SIC Billing Framework Usecase

Overview: SIC Billing Feed Implementation for Core & Supplemental Data

Learning Objective
This content outlines the process for transforming source data files (LDEx and SIC.txt) into two distinct output formats based on coverage codes (Core or Supplemental). The goal is to route Core coverage data to a database and Supplemental coverage data to a pipe-delimited CSV.

Object Zip: Click Here

Key Components of the Implementation:

1. SIC_PF_Inbound_Input_To_Canonical

   • Converts LDEx and SIC.txt files into a canonical format.

   • Published as a template for transaction creation.

2. SIC_PF_Orchestration

   • Splits records by coverage codes (Core and Supplemental).

   • Calls specific process flows for Supplemental (SIC_PF_Canonical_To_V3) and Core (SIC_PF_StructureCanonical_To_EBMR) records.

3. SIC_PF_Canonical_To_V3

   • Performs validation and transformation for Supplemental records.

   • Generates error reports for invalid Supplemental records and stores them in Adeptia shared locations.

4. SIC_PF_StructureCanonical_To_EBMR

   • Validates and transforms Core records.

   • Generates error reports for invalid Core records.

5. SIC_PF_MERGE_ERROR_REPORT

   • Collects error reports generated by both Supplemental and Core flows for further review and processing.

6. SIC_Generic_Error_Flow

   • Activated when errors occur during any of the process flows.

   • Sends email notifications and logs error details in the database.

Target Output Formats:

• Core Data: Routed to a database.

• Supplemental Data: Converted to a pipe-delimited CSV format.

Error Handling:

• Error reports are stored in Adeptia shared locations and handled through automated flows. Upon the failure of any flow, email notifications are sent.