Table 5. Siebel eHealthcare Integration Messages
Type
|
Message
|
Target Application
|
Description
|
ASI
|
Request Add/Cancel Group Policy Member
|
Policy Administration System
|
A message to add or cancel a group policy member.
For information, see Application Services Interface Reference: Siebel eBusiness Application Integration Volume VI.
|
ASI
|
Response Add/Cancel Individual Policy Member
|
Policy Administration System
|
A message to add or cancel an individual policy member.
For information, see Application Services Interface Reference: Siebel eBusiness Application Integration Volume VI.
|
ASI
|
Request Authorization
|
Referrals and Authorizations System
|
A message to search for appropriate providers.
For information, see Application Services Interface Reference: Siebel eBusiness Application Integration Volume VI.
|
ASI
|
Request Benefit Detail
|
Benefits System
|
A message to submit information required for determining eligibility.
For information, see Application Services Interface Reference: Siebel eBusiness Application Integration Volume VI.
|
ASI
|
Request Member Details Update
|
Membership System
|
A message to update demographic and contact details for a member.
For information, see Application Services Interface Reference: Siebel eBusiness Application Integration Volume VI.
|
ASI
|
Request Preliminary Rating
|
Rating Engine
|
A message to request a preliminary rate based on census and plan information.
For information, see Application Services Interface Reference: Siebel eBusiness Application Integration Volume VI.
|
ASI
|
Request Providers
|
Provider System
|
A message requesting benefit detail.
For information, see Application Services Interface Reference: Siebel eBusiness Application Integration Volume VI.
|
ASI
|
Request Referral
|
Referrals and Authorizations System
|
A message to submit authorization request.
For information, see Application Services Interface Reference: Siebel eBusiness Application Integration Volume VI.
|
ASI
|
Update Provider Details
|
Provider System
|
A message to update the demographic and contact details for a provider.
For information, see Application Services Interface Reference: Siebel eBusiness Application Integration Volume VI.
|
VCML
|
Request Claim Status Date Request
|
Claim Administration System
|
A request message for claim status and date.
|
VCML
|
Request Claim Status Date Response
|
Claim Administration System
|
The response message to a request message for claim status and date.
|
VCML
|
Request Claims Adjudication Request
|
Claim Administration System
|
A message submitting claims detail to request for adjudication.
|
VCML
|
Request Claims Adjudication Response
|
Claim Administration System
|
The response message to an adjudication request. It may contain advice of amount payable and Explanation of Benefits.
|