Sample Scenario Business Description

This sample scenario and its Projects demonstrate the configuration of eXchange to support HIPAA. The scenario involves the HIPAA PM and two TPs, an Atlanta healthcare provider company, and a Berlin health insurance company. The current viewpoint is assumed to be Atlanta.

The resulting B2B solution functions as follows:

• HIPAA 270 Health Care Eligibility Benefit Inquiry payloads are read from a local (internal) file.

• The individual payloads are wrapped in the inner and outer HIPAA envelopes and sent to the Berlin TP.

• Berlin replies with a TA1 and 997 Functional Acknowledgments.

• Berlin delivers an 271 Health Care Eligibility Benefit Response eXchange prepares and writes the individual response payloads to an internal file and displays the messages in Message Tracking.

You can change the sample’s scenario to reverse the companies’ sender and receiver roles, if you want (see Chapter 6, HIPAA PM Sample Scenario Tutorial for more details). See Using Message Tracking for details on this feature.

Figure 5–1 shows a diagram of the HIPAA PM sample’s basic operation.

Figure 5–1 Sample Scenario Diagram

For a more detailed diagram, see Figure 6–1.