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 –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).

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

Provider Client Functionality

Plans Server Functionality

Timeline Straw man

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

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