user login name to connect to the DHPO\eReferralHub
Pwd user password to connect to the DHPO\eReferralHub
clinicianLogin Clinician user login name to connect to the DHPO\eReferralHub. (Allowed to be Null)
clinicianPwd Clinician user password to connect to the DHPO\eReferralHub (Allowed to be Null)
eReferalReferenceNo eReferalReferenceNo reference of a given eReferral.
memberID ID for a given member (member insurance card number).
LockReferralResult Result of the LockReferralResult. Value Table provided in a separate section below.
errorMessage
output parameter that contains eventual error message if something goes wrong; web service can also send warnings using this parameter; the parameter may be null or empty string if the web service returns zero, otherwise the error message is expected
Return value: The web service may return values described in the section Web Services Returned Values.
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Release eReferral (Provider) Web service method: ReleaseReferral
Description: web service used to get report that an eReferral transaction is released for a given facility and clinician on the DHPO\eReferralHub.
Signature:
int ReleaseReferral (
string facilityLogin,
string facilityPwd,
string clinicianLogin,
string clinicianPwd,
string eReferalReferenceNo,
string memberID,
out int ReleaseReferralResult,
out string errorMessage)
Element Description
login user login name to connect to the DHPO\eReferralHub
Pwd user password to connect to the DHPO\eReferralHub
clinicianLogin Clinician user login name to connect to the DHPO\eReferralHub. (Allowed to be Null)
clinicianPwd Clinician user password to connect to the DHPO\eReferralHub (Allowed to be Null)
memberID ID for a given member (member insurance card number).
eReferalReferenceNo eReferalReferenceNo reference of a given eReferral.
ReleaseReferralResult Result of the ReleaseReferral. Value Table provided in a separate section below.
errorMessage
output parameter that contains eventual error message if something goes wrong; web service can also send warnings using this parameter; the parameter may be null or empty string if the web service returns zero, otherwise the error message is expected
Return value: The web service may return values described in the section Web Services Returned Values.
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Discharge eReferral (Provider) Web service method: dischargeReferral
Description: web service used to confirm the discharge of the patient for a given facility and clinician (Specialist) on the DHPO\eReferralHub.. The report will be accessible by the referring GP.
Signature:
int dischargeReferral (
string facilityLogin,
string facilityPwd,
string clinicianLogin,
string clinicianPwd,
string eReferalReferenceNo,
string memberID,
out int dischargeReferralResult,
out string errorMessage)
Element Description
login user login name to connect to the DHPO\eReferralHub
Pwd user password to connect to the DHPO\eReferralHub
clinicianLogin Clinician user login name to connect to the DHPO\eReferralHub. (Allowed to be Null)
clinicianPwd Clinician user password to connect to the DHPO\eReferralHub (Allowed to be Null)
MemberID ID for a given member (member insurance card number).
eReferalReferenceNo eReferalReferenceNo reference of a given eReferral.
dischargeReferralResult Result of the dischargeReferral. Value Table provided in a separate section below.
errorMessage
output parameter that contains eventual error message if something goes wrong; web service can also send warnings using this parameter; the parameter may be null or empty string if the web service returns zero, otherwise the error message is expected
Return value: The web service may return values described in the section Web Services Returned Values.
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Get New eReferral (Payer) Web service method: GetNewReferral
Description: web service used to get a list of new eReferral transactions available on the DHPO\eReferralHub. The service returns back a list of transactions that haven’t yet been flagged as downloaded.
Signature:
int GetNewReferral (
string PayerLogin,
string PayerPwd,
out int GetNewReferralResult,
out string xmlTransactions,
out string errorMessage)
Element Description
Payerlogin user login name to connect to the DHPO\eReferralHub
PayerPwd user password to connect to the DHPO\eReferralHub
GetNewReferralResult Result of the GetNewReferral. Value Table provided in a separate section below.
xmlTransactions output parameter that contains xml with description of the eReferral files
errorMessage
output parameter that contains eventual error message if something goes wrong; web service can also send warnings using this parameter; the parameter may be null or empty string if the web service returns zero, otherwise the error message is expected
Return value: The web service may return values described in the section Web Services Returned Values.
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Search eReferral History (Provider & Payer) Web service method: SearchReferralHistory
Description: The web service performs advanced search for uploaded eReferral transactions.
Signature:
int SearchReferralHistory (
string facilityLogin,
string facilityPwd,
int direction,
sting clinicianLicense,
sting memberID,
string eReferalReferenceNo,
int transactionStatus,
string transactionFromDate,
string transactionToDate,
int minRecordCount,
int maxRecordCount,
out int SearchReferralHistoryResult,
out string foundTransactions,
out string errorMessage)
Element Description Mandatory
facilityLogin user login name to connect to the DHPO\eReferralHub Yes
facilityPwd user password to connect to the DHPO\eReferralHub Yes
direction
flag to indicate if function will search for sent or received transactions; the parameter may have values 1 (sent only) or 2 (received only);
Yes
clinicianLicense
License of the clinician on the e-Prescription; if the parameter is NULL, it is not used as search criteria; otherwise the parameter value must be in the list of licenses your DHPO login is associated with. Restrictions:
If Null: consider all
Yes
memberID
ID of the patient on the e-Prescription Restrictions:
Provider\Pharmacy the field is mandatory
Provider\Clinician\Facility the field is optional
Payer the field is optional
If Null: consider all
No
eReferalReferenceNo Reference number generated for the eReferral by the DHPO\eReferralHub.
If Null: consider all No
transactionStatus
flag to indicate if function will search for new transactions or transactions already downloaded from the DHPO\eReferralHub; the parameter may have values 1 (new only) or 2 (already downloaded only);
Yes
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transactionFromDate
transaction date from which the e-claim files will be found; the parameter may not be in the future;
date must be provided as a string in a format 'dd/MM/yyyy HH:mm:ss';
if time is missed, the zero is used by default;
if the parameter is NULL, it is not used as search criteria
If Null: consider 3 months data up to current date
No
transactionToDate
transaction date until which the e-claim files will be found;
the parameter may not be in the future;
date must be provided as a string in a format 'dd/MM/yyyy HH:mm:ss';
if time is missed, the zero is used by default;
if the parameter is NULL, it is not used as search criteria
If Null: consider 3 months data up to current date
No
minRecordCount
minimum number of records in the transaction file to search for.
If the parameter is greater than zero, it must be less or equal to the value in the parameter maxRecordCount;
Restrictions:
if the parameter is -1, it is not used as search criteria
If Null: consider 1
minRecordCount has to be < maxRecordCount
No
maxRecordCount
maximum number of records in the transaction file to search for; if the parameter is greater than zero, it must be greater or equal to the value in the parameter minRecordCount; Restrictions:
if the parameter is -1, it is not used as search criteria
If Null: consider 50 latest records
maxRecordCount < 500
No
SearchReferralHistoryResult Result of the SearchReferralHistory. Value Table provided in a separate section below.
foundTransactions
output parameter that contains xml with description of the found eReferral files;
note that this web service will return maximum 500 records
errorMessage
output parameter that contains eventual error message if something goes wrong;
web service can also send warnings using this parameter; the parameter may be null or empty string if the web service returns zero, otherwise the error message is expected.
Return value: The web service may return values described in the section Web Services Returned Values.
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Set eReferral as Downloaded (Payer) Web service method: SetReferralDownloaded
Description: web service is used to report the eReferral file as downloaded. User is supposed to call this we service to avoid receiving the same eReferral file using GetNewReferral web service.
Signature:
int SetReferralDownloaded (
string PayerLogin,
string PayerPwd,
string fileId,
out int SetReferralDownloadedResult,
out string errorMessage)
Element Description
PayerLogin user login name to connect to the DHPO\eReferralHub
PayeryPwd user password to connect to the DHPO\eReferralHub
fileId id of the file to receive the downloading link for; this id is received from xml file returned by GetNewReferral web services
SetReferralDownloadedResult Result of the SetReferralDownloaded. Value Table provided in a separate section below.
errorMessage
output parameter that contains eventual error message if something goes wrong; web service can also send warnings using this parameter; the parameter may be null or empty string if the web service returns zero, otherwise the error message is expected
Return value: The web service may return values described in the section Web Services Returned Values.
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Web Services Returned Values All DHPO\eReferralHub web services share the return value, so that client application can implement one handler to process the result of web service execution and share it with all web service calls. The supported returned values are shown below:
Element Description
login user login name to connect to the DHPO\eReferralHub
3 Member has no approved trade drugs, hence Prescription transaction is not returned.
2 No new prior authorization transactions are available for download.
1 E-claim transaction validation succeeded with warnings.
0 Operation is successful.
-1 Login failed for the user.
-2 E-claim transaction validation is failed with errors.
-3 Required input parameter for the web service is empty, or null, or contains invalid value.
-4 Unexpected error occurred.
-5 If difference between date from and date to parameters is longer than 100 days.
-6 The specified file is not found.
-7 Transaction is not supported.
-10 If no search criteria is found.
eReferral Web Services Address \ WSDL eReferral web services are available on this Address:
https://www.eclaimlink.ae/DHPO/eReferralTransactions.asmx
Web Services WSDL eReferral web services WSDL are available on this Address:
https://www.eclaimlink.ae/DHPO/eReferralTransactions.asmx?wsdl