Implementation: Bridge Network

Solution Design

This framework outlines the steps for processing an inbound EDI 837I/P file using Adeptia, sending an ASB message to ADVA, and generating an EDI 837I/P file based on the response from ADVA. The process involves several flows: Bill Submission Flow (ASB), Consume ADVA Flow (ASB), Aggregate Flow, and Outbound Flow.

Step-by-Step Instructions


Inbound Transaction

  1. Receive Inbound EDI 837I/P File

    • Input: EDI 837I/P file

    • Process: Adeptia receives the inbound EDI 837I/P file from the trading partner.

    • Output: An intermediate json with file level info into the solution DB.

  2. Initial Validation

    • Input: EDI 837I/P file

    • Process: Validate the file for compliance with EDI standards and business rules.

    • Output: Validated EDI 837I/P file or error report if validation fails.


Bill Submission Flow (ASB)

  1. Extract Bill Details

    • Input: Intermediate json

    • Process: Split json per bill for submission, add json in ASB queue along with insertion of bill level information into billdetails table.

    • Output: json in ASB queue along with bill level information into billdetails table

  2. Create ASB Message

    • Input: Extracted bill details

    • Process: Format the bill details into an ASB message suitable for ADVA.

    • Output: ASB message containing the bill details.

  3. Send ASB Message to ADVA

    • Input: ASB message

    • Process: Send the ASB message to ADVA for processing.

    • Output: Confirmation of ASB message receipt by ADVA.


Consume ADVA Flow (ASB)

  1. Receive Response from ADVA

    • Input: ASB message response as per subscription id

    • Process: Adeptia fetch the response from ADVA based on subscription/partnerid and add the json to billdetails table with status as "Price Received".

    • Output: Updating in billdetails table.

  2. Parse ADVA Response

    • Input: ADVA response message

    • Process: Extract relevant information from the ADVA response.

    • Output: Parsed data ready for aggregation.


Aggregate Flow

  1. Aggregate Bill Details

    • Input: Price json and their respective source file xml

    • Process: Aggregate the source file xml with their respective Price json and create an intermediate outbound xml file.

    • Output: Outbound XML file

Note: There is separate data mapping based on partner requirement[ExternalBillID field name], we have created separate mapping that will merge the price json and source edi xml to generate intermediate xml file in the Aggregate flow. The mapping id with respect to partner id is stored in the DataMappingIDBasedonPartner value map


Outbound Flow

Note: To archive the Outbound file with respect to partner id we have EDIOutboundArchivalConfiguration value map

  1. Validate Outbound EDI File

    • Input: Outbound XML file

    • Process: Create EDI file from Outbound XML file

    • Output: Outbound EDI File.

  2. ISA GS Changes

    1. Input : Outbound EDI file and Source File XML

    2. Process : ISA GS segment updated in Outbound EDI file as per the Source File.

    3. Output : Outbound EDI file with ISA GS segment same as Source file at the Outbox location

  3. Log and Archive

    • Input: Processed files

    • Process: Archive the files and store it into the SolutionDB for future reference.
      Output: Archived files with SolutionDB data insertion.


Following these steps ensures the successful processing of inbound EDI 837I/P files, interaction with ADVA via ASB messages, and the generation of outbound EDI files based on ADVA's responses.


Bridge Partner

Partner creation

  1. Click Partners > Partners > Add Partner.

  1. Provide Partner Details such as Partner Name, Network name, PartnerID, and Partner Type. Click Next.

Partner Type

Bridge Network Partner

Partner ID

As per provided by Paradigm

  1. To enable the exchange of Electronic Data Interchange (EDI) data with the Partner, it is essential to activate the "Configure EDI Settings" checkbox. This step is crucial for establishing the required EDI configurations and parameters for the Partner. Upon completion, three distinct groups will be revealed: EDI Configuration, Inbound Global Control Numbers, and Outbound Global Control Numbers.

  • Click + icon to expand EDI Configuration.

  • Provide the Partner email.

  • Provide the Partner ID. The host ID(461084856) of the company is populated automatically. You can change the Host ID if required.

The values in the fields of the group - Inbound Global Control Numbers and Outbound Global Control Numbers are populated automatically. If you intend to make any modifications to these values, kindly click the "+" icon to expand Inbound Group Control Numbers and Outbound Group Control Numbers, and enter the respective values into the fields. The values entered in these fields will serve as globally defined values during the generation of EDI Transactions.

Please proceed by clicking on the "Add" button.


Bridge Partner (Inbound Transaction)

Create an Inbound  EDI Transaction:

  1. Click Transactions > Templates.

  2. On the Templates screen, search EDI Inbound in the Search bar.

  3. Click “Use this” for the EDI Inbound Template to create an EDI Transaction.

  1. Connect automatically populates the name and description for the Transaction, you can edit the name and description, if necessary.

  2. Click Continue to define the Network and Partner.

  3. Select the Network and Partner for which you are creating the Transaction. Only EDI Partners will be listed in the drop-down list.

  1. Click Next to define the EDI Configuration.

  2. On the EDI Configuration window, please follow these steps:

    1. Choose the EDI standard as HIPPA from the EDI Standard drop-down list.

    2. Select the 005010X222A1 version for the Professional file or 005010X223A2 for the Institutional file from the EDI Standard Version drop-down list. This list contains all the EDI versions created in the Data Dictionary.

    3. Once the EDI version is selected, the Transaction Set Code drop-down list will populate with the list of transaction set codes. Choose the 837 code from this list.

    4. From the Test/Production Indicator drop-down list, select the appropriate indicator. The options available are T-Test and P-Production.

    5. To generate acknowledgment for the inbound messages sent, select the ”Yes - With error detail” option from the Generate Acknowledgement dropdown.

  3. Select Compliance Check checkbox, if required.

  4. Expand Translation Properties and Select the number of translation(s) as 2.

  1. Expand Interchange Properties and select the type of sequence checking from the Sequence Checking drop-down list, if required.

  2. Click Next to define the Source information

  1. Select the appropriate FTP account from the drop-down or create new one by clicking button and click on Next

  1. Now select the appropriate option for “Which event should trigger the data transfer”.

  1. Now provide source location and naming pattern and click next.

  2. Check the checkbox to create Archival Box, Provide Required information and click on Next.

  1. Select Destination as Advanced Database.

  1. Click Next and select Data Mapping PC_DM_FileQueue_837P for Professional file and PC_DM_FileQueue_837I for institutional.

  2. Select Destination 2 as LAN File.

  3. Create LAN File Target and select activity and provide the name.

  4. Select your Target Data format.

  1. Select  Data Mapping PC_DM_837P_Plexas for Professional and PC_DM_837I_Plexas for Institutional file.

Note: Mapping will be created based on partner requirement there is no default mapping

  1. Click Sava & Exit.


Bridge Partner (Outbound Transaction)

Create an Outbound EDI Transaction:

  1. Navigate to Transactions > Templates.

  2. Within the Templates screen, utilize the Search bar to look for Outbound.

  3. Select "Use this" for the EDI Outbound Template in order to initiate the creation of an EDI Transaction.

  1. Connect automatically populates the name and description for the Transaction, you can edit the name and description, if necessary.

  2. Click Continue to define the Network and Partner.

  3. Select the Network and Partner for which you are creating the Transaction. Only EDI Partners will be listed in the drop-down list. 

  1. Click Next to define the EDI Configuration.

  2. On the EDI Configuration window, do the following-

    1. Select the EDI standard as HIPPA from the EDI Standard drop-down list. 

    2. Select the 005010X222A1 version for the Profession file or 005010X223A2 for Institutional file. from the EDI Standard Version drop-down list. This list will have all the EDI versions you have created in the Data Dictionary

    3. On the basis of the selected EDI version, the list of transaction set codes is populated in the Transaction Set Code drop-down list. Select the 837 from the drop-down list.

    4. Select the indicator from the Test/Production Indicator drop-down list. The available options are T-Test and P-Production.

    5. Select the ”No” option from the Expect Acknowledgement.

    6. Scroll down and expand of ISA Envelope Properties.

    7. Create an ISA Envelope and fill the required information.
       

  1. Click Next to define the Source information.

  1. Select the suitable File event (containing a file naming pattern) from the drop-down menu or create a new one by clicking, then proceed by clicking on Next.

  1. Select your Source Data format as XML and select the appropriate data layout.

  1. Select the Destination as LAN and Click Next.

  2. Provide information in “File Generation Policy

  1. Select the appropriate mapping or create a new one using the addition icon.

  1. Now proceed by clicking on "save and exit."


Value Map Entry

  1. Go to Configure>Data Transformation>Value Map.

  1. Modify the TargetConfigurationMap Value Map accordingly.

  2. Specify the File Path and File Name. These details refer to the intermediate File Name and File Path for Outbound post the merging of Price JSON and EDI files.

  1. Modify the EDIOutboundConfiguration Value Map.

  2. Populate the Partner ID and the FTP Target location for the generation of the EDI Output.

  1. Please click on the "save" button.

  2. Proceed to edit the value of BackendStatusLocationMap in the map.

  3. Insert a new row and input patnerId.BackendStatus as the Value, and “location of Backend status” as the Map entry.

  1. Click "Save" to store the changes.


Creating Event

  1. Navigate to Configure > Events > Calendar.

  1. Create a new calendar event for the aggregate flow with the partner's name included in the event title. For example, the event name should follow the format: PC_CE_AggregatePrice_EDI_Plexas.

  1. Please proceed by clicking on the Save button.‌


Event Registry

  1. Now go to Event Registry.

  1. Create a new Event Registry and Select Event created in the last step.

  2. Select Process Flow as "PC_PF_AggregateOutboundBillData".

  1. Now save the Event Registry.