BizTalk 2013 EDI for Health Care: HIPAA-Compliant 834 (Enrollment) and 837 (Claims) Solutions (2014)

Chapter 11. Solution: Sending 834 - Simplified

The previous chapter outlined an outbound 834 solution that had a number of components (orchestration, role links, etc.) and steps. You will now look at a solution that uses only schemas, ports, maps, and party configurations. The architectural overview of this solution is shown inFigure 11-1.

Figure 11-1. Outbound 834 Simplified Solution Overview.

Note This chapter builds on concepts outlined in the previous solution-based chapters, and assumes knowledge of foundational concepts and best practices that have already been outlined.

Visual Studio Solution

For this solution, the following Visual Studio projects and namespaces will be used:

· Solution Name: Company.BizTalk. You can use the same solution you used for the 834 projects in the earlier chapters, or you can create a new one.

· Schemas. There are two schemas that will be used in this solution, as follows. The name of this project is Company.BizTalk.Schemas.X834.

o The 834 Schema. This is the target schema that will be mapped to and sent out.

o The Source Schema. This schema represents the internal representation of the enrollment data.

· Maps. The map project will contain a single map with logic to create an 834 from the source data, and will have a namespace of Company.BizTalk.Maps.X834.

The Schema Project

There will be two schemas required for this project. The first is the 834 schema that ships with BizTalk, the second is the schema representing the internal format of the enrollment data. For this solution, it will be an XML document dropped on a file drop. In a real-world scenario, this XML could be generated by an SSIS process, or other similar process.

The Map Project

You will have a single map for the outbound process, which will map the source data to the target 834 structure. Details for mapping are given in Chapter 4 “Mapping Data,” while advanced concepts for 834 mapping are outlined in Chapter 9 “Advanced 834 Mapping.”

The map project structure should be as follows:

· Create a new project in Visual Studio called Demo.BizTalk.Maps.X834.

· Add a reference to the schema project you have created.

Setting up the BizTalk Components

For this solution, you will need to set up the receive port and receive location, and configure a send port to subscribe to this receive port.

Before configuring these components, you will want to deploy your Visual Studio assemblies to the BizTalk Application. Steps for doing this are outlined in Chapter 2 “Solution: Receiving 837P Data.”

File Receive Port

The input to this solution is a simple File Receive Port. An XML document will be picked up by this port.

· Create a new Receive Port and Receive Location combination, both named Company.BizTalk.Receive.Enrollment.XML.

· Set the Type to File and point it to the directory where the XML will be dropped.

· Set the Receive Pipeline to the default XMLReceive.

File Send Port

This port, which will be associated with a BizTalk party shortly, will subscribe to all data arriving on the receive port you just configured, and will map and deliver the data. Take the following steps:

· Create one Send Port named Company.BizTalk.Send.X834.

· Set the Type to File.

· Set the Send Pipeline to EdiSend.

· On the Filters tab, set the filter to BTS.ReceivePortName == [the name of the receive port you just configured, which is Company.BizTalk.Receive.Enrollment.XML].

· On the Outbound Maps tab, select the map that you just deployed (Demo.BizTalk.Maps.X834).

Note You can add multiple maps to a Send Port, which will allow you to reuse it to send a variety of outbound document types. When you have multiple maps, BizTalk will iterate through each of them to see if the document that the Send Port just received matches any of the source document schemas in the maps. It will use the first map that it finds which matches this source schema.

Party Settings

You can reuse most of the party settings that you have created in previous chapters. The required components are as follows.

· Two trading partners. One representing the home organization (your company), and one for the recipient organization that the 834 EDI documents are being sent to.

· One agreements. Again, if you have configured an agreement from an earlier solution in this book, you can reuse it – just extend it to handle the 834.

· In the agreement, the key information to configure is as follows:

o The Identifiers tab must be set up on both the inbound and outbound settings.

o The Send Port tab on the outbound settings (Home Company->Trading Partner) must have a reference to the send port configured earlier in this chapter.

o The Envelope tab must have the information for the 834 transaction type configured.

§ Transaction Type should be 834-Benefit Enrollment and Maintenance.

§ Version is set to 00401 or 00501 (match your correct version).

§ Target namespace should be http://schemas.microsoft.com/BizTalk/EDI/X12/2006

§ GS1 should be BE-Benefit Enrollment and Maintenance (834)

§ GS2 through GS7 should be set based on what your trading partner requires (see the trading partner implementation guide or a sample 834 instance from them)

§ GS8 should be 004010 (or 005010 for 5010, you will need to match the right version).

Enabling and Running the Solution

In order for this solution to work, the Receive Location and the Send Port must be enabled. You will want to restart the BizTalk Host Instance to ensure that all of the most recent configurations and components are loaded into memory.

Conclusion

You have just configured and deployed the simplest of outbound EDI solutions. It is important to understand the core components required in an implementation. When building a solution, always think of the simplest process, and then build in the additional architectural components required by your specific implementation. You have now looked at a variety of complex (requiring multiple BizTalk components) and simple solutions. You should now have the tools and skills to develop any kind of health care EDI based solution that you may come across.