Introduction to Designer Workbench

Oracle Health Insurance Data Exchange Cloud Service provides all the necessary building blocks to create an out-of-the-box data exchange . Using the Designer Workbench, you can configure these building blocks and combine them to design complete data exchanges based on your business requirements.

Design your Data Exchange

To design your first data exchange, follow these steps:

  1. Create your Line of Business

    • When building your first data exchange for a new line of business, you must create a new line of business using one of the Data Exchange Cloud Service system-defined lines of business as the base. See Manage Lines of Business.

  2. Create your Trading Partners

    • After ensuring that a proper line of business exists for your data exchange, you must create the partner that will send data to you. See Manage Trading Partners.

    • Now, you need to establish your own internal core administration system. This system acts as a partner, to receive data from your external trading partners efficiently.

  3. Create your Transmission Models

    • The transmission model combines data format and transaction type available out-of-the-box in Data Exchange Cloud Service, along with the direction of data flow and line of business, to define a unique way of receiving or sending data. See Manage Transmission Models.

    • Create two transmission models, one for data inbound from an external trading partner and another for data outbound to your core administration system or another trading partner.

  4. Create your Trading Partner Agreements

    • For your external trading partner sending the data, create an Inbound Trading Partner Agreement (TPA). See Set up an Inbound Agreement.

    • For your internal core administration system or other external trading partner receiving the data, create an Outbound Trading Partner Agreement (TPA). See Set up an Outbound Agreement.

  5. Connect Outbound TPA to Inbound TPA

  6. Configure Data Enrichment

    • When incoming data values must be cross-walked to values recognized by the DECS canonical data model or to values required by the receiving partner, you can define look-up sets to perform this data enrichment.

    • You can also use look-up sets to derive new data values based on incoming data values to meet your business requirements.

    • Look-up sets can be configured at the Transmission Model, Trading Partner Agreement, or Line of Business level. See Manage Lookup Set Definitions.

  7. Define Exceptions and Severity Levels

    • You have to define new exception codes if you intend to create new business validation rules on inbound data. See Manage Exception Definitions.

    • When defining new exception codes, you can choose to use the severity levels provided by Data Exchange Cloud Service or define your own. See Define Severity Definitions.

  8. Define Business Validation Rules

    • You can define your data validation rules on incoming data to ensure it meets your business requirements.

    • When using transmission models with the inbound data format of X12 HIPAA EDI, note that Data Exchange Cloud Service performs HIPAA SNIP level validations out-of-the-box. So, you just have to create rules for scenarios that are not part of HIPAA validations. See Define Business Validation Rules.

  9. Define Exception Threshold

    • You can create threshold conditions on the inbound trading partner agreement to stop automated processing if the total number of exceptions logged against all the transactions within a transmission meets or exceeds a specific number.

    • Defining this allows Operations Workbench users to decide whether to accept a particular transmission that meets or exceeds threshold conditions or reject it so that it does not go to outbound TPA and cause even more problems downstream. See Define Exception Thresholds.