File Based Import

Oracle Health Insurance Claims Adjudication and Pricing supports the import of data from file for the following entities:

Claims also supports the import of data from file for the purpose of reprocessing claims.

The Process of File Based Imports

A file based import is a two-step process:

  1. Upload the file using Data File Set Integration Point

  2. Process the file contents by initiating the proper activity type using the Activity Integration Point. For example, use the Relation Import activity type to process the file based request for relation integration point.

Parameters

The parameters for the file import based activity are as follows:

  • Data File Set Code

    This parameter indicates the data file set that needs to be processed.

    The activity can be created only when the Indicator Locked on the data file set code is "N" otherwise an error ACT-VL-FIAT-001 is raised.

    Once the activity picks up a data file set for processing (that is, starts a created activity), it places a lock on it by updating the indicator Locked to "Y". If the indicator Locked is already found to be "Y" then an error ACT-VL-FIAT-001 is raised. Activity must unlock the data file set in case if the processing completes with the errors.

  • Response Data File Set Code

    The data file set code that should be used for the data file set of the response file. If not provided the system generates a UUID based value as data file set code.

Data File Validation

The first step in every data file import activity is to check whether the datafile that is provided through the parameters is valid for the specific data import. The following checks are executed:

  1. Does the datafile exist (that is, is there a datafile in the datafile set)?

  2. Is the datafile empty?

  3. Is the datafile of the correct type for the import activity (that is, does it have the correct root element)?

Error Message

The file import based activity can result in the following messages:

Table 1. Error Message
Code Sev Message

ACT-VL-FIAT-001

Fatal

Data file set {code} is locked and cannot be picked up for processing.

ACT-VL-DAFI-001

Fatal

No data file exists in datafile set {code}.

ACT-VL-DAFI-002

Fatal

Data file {code} is empty.

ACT-VL-DAFI-003

Fatal

Data file {code} is of incorrect type for this integration point.

Example

This example gives a step-by-step explanation of how to load a data file with providers.

NOTE

Not all Oracle Health Insurance components supoort providers.

Step 1: Create Data File Set With a Data File

Request Message

The create data file set with a data file request has the following structure:

<dataFileSet code="ProviderImport_20141210_01" description ="Provider Import">
  <dataFiles>
    <dataFile
      code="IndividualProviderFile1"
      descr="Individual Provider File 1"
      filepath="system1/tmp/Providers/1_1212121_v2.xml" -- For example, reference path of the external system, for information only.
    />
  <dataFiles>
</dataFileSet>

Response Message

<dataFileSet code="ProviderImport_20141210_01">
  <links>
    <link rel="self" type="application/vnd.ohi-xml" uri="http://host:port/api/datafilesets/ProviderImport_20141210_01"/>
  </links>
  <dataFiles>
    <dataFile code="IndividualProviderFile1">
      <links>
        <link rel="content" type="text/xml" uri="http://host:port/api/datafilesets/ProviderImport_20141210_01/datafiles/IndividualProviderFile1/data"/>
      </links>
    </dataFile>
  </dataFiles>
</dataFileSet>

Step 2: Upload Content

Use the URI /datafilesets/ProviderImport_20141210_01/datafiles/IndividualProviderFile1/data and upload the file having the structure as specified in Provider Integration point.

We recommend uploading files with sizes under 20 MB. Larger files impact the stability of the system.

Request Message (JSON)

[
    {
        "code": "9200000060",
        "flexCodeDefinitionCode": "US_PROVIDER",
        "elementType": "organizationProvider",
        "name": "Organization Provider 1",
        "outputLanguageCode": "en",
        "startDate": "2010-01-01",
        "endDate": "2034-12-31"
    }
]

Request Message (XML)

<organizationProviders>
    <organizationProvider code="9200000060" endDate="2034-12-31" flexCodeDefinitionCode="US_PROVIDER" name="Organization Provider 1" outputLanguageCode="en" startDate="2010-01-01">
   </organizationProvider>
</organizationProviders>

Response Message (XML)

The add content to data file request’s success response will have an appropriate HTTP status code in the header and the following structure:

<dataFileSet code="ProviderImport_20141210_01">
  <links>
    <link rel="self" type="application/vnd.ohi-xml" uri="http://host:port/api/datafilesets/ProviderImport_20141210_01"/>
  </links>
  <dataFiles>
    <dataFile code="IndividualProviderFile1">
      <links>
        <link rel="content"  uri="http://host:port/api/datafilesets/ProviderImport_20141210_01/datafiles/IndividualProviderFile1/data"/>
      </links>
    </dataFile>
  </dataFiles>
</dataFileSet>

Step 3: Initiate the Provider Import Activity Using Create Activity

Activities

<activity level="GL" code="PROVIDER_IMPORT" description="Processed data file set 001.11">
  <parameters>
    <parameter   name="dataFileSetCode" value="ProviderImport_20141210_01"/>
    <parameter   name="responseDataFileSetCode" value="responseProviderImport_20141210_01"/>
  </parameters>
</activity>

Response Message

The start activity response has an appropriate HTTP status code in the header and the following structure:

<activity code="PROVIDER_IMPORT" status ="IN">
  <links>
    <link rel="action/startprocessing" type="application/vnd.ohi-xml" uri="http://host:port/api/activities/12345/start"/>
  </links>
</activity>

Step 4: Start Provider Import Activity

Use the URI /activities/12345/start to start the activity.

Response Message

The start activity response has an appropriate HTTP status code and location in the header and has the following structure:

<activity code="PROVIDER_IMPORT" status="IP"/>

Step 5: Get Status

Use the URI /activities/12345 to get the status of the activity

Response Message

When the activity has not concluded the response structure is

<activity code="PROVIDER_IMPORT" status="IP"/>

When the activity has concluded with business errors the response structure is

<activity code="PROVIDER_IMPORT" status="CB">
  <links>
    <link rel="messages" uri="http://host:port/api/activities/12345/messages"/>
    <link rel="datafilesets" uri="http://host:port/api/datafilesets/responseProviderImport_20141210_01/datafiles/67890/data"/>
  </links>
</activity>

Step 6: Get Result Messages

Get more information about the result message by sending a request to URI /activities/12345/messages

Response Message

<activityMessages>
  <resultMessages result="F" elementId="1234 A">
    <resultMessage code ="REL-IP-PROV-031">
      REL-IP-PROV-031: Country code AA is unknown
    </resultMessage>
  </resultMessages>
  <resultMessages result="F" elementId="1235 B">
    <resultMessage code ="REL-IP-PROV-031">
      REL-IP-PROV-031: Country code AA is unknown
    </resultMessage>
  </resultMessages>
</activityMessages>

Step 7: Get Response File

The response file is downloaded using "Get details of a data file" request from data file integration point with URI datafilesets/responseProviderImport_20141210_01/datafiles/67890/data

File Details

  <resultMessages result="F" elementId="1234 A">
     <resultMessage code ="REL-IP-PROV-031">
      REL-IP-PROV-031: Country code AA is unknown
     </resultMessage>
  </resultMessages>
  <resultMessages result="F" elementId="1235 A">
     <resultMessage code ="REL-IP-PROV-031">
      REL-IP-PROV-031: Country code AA is unknown
     </resultMessage>
  </resultMessages>