Transcript TriZetto 2008 Corporate Template

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Copyright © 2014 TriZetto Corporation
Advancing the Architecture
via Real-Time Accumulators
DeWitt Angevine, Architect
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Agile from the start - User Stories
As a health plan, I want to be able to pay
claims on my core administration system and
have any resulting changes in deductibles
and limits reflected in my pharmacy benefits
management system.
As a health plan, I want to be able to pay
claims on my pharmacy benefits
management system and have any resulting
changes in deductibles and limits reflected in
my core administration system.
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Business Drivers
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ACA Impact
• A recent ACA mandate to comply with maximum out-of-pocket limits for
an individual and a family is driving a need for improved synchronization
of accumulators between plans and vendors.
Batch vs. Real-time
• Most plans using Facets have batch interface with their PBM vendors to
synchronize accumulators. Latency between processing and updating
systems can cause accumulators to be out of balance.
 Reduced administrative cost
 Real-time synchronization between Facets and an ancillary
benefit platform like pharmacy benefit manager (PBM) reduces
the administrative time required to handle accumulators that are
not accurately synchronized at the time of claims processing.
 Compliance
 Enables plans to support ACA requirements for MOOP.
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Architecture Requirement - User Stories
I need a way to apply transactional updates
to Facets accumulators based on
transactions occurring in an external system.
I need a way to create transactional updates
to be sent to an external system that reflect
all changes to accumulators resulting from
Facets™ processing.
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Putting it together with messages
 Scenario 1 – Payment Bundling Manager Pays Claim
 PBM generates transaction message
 “Add 100 to Accum 1 for member X”
 Message is put on a queue for delivery to Facets
 Facets receives message and adds 100 to Accum 1
 Scenario 2 – Facets™ Pays Claim
 Facets generates transaction message
 “Add 100 to Accum 1 for member X”
 Message is placed on a queue for delivery to PBM
 PBM receives message and adds 100 to Accum 1
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Defining the Groundwork for Messaging
The Solution Should….
 Enable the REST pattern
 Standard HTTP codes
 Use JSON as a message format
 Be Messaging Infrastructure Agnostic
 Enable communication with multiple messaging vendors through
the use of pluggable components
 Be Asynchronous
 Keep messaging infrastructure out of the claims transaction
bracket.
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REST API – Facets Accumulator Update
 Implemented on Microsoft ASP.NET Web API
 Does not use FXI Broker engines
 Supports multiple accumulator updates for a
member in one message.
 Uses Lock Token optimistic locking with re-try logic.
 Standard HTTP codes
 Standard MS log formats for error and trace logs.
 Can be configured to use SAML tokens and Facets
EXTU validation.
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Defining a message
{
"Status": {
"Message": []
},
"GroupId": "group1",
"SubscriberId": "subscriber1",
"MemberSuffix": 1,
"MemberAccums": [
{
"AccumType": "C",
"AccumSuffix": “SFX1",
"AccumNo": 1,
"PlanYear": 2013,
"AmountOne": {
"UpdateValue": 100.00
}
}
],
"FamilyAccums": [
{
"AccumType": "C",
"AccumSuffix": “SFX1",
"AccumNo": 1,
"PlanYear": 2013,
"AmountOne": {
"UpdateValue": 100.00
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Response Message – 201 Created
"Status": {
"HttpStatusCode": "201",
"Message": []},
"GroupId": "group1",
"SubscriberId": "subscriber1",
"MemberSuffix": 0,
"MemberAccums": [
{
"AccumType": “C",
"AccumSuffix": “SFX1",
"AccumNo": 1,
"PlanYear": 2013,
"AmountOne": {
"PriorValue": 250.00,
"UpdateValue": 100.00,
"FinalValue": 350.00
}
}
],
"FamilyAccums": [
{
"AccumType": "C",
"AccumSuffix": “SFX1",
"AccumNo": 1,
"PlanYear": 2013,
"AmountOne": {
"PriorValue": 400.00,
"UpdateValue": 100.00,
"FinalValue": 500.00
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Response Message – 400 Bad Request
"Status": {
"HttpStatusCode": "400",
"Message": [
{
"MessageCode": "100003",
"MessageLevel": "Error",
"MessageContent": "Group not found",
"MessageResolution": "GroupId was not found on
our records. Correct and resubmit.",
"ResourceInformation": [
"AccumUpdate.GroupId = ‘badGroup'"
],
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Error Logging
Message Publishing
 Updates to Accumulator tables are captured at the
Database Access Class level.
 Messages are persisted to the database using the
Facets Document Storage Model.
 Windows Service responsible for picking up
Messages and delivering them to the proper Queue.
 System Parameter to Enable Publishing.
 Configuration by Group and Accumulator to only
publish required data.
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Asynchronous Message Publishing
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MQ
Connector
Messaging Bus
Accum
Maint
Message
Store
Synch Service
Batch
Claims
DB Access Interceptor
Online
Claims
REST API – Configuration
 Ability to configure the solution without use of a GUI.
 Configuration consists of a Group ID as well as a
valid set of accumulators for the Synch Solution.
 REST services to maintain configuration.
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Add a Group (POST)
Add an accumulator (POST)
Delete an Accumulator (DELETE)
Delete a group (DELETE)
Get a Group configuration (GET)
Update an accumulator (PUT)
Copyright © 2014 TriZetto Corporation
Facets Accumulator
Solution
Demonstration
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Workshop Survey
We would like to extend you an opportunity
to provide candid feedback.
During the workshop you should have received an e-mail
notification for you to take an on-line survey.
If you could take a few minutes to complete at this time ,
we would greatly value your feedback. For your convenience,
the survey will be available throughout the remainder of the conference
should you not be able to complete immediately.
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Thank You!
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