Use Case Overview
Objective:
Receive individual health claim bills in JSON format from ADVA.
Merge these bills and create one EDI 837 outbound file.
Send the merged EDI 837 file to the supplemental partner.
Receive pricing from the supplemental partner in the HCP segment of the EDI 837 file.
Process the EDI 837 file and send the pricing information in JSON format back to ADVA.
2. High-Level Design Overview
A. ASB Consumer
Functionality:
Read bill JSON from Azure Service Bus (ASB).
Store the bills in the solution database named
supplementaldata.
B. MergeJSON Process
Trigger:
A calendar event triggers this process.
Process:
Pick all bills with the status "price received" and bill type.
Each partner and bill type has a different calendar event, ensuring one merged file is created for each partnerID and bill type (HCFA and UB).
C. Outbound Process
Process:
The outbound transaction picks the merged JSON to create an EDI 837 file.
Transmission:
The EDI 837 file is sent to the supplemental partner through LAN.
D. Inbound Process
Reception:
The supplemental partner sends pricing for the bill in the HCP segment of the file.
Conversion:
The inbound process picks the EDI 837 file and converts it into JSON.
E. Split JSON Process
Process:
Intermediate JSON files are picked using a file event.
Split:
The JSON is split from that file and individual JSON files are sent to ADVA through ASB.