24.06.000

Oracle Health Insurance introduced a new cloud service called Data Exchange Cloud Service (DECS). It aims to simplify and automate the exchange of operational data, such as enrollments, between payer’s core administration systems and their partners like employer groups, government authorities, and providers.

This document contains the release notes for Oracle Health Insurance Data Exchange Cloud Service.

For the product documentation library, see Oracle Health Insurance Components Product Documentation Library.

If you have any questions about the use of our products, please visit My Oracle Support.

New Features

This initial release of the Data Exchange Cloud Service offers the following functionalities:

Feature Area	Description
Designer Workbench	Introducing Oracle Health Insurance Data Exchange Cloud Service - Designer Workbench that allows you to configure end-to-end data exchanges. In this release, the Designer Workbench provides the following features: Supported Data Formats: The Data Exchange Cloud Service currently supports the processing of health insurance operational data with a transaction type of Enrollment received using: X12 HIPAA Electronic Data Interchange (EDI) 834 format Centers for Medicare & Medicaid Services Online Enrollment Center (CMS OEC) format for Medicare Advantage member enrollment Proprietary Comma-Separated Value (CSV) formats Integration with Oracle Health Insurance: Data Exchange Cloud Service provides out-of-the-box ability to exchange data with Oracle Health Insurance Enterprise Policy Administration cloud service. This enables enrollments to be sent as policy update requests using the Oracle Health Insurance Policy Administrstion data format. Key Functionalities: Exchange data using common US Healthcare data formats available out-of-the-box, including: Standard data mapping for Enrollment messages Standard data validation for Enrollment messages Create custom Data Exchanges per Trading Partner and Line of Business using: Custom inbound and outbound data mapping Custom data validation rules Custom data enrichment rules Custom severity, exceptions, and associated Exception Threshold Conditions To learn more about Designer Workbench, see the Designer Workbench Guide.
Operations Workbench	Introducing Oracle Health Insurance Data Exchange Cloud Service - Operations Workbench, which provides functionalities to manage day-to-day operational activities. In this release, the Operations Workbench offers the following features: Key Functionalities: Use dashboards to get a real-time view of all data exchange activities Check processing status and details of incoming and outgoing files and messages View and work on user tasks assigned to you to address: Transmissions pended for exceeding exception threshold – Accept or Reject these Transmissions Transactions with exceptions - Edit and re-validate to resolve exceptions To learn more about Operations Workbench, see the Operation Workbench Guide.

Feature Area

Description

Designer Workbench

Introducing Oracle Health Insurance Data Exchange Cloud Service - Designer Workbench that allows you to configure end-to-end data exchanges. In this release, the Designer Workbench provides the following features:

Supported Data Formats: The Data Exchange Cloud Service currently supports the processing of health insurance operational data with a transaction type of Enrollment received using:
- X12 HIPAA Electronic Data Interchange (EDI) 834 format
- Centers for Medicare & Medicaid Services Online Enrollment Center (CMS OEC) format for Medicare Advantage member enrollment
- Proprietary Comma-Separated Value (CSV) formats
Integration with Oracle Health Insurance: Data Exchange Cloud Service provides out-of-the-box ability to exchange data with Oracle Health Insurance Enterprise Policy Administration cloud service. This enables enrollments to be sent as policy update requests using the Oracle Health Insurance Policy Administrstion data format.
Key Functionalities:
- Exchange data using common US Healthcare data formats available out-of-the-box, including:
  - Standard data mapping for Enrollment messages
  - Standard data validation for Enrollment messages
- Create custom Data Exchanges per Trading Partner and Line of Business using:
  - Custom inbound and outbound data mapping
  - Custom data validation rules
  - Custom data enrichment rules
  - Custom severity, exceptions, and associated Exception Threshold Conditions

To learn more about Designer Workbench, see the Designer Workbench Guide.

Operations Workbench

Introducing Oracle Health Insurance Data Exchange Cloud Service - Operations Workbench, which provides functionalities to manage day-to-day operational activities. In this release, the Operations Workbench offers the following features:

Key Functionalities:
- Use dashboards to get a real-time view of all data exchange activities
- Check processing status and details of incoming and outgoing files and messages
- View and work on user tasks assigned to you to address:
  - Transmissions pended for exceeding exception threshold – Accept or Reject these Transmissions
  - Transactions with exceptions - Edit and re-validate to resolve exceptions

To learn more about Operations Workbench, see the Operation Workbench Guide.