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CAQH Eligibility Checking

CAQH Eligibility Checking. PoC Design. Overview. Mini-project to implement a PoC for CAQH Eligibility Use existing tools and components; make as lightweight as possible; suitable for internet dial-up connections Demonstrate – Small-footprint client for doctors offices / providers

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CAQH Eligibility Checking

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  1. CAQH Eligibility Checking PoC Design

  2. Overview • Mini-project to implement a PoC for CAQH Eligibility • Use existing tools and components; make as lightweight as possible; suitable for internet dial-up connections • Demonstrate – • Small-footprint client for doctors offices / providers • Consolidation routing hub to / from plans • Use XML and EDI in tandem ( EDI to plans, XML to offices) • Design service that could be scaled up into full offering for CAQH • Use open standards / tools as much as possible • Fit into typical Windows desktop environment, but also support low-cost (e.g. Wal-Mart LINUX systems) and Mac (gives lowest entry costs to new providers).

  3. Overall Component Architecture Provider’s Office Eligibility Lookup (Browser Form) Internet Connection CAQH Eligibility Transaction XML XML Ruby Routing Server (Store / Xvert / Forward) XML EDI Secure SOAP based interchange Plan Eligibility Systems Lookup

  4. Provider Client Functionality

  5. Plans Server Functionality

  6. Timeline Straw man

  7. Resources Estimate • Ruby based routing server • 1 person • Client front end functionality in IE / AJAX • 1 person • Standards design – XML and EDI mappings • 1 person • SOAP-based message interfacing from/to routing server to one or more plans for testing • 1 person

  8. Deliverables • Working demo’ system to one or two plans • Client Web page “zero foot print” package for providers office – • Html pages + AJAX Javascript + User Security Certificate • Ruby routing server system • Exchange mapping to/from EDI and XML • CAQH standards use documentation

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