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2010 MMIS Conference Interoperability Showcase Presented by the Technical Architecture Committee (TAC) PowerPoint Presentation
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2010 MMIS Conference Interoperability Showcase Presented by the Technical Architecture Committee (TAC). Watch the Transaction Flow for MITA Inquire Member Eligibility. PROVIDER DESKTOP Direct Internet Connection Schedule Appointment Standalone Eligibility. MITA-Based MMIS. PMS.

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Presentation Transcript
slide1
2010 MMIS ConferenceInteroperability ShowcasePresented by the Technical Architecture Committee (TAC)
slide2

Watch the Transaction Flow for

MITA Inquire Member Eligibility

PROVIDER DESKTOP

Direct Internet Connection

Schedule Appointment

Standalone Eligibility

MITA-Based MMIS

PMS

Operations

Management

Program

Management

CAQH CORE II

Adapter

Program

Integrity

Management

Contractor

Management

Care

Management

Business

Relationship

Management

Internet

CORE with NHIN SAML Adapter

Provider

Management

Member

Management

PROVIDER EMR

HIE/NHIN Connection

Integrated Eligibility Verification

Standalone Eligibility

IME

Medicaid-NHIN

CONNECT Gateway

EMR

Administrative NHIN Service

CHIC (MN) - NHIN

CONNECT Gateway

Administrative NHIN Service

PROVIDER EMR

HIE/NHIN Connection

Integrated Eligibility Verification

Standalone Eligibility

EMR

slide3

Watch the Transaction Flow for

MITA Authorization Service

Incorporating Clinical Data from NHIN

PROVIDER DESKTOP

Direct Internet Connection

Schedule Appointment

Standalone Eligibility

Prior Authorization Process

MITA-Based MMIS

Prior Auth

PMS

Operations

Management

Program

Management

CAQH CORE II

Adapter

Program

Integrity

Management

Contractor

Management

Care

Management

Business

Relationship

Management

Internet

CORE with NHIN SAML Adapter

Provider

Management

Member

Management

PROVIDER EMR

HIE/NHIN Connection

Integrated Eligibility Verification

Standalone Eligibility

Prior Authorization Process

Medicaid-NHIN

CONNECT Gateway

EMR

Administrative NHIN Service

CHIC (MN) - NHIN

CONNECT Gateway

Administrative NHIN Service

PROVIDER EMR

HIE/NHIN Connection

Integrated Eligibility Verification

Standalone Eligibility

Prior Authorization Process

EMR

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MITA Authorization Service – MITA Business Service Details

MITA-Based MMIS

Internet

Member

Management

Program

Management

278 5010 EDI

Program

Integrity

Management

Contractor

Management

Operations

Management

Prior Auth Business Process

  • incorporate clinical data
  • review of clinical documents

Care

Management

Business

Relationship

Management

Provider

Management

Note: Requires support for long running transactions

Medicaid-NHIN CONNECT Gateway

Medicaid-NHIN CONNECT Gateway

Clinical

NHIN Services

Clinical

NHIN Services

EMR

pa flow diagram
PA Flow Diagram

Authentication Service

Provider Desktop

PA Adapter

(EDI to XML)

Perform Auditing

SAML Assertion

Transform Request

User Token Data

CAQH CORE 278 Request (w/ User Security Header or X 509 Transport)

Perform Authorization

Internet

278 Request / 278 ACK Response

CAQH CORE Connectivity

Orchestrator

Perform Auditing

PA Service

Invoke Business Service (XML, Input/Output)

278/278 (w/ SAML Header)

Perform Authorization

Submit Request

Perform Auditing

Requires Manual Review?

NHIN Gateway

Perform Auditing

PA Adapter (XML to EDI)

Perform Auditing

Perform Authorization

NHIN Administrative Request (w/ CAQH CORE 278 Request)

Transform Request

No (service returns response)

OR

Perform Authorization

Perform Authorization

NHIN Gateway

Yes (service returns ACK)

Convert Approval Data To 278 XML Response

Workflow Engine

NHIN Administrative Request

(w/ CAQH CORE 278 Request)

NHIN Clinical Query (Patient Discovery, Document Query, Document Maintenance)

Notification (Client Polling, Web Device Callback, Email, etc…)

Perform Auditing

Audit Response (Options)

SAML Assertion

HIE System

Response

Audit Service

Authorization Service

Manual Review

Database, CEF Flat File, etc…

Database, LDAP Flat File, etc…

Approve/Deny

HIE Desktop

Approval Application

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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 dwalsh@esrv.com, Kimberly Ellison-Taylor at kimberly.ellison-taylor@oracle.com or Julie Walsh at julie.walsh@MolinaHealthCare.com.