1 Introduction

Oracle Health Insurance Value-Based Payments (OHI VBP) was designed to operate as a component in a component-based or service oriented architecture. This Integration Guide provides an overview of the Integration Points that are available for exchanging data with the OHI VBP application.
Additional information with respect to OHI VBP integration points is available in other guides or from the runtime system:

• Access relative URL "/api/doc" for a overview of the HTTP API services that OHI VBP supports
• See the Installation Guide for SOAP service endpoint URLs and configuration options for these
• See the Security Guide for guidance on properly securing integration endpoints

1.1 Integration Points Overview

The following diagram provides an overview of the integration points that are available for exchanging data with OHI VBP:

The arrows in the diagram indicate whether data is inbound to or outbound from the system, i.e. Member Input Details are entered into OHI VBP whereas the system produces Financial Messages (outbound data). OHI VBP comes with real-time and batch-oriented integration points for exchanging data. Real-time integration points are provided for:

• User Provisioning (inbound, request-response): this integration point is used to provide users access to the system and grant them specific roles and privileges.
• Provider Import (inbound, request-response): for entering provider data into the system and for making changes to existing provider data.

Batch-oriented integration points include:

• Member Input Details (inbound): to create and supersede member input details. Member input details are demographic details combined with enrollment data.
• Member Periods (inbound): a member period indicates that a member meets the criteria (e.g. is enrolled) for a given full or partial calendar period for one or more value-based payments contracts. Member Period records can be generated from Member Input Details or can be entered using this integration point. The
  Data File integration point is used for entering (a set of) files into the system.
• Financial Messages (outbound): to retrieve generated Financial Messages for processing these in a financial system in order to generate payments. Financial
  Message files are stored as Data Files that can be retrieved using the Data File integration point.

The following table lists additional characteristics of OHI VBP integration points and places these into context:

Name	Usage Frequency	Connects to these types of Architecture Components	Oracle Architecture Components	Must Have or Option
User Provisioning	Incidental, to give new users access to the system	User Store, like LDAP	Oracle Unified Directory	Must Have
Provider Data	Frequent, as provider (contract) data or provider networks change	Provider Contracting System		Must Have
Load Member Input Details	For every calculation period	Policy Administration for Health Products	Oracle Health Insurance Enterprise Policy Administration	Optional: either this or loading Member Periods
Load Member Periods	For every calculation period	Policy Administration for Health Products	Oracle Health Insurance Enterprise Policy Administration	Optional: either this or loading Member Input Details

User Provisioning

Before users can access OHI Components applications they must be provisioned for each application that they are supposed to work with. It is assumed that OHI Components are not the system of record for user details. This interface is meant to load a subset of user data from a source system. This integration point can be used to react to different types of changes in the source system:

• Adding a new user
• Changing data for an existing user
• Deleting an existing user
• Deactivating a user so that he or she cannot access the system and reactivating a deactivated user
• Changing user privileges, e.g. by adding a user to a group

See the Installation Guide for an overview of the operations and message formats that the User Provisioning IP supports.

Implementation details for the User Provisioning IP are summarized in the following table:

Characteristic	Value
Protocol	SOAP web service
Contract	WSDL service contract and XSDs that define the messages
Messaging pattern	Stateless, synchronous request-response

Provider Data

This integration point can be used to react to different types of changes in the source
system(s):

• Adding a new provider by first sending the relation data for the provider and subsequently sending the provider details
• Changing data for an existing provider
• Adding and changing affiliations for a provider to build up a provider network
• Logically deleting provider affiliations or providers by entering end dates for these

See the Reference Data Implementation Guide for an overview of the operations and message formats that the Provider Integration Points support.

Implementation details for the Relation and Provider Integration Points are summarized in the following table:

Characteristic	Value
Protocol	File Based, batch oriented (using the Data File Set service and Activity Processing service) or message oriented (using an HTTP API service)
Contract	See the Implementation Guide for the XML file format
Messaging pattern	File based for batch operations or stateless, synchronous request-response for the HTTP API variant

Member Input Details Import

Member input details are demographic details combined with enrollment details that can be used as the basis for generating member period records. The purpose of this integration point is to enter new member input details in OHI VBP or to supersede existing member input details. Member input details are imported from one or more XML files. The structure for the XML file is explained in an OHI VBP Implementation Guide. The contents of the file(s) are typically constructed from data is maintained in a Policy Administration system, like OHI Enterprise Policies Administration.

Entering Member Input Details into OHI VBP typically involves the following steps:

1. Create a Data File Set using the Data File Sets HTTP API resource
2. When a Data File Set is created, trigger Member Input Details import by invoking the MEMBER_INPUT_DETAIL_IMPORT activity using the Activities HTTP API resource
3. Review the results of the import activity which can be retrieved using the Data File Sets HTTP API resource

Implementation details for the Member Input Details integration are summarized in the following table:

Characteristic	Value
Protocol	Using Data File Sets and Activities HTTP API services
Contract	See the Implementation Guide for the XML file format and the RAML specification of the HTTP API for supported methods of interaction
Messaging pattern	Stateless, asynchronous request-response

Member Periods Import

A Member Period is a record indicating that a member meets certain criteria (e.g. is enrolled or aligned) so that he or she is considered 'active' for a given full or partial calendar period and is eligible to be matched to one or more value-based payments contracts.

Member Period records are the main input to OHI VBP calculations. These include a reference to the member details and enrollment periods needed for each calculation to determine if a member is covered by a calculation and for determining the rate that applies in case it is covered.

Member Periods are imported from a file set. The file set may contain multiple files. One file of a file set holds Member Period record data within the context of a Member Period Set. All Member Periods for the Member Period Set should be specified within the same file.

To start the import of Member Period data, a file set first has to be specified and file contents have to be uploaded to OHI VBP through the Data File Set HTTP API service. Details of the Data File Set web service are explained elsewhere in this guide. After the file set is prepared then the MEMBER_PERIOD_IMPORT activity needs to be executed from a user interface page or from the Activities HTTP API resource. The Import File Set needs to be specified as a parameter for this activity. The system processes the given file set and generates a Result File Set. Result files can be retrieved using the Data File Set service again.

Implementation details for the Member Input Details integration are summarized in the following table:

Characteristic	Value
Protocol	Using Data File Sets and Activities HTTP API services
Contract	See the Implementation Guide for the XML file format and the RAML specification of the HTTP API for supported methods of interaction
Messaging pattern	Stateless, asynchronous request-response

Product and Benefits Import

To successfully process value-based payments calculations based on product configurations, the OHI VBP application requires details of products that may be maintained (mastered) outside of the OHI VBP application. Where this is the case, OHI VBP needs to store an up-to-date copy of these products. This copy in the OHI VBP application is maintained by external (not part of the OHI application) interfaces using the Product and Benefits Integration Point.

Products and benefits are imported from a file set. The file set may contain multiple files. One file of a file set holds benefits and/or product record data.

To start the import of product and benefit data, a file set first has to be specified and file contents have to be uploaded to OHI VBP through the Data File Set web service. Details of the Data File Set web service are explained elsewhere in this guide. After the file set is prepared then the PRODUCT_IMPORT activity needs to be executed from the Global Activities user interface page or from the Activities HTTP API resource. The Import File Set needs to be specified as a parameter for this activity. The system processes the given file set and generates a Result File Set. Result files can be downloaded using the Data File Integration Point.

Implementation details for the Member Input Details integration are summarized in the following table:

Characteristic	Value
Protocol	Using Data File Sets and Activities HTTP API services
Contract	See the Implementation Guide for the XML file format and the RAML specification of the HTTP API for supported methods of interaction
Messaging pattern	Stateless, asynchronous request-response

Retrieving Generated Financial Messages

OHI VBP is capable of generating Financial Messages as part of various (composite) activities like the CALC_TO_FINPROC activity. Generated Financial Messages are stored in files that are made available as a Data File Set that is securely stored and managed in the Oracle database.

After completion of the Generate Financial Message activity, a message is added to the activity with a URL that can be used to retrieve the file(s) that contain Financial Messages so that these can be further processed, for example to generate payments in downstream systems.