Provider Integration Point
When providers' details of providers are primarily maintained outside Oracle Health Insurance, Oracle Health Insurance needs an up-to-date copy of these details. The Provider Integration Point enables external parties to create and maintain these copies.
Operations
Individual Providers |
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Organizational Providers |
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Rules
Uniqueness
A provider’s code in combination with a flex code definition is unique to the application’s providers. The flex code definition can refer to, for example, an external party that delivers the provider codes.
A provider’s identifier of a unique identifier type is unique to the application’s providers.
Create or Update Behavior
External interfaces determine when request messages are sent and what they contain. Each request message contains one of the following:
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Individual provider details
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Organization provider details
Provider codes are unique within a given provider flex code definition. The provider code in combination with its flex code definition drives whether the API creates a new provider or updates an existing one
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If the provider code is not included in the message, the system generates a code using that provider’s signature,
Provider Code Generation
. If no dynamic logic function with the signature Provider Code Generation exists, the ID will be assigned to provide code. The provider flex code definition must be included in each message.
Request Messages
Each request message may contain the details of one provider (individual or organization). The external interfaces will create request messages for the initial data load and in response to entry and update of providers.
Individual Provider
Individual provider request messages have the following structure:
Example of an Individual Provider Request Message (click to open)
<providerIdentifierList> <providerIdentifier identifierTypeCode="" identifier="" enabled="" /> </providerIdentifierList> <providerTitleList> <providerTitle titleCode="" /> </providerTitleList> <renderingAddressList> <renderingAddress startDate="" endDate="" > <serviceAddress street="" houseNumber="" numberAddition="" additionalPart1="" additionalPart2="" additionalPart3="" city="" postalCode="" countryRegionCode="" countryCode="" /> </renderingAddress> </renderingAddressList> <providerSpecialtyList> <providerSpecialty specialtyCode="" startDate="" endDate="" /> </providerSpecialtyList> <providerGroupAffiliationList> <providerGroupAffiliation providerGroupCode="" startDate="" endDate="" /> </providerGroupAffiliationList> <bankAccount relationCode="" bankCode="" bankAccountNumber="" />
Provider Group Affiliations
Provider group affiliations are handled as time valid details of the individual provider. This means that all provider group affiliations of that individual provider (in all provider groups) are replaced by the new list of provider group affiliations (if specified).
Addresses
Rendering addresses are handled as time valid details. Upon insert a new service address (with the same start and end date as the rendering address) and a new rendering address with a reference to the new service address are created. Suppose an update to an individual provider results in the deletion of a rendering address.In that case, the related service address is deleted if it has no reference to an organization provider and if any other rendering address does not reference it.
Organization Provider
Organization provider request messages have the following structure:
Example of an Organization Provider Request Message (click to open)
<organizationProvider code="" flexCodeDefinitionCode="" name="" phoneNumberBusiness="" phoneNumberMobile="" phoneNumberPrivate="" emailAddress1="" emailAddress2="" faxNumber="" outputLanguageCode="" preferredLanguageCode="" startDate="" endDate="" > <providerIdentifierList> <providerIdentifier identifierTypeCode="" identifier="" enabled="" /> </providerIdentifierList> <parentOrganizationProvider code="" flexCodeDefinitionCode="" /> <serviceAddressList> <serviceAddress street="" houseNumber="" numberAddition="" additionalPart1="" additionalPart2="" additionalPart3="" city="" postalCode="" countryRegionCode="" countryCode="" startDate="" endDate="" > <renderingAddressList> <renderingAddress startDate="" endDate="" > </renderingAddress> </renderingAddressList> </serviceAddress> </serviceAddressList> <providerSpecialtyList> <providerSpecialty specialtyCode="" startDate="" endDate="" /> </providerSpecialtyList> <providerGroupAffiliationList> <providerGroupAffiliation providerGroupCode="" startDate="" endDate="" /> </providerGroupAffiliationList> <bankAccount relationCode="" bankCode="" bankAccountNumber="" /> </organizationProvider>
The address and provider group affiliation specifications are the same as for the individual provider.
Response Messages
The Oracle Health Insurance application creates the response messages in response to request messages it receives from external interfaces. See the Response Messages section in the HTTP API/IP Concepts as part of the Developer Guide for more details.
See Response Messages for more details.
Batches
This API supports sending in multiple providers in one go.
This API
The request message for sending in multiple individual providers has the following structure:
<individualProviders> <individualProvider/> -- refer to Individual Provider Request above for details </indiviudalProviders>
and for organization providers:
<organizationProviders> <organizationProvider/> -- refer to Organization Provider Request above for details </organizationProviders>
Data File Sets
Oracle Health Insurance also supports handling of multiple providers from a data file. See How to Migrate Data Using a Data File Set for more details.
The elementId
attribute that is included as part of the result messages element (see Activities for more details) contains the code and the flex code definition code (separated by a space; for example, elementId="1234567890 US_PROVIDER") of the provider for which the messages are raised.
Authorization
A user authorization configuration protects access to this feature.
The relevant access restriction is Provider In IP
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Error Messages
The following error messages that are specific to the provider interface may be returned in the response messages:
Code | Severity | Response | Message |
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REL-IP-PROV-003 |
Fatal |
Org |
Parent organization provider identified by code {code} and flex code definition code {code} is unknown. |
REL-IP-PROV-004 |
Fatal |
Ind and Org |
Bank account number {bank account number} is unknown. |
REL-IP-PROV-005 |
Fatal |
Ind and Org |
Provider bank account number matching returned more than one bank for bank account number {bank account number}. |
REL-IP-PROV-014 |
Fatal |
Ind and Org |
Flex code definition code {code} is unknown. |
REL-IP-PROV-015 |
Fatal |
Ind and Org |
Provider group code{code} is unknown. |
REL-IP-PROV-016 |
Fatal |
Ind and Org |
Specialty code {code} is unknown. |
REL-IP-PROV-027 |
Fatal |
Ind |
Title code {code} is unknown. |
REL-IP-PROV-028 |
Fatal |
Ind |
Prefix code {code} is unknown. |
REL-IP-PROV-030 |
Fatal |
Ind and Org |
Language code {code} is unknown. |
REL-IP-PROV-031 |
Fatal |
Ind and Org |
Country code {code} is unknown. |
REL-IP-PROV-032 |
Fatal |
Ind and Org |
Country region code {code} is unknown. |
REL-IP-PROV-033 |
Fatal |
Org |
Individual provider identified by code {code} and flex code definition code {code} for rendering address is unknown. |
REL-IP-PROV-035 |
Fatal |
Ind and Org |
Identifier type code {code} is unknown. |
In addition, functional business rule messages may be returned, as well as the standard messages related to dynamic fields and dynamic records. See Response Messages for more details.