INTERNET TRANSACTION SERVICES CORE

Transcription

1 INTERNET TRANSACTION SERVICES CORE User Guide Version CAQH CORE Operating Rules Connectivity Specification v2.2.0

2 Contents Contents 1 Introduction Specifications CORE Connectivity Specification Version Interfaces URLs Authentication / Authorization Policy Receiver ID Maximum Batch File Size SSL Certificates System Availability Rules of Behavior Contact Information Supported Transactions RealTime Transaction Batch Transactions Batch Submission Batch Submission Acknowledgement Retrieval Request Batch Results Retrieval Request Batch Results Acknowledgement Submission Generic Batch Transactions Generic Batch Retrieval Request Generic Batch Receipt Confirmation Generic Batch Submission with Batch Payload and Synchronous Payload Receipt Confirmation Error Codes and Messages Change Summary Change Healthcare Operations LLC. All rights reserved. Page 2

3 Introduction 1 Introduction Internet Transactions Services CORE (herein referred to as ITS-CORE) is a communications application which provides a Safe Harbor as defined in the CAQH Committee on Operating Rules for Information Exchange (CORE ) Phase II Connectivity Rule 270, version It is expected that ITS-CORE clients are familiar with the CORE Phase II 270 Connectivity Rule document, as authored by CORE, and possess the technical skills and expertise to comply with its requirements. This ITS-CORE User Guide contains the specifications necessary for exchanging information with ITS-CORE in a CORE-compliant manner 1. This guide is referenced by the Change Healthcare ERA Companion Guide. 1 CAQH launched CORE to give providers consistent access to patient coverage information before or at the time of service using the electronic system of their choice for any patient or health plan, effectively reducing administrative burden and costs. For more information about CORE, please visit or contact CAQH at (202) Change Healthcare Operations LLC. All rights reserved. Page 3

4 Specifications 2 Specifications 2.1 CORE Connectivity Specification Version The CORE connectivity specification version applicable to this guide is Interfaces ITS-CORE supports both the SOAP+WSDL and HTTP MIME Multipart interfaces as prescribed by the Phase II CORE 270 Connectivity Rule version The Phase II CORE 270 document should be consulted for details pertaining to the specific implementation of these interfaces. Additionally, with regard to SOAP+WSDL, the WSDL and associated XSD Schema documents can be downloaded from CAQH CORE at the following URL: URLs There are four URLs available for ITS CORE depending on the environment and interface: Test Environment: SOAP+WSDL Interface: HTTP MIME Multipart Interface: Production Environment SOAP+WSDL Interface HTTP MIME Multipart Interface Authentication / Authorization Policy ITS-CORE employs the use of username/password authentication. Change Healthcare will assign a username and password to the client for the test environment during the implementation process. A username and password for the production environment will be assigned during the enrollment process. Test credentials and production credentials will most likely differ and will not necessarily be the same. During processing of each transaction, ITS-CORE extracts the username and password from the incoming request and verifies these to authenticate the client. Five consecutive failed authentication attempts will disable the client s account. If this occurs, please contact customer support to have the password reset. ITS-CORE will also perform authorization during each transaction to determine if the client is authorized for the particular service requested Change Healthcare Operations LLC. All rights reserved. Page 4

5 Specifications 2.5 Receiver ID ITS-CORE will expect the value of the ReceiverID on incoming transactions to be Emdeon. This value will be treated in a case-sensitive manner. Any value other than this in the ReceiverID field will cause the transaction to be rejected with an error. ITS-CORE will use this same value as the SenderID in the response returned to the client. 2.6 Maximum Batch File Size ITS-CORE will impose a maximum file size of five megabytes on batch files submitted by the client. 2.7 SSL Certificates Secure communications are provided by the use of SSL certificates with the ITS-CORE application. These certificates provide server identification and encryption at the network transport level using public and private keys. Clients will need to obtain and install the two public key certificates (the root authority and an intermediate authority) on their system in order to successfully complete the SSL handshake process. Certificates are available here: which-is-root-which-is-intermediate 2.8 System Availability Change Healthcare will perform any needed maintenance on the ITS-CORE system on an as needed basis. Maintenance will be performed during off-peak and after hours timeframes to minimize the possibility of impact to production traffic. The ITS-CORE system is built with a redundant architecture allowing maintenance of individual servers without having to take down the entire system. With this in mind, system availability is expected to be at or near 100%. In the unlikely event that the system must be taken offline, customers will be notified of the downtime and duration. 2.9 Rules of Behavior Customers are requested to observe the following rules of behavior: Do not deliberately submit batch files that contain viruses. Do not use any unattended automated process that continually sends transactions in a loop in an attempt to test system availability. Such processes will place an undue burden on the system and will be considered as a Denial of Service attack Contact Information Contact information is listed in the ERA Companion Guide Change Healthcare Operations LLC. All rights reserved. Page 5

6 Supported Transactions 3 Supported Transactions ITS-CORE supports RealTime, Batch, and GenericBatch transactions as defined in the CORE Phase II 270 Connectivity Rule version ITS-CORE does not support the Batch Interaction for Mixed Payload Types. 3.1 RealTime Transaction The RealTime Transaction is supported as per Section Real Time Interaction of the Phase II CORE 270 Connectivity Rule version ITS-CORE supports the use of the following PayloadTypes with the RealTime Transaction. Use of any other PayloadType will result in an error response. X12_270_Request_004010X092A1 X12_276_Request_004010X093A1 X12_278_Request_004010X094A1 X12_278_Request_004010X059 X12_278_Request_004010X111 X12_270_Request_005010X279A1 X12_276_Request_005010X212 X12_278_Request_005010X217E1_2 X12_278_Request_005010X215 X12_278_Request_005010X216E2 When using the SOAP+WSDL interface, ITS-CORE will expect the Payload field to contain the request data in Base64 Encoded format and then enclosed within CDATA brackets. For example, if the request data itself were This is a realtime request string, the Payload field in the SOAP envelope would appear as: <Payload><![CDATA[VGhpcyBpcyBhIHJlYWx0aW1lIHJlcXVlc3Qgc3RyaW5n]]></Payload> The same will be true for the Payload field in the response returned by ITS-CORE. 3.2 Batch Transactions ITS-CORE supports Batch Transactions as defined in Section Batch Interaction for Specific Payload Types of the CORE Phase II 270 Connectivity Rule version Change Healthcare Operations LLC. All rights reserved. Page 6

7 Supported Transactions Batch Submission ITS-CORE supports the use of the following PayloadTypes with the BatchSubmission Transaction. Use of any other PayloadType will result in an error response. X12_270_Request_004010X092A1 X12_276_Request_004010X093A1 X12_278_Request_004010X094A1 X12_278_Request_004010X059 X12_278_Request_004010X111 X12_270_Request_005010X279A1 X12_276_Request_005010X212 X12_278_Request_005010X217E1 X12_278_Request_005010X215E1 X12_278_Request_005010X216E1_ Batch Submission Acknowledgement Retrieval Request ITS-CORE supports the use of the following PayloadTypes with the Batch Submission Acknowledgement Retrieval Request Transaction. Use of any other PayloadType will result in an error response. X12_997_RetrievalRequest_00401 X12_TA1_RetrievalRequest_00401 X12_004010_Request_Acks X12_005010_Request_Acks X12_999_RetrievalRequest_005010X231A1 X12_TA1_RetrievalRequest_005010X231A1 X12_824_Request_005010X Change Healthcare Operations LLC. All rights reserved. Page 7

8 Supported Transactions Batch Results Retrieval Request ITS-CORE supports the use of the following PayloadTypes with the Batch Results Retrieval Request Transaction. Use of any other PayloadType will result in an error response. X12_004010_Request_BatchResults271 X12_004010_Request_BatchResults277 X12_278_Request_Batch_Results_004010X094A1 X12_278_Request_Batch_Results_004010X111 X12_005010_Request_Batch_Results_271 X12_005010_Request_Batch_Results_277 X12_278_Request_Batch_Results_005010X217E1 X12_278_Request_Batch_Results_005010X215E1 X12_278_Request_Batch_Results_005010X216E1_ Batch Results Acknowledgement Submission ITS-CORE supports the use of the following PayloadTypes with the Batch Results Acknowledgement Submission Transaction. Use of any other PayloadType will result in an error response. X12_TA1_SubmissionRequest_00401 X12_004010_SubmissionRequest_997 X12_TA1_SubmissionRequest_005010X231A1 X12_999_SubmissionRequest_005010X231A Change Healthcare Operations LLC. All rights reserved. Page 8

9 Supported Transactions 3.3 Generic Batch Transactions ITS-CORE supports the use of the Generic Batch transactions as defined in Section Generic Batch Retrieval Request and Receipt Confirmation and Section Generic Batch Submission with Batch Payload and Synchronous Payload Receipt Confirmation of the CORE Phase II 270 Connectivity Rule version Generic Batch Retrieval Request ITS-CORE supports the use of the following PayloadTypes with the Generic Batch Retrieval Request Transaction. Use of any other PayloadType will result in an error response. X12_835_Request_004010X091A1 X12_835_Request_005010X221A1 ITS-CORE expects the Generic Batch Retrieval Request to be followed by a Generic Batch Receipt Confirmation Transaction Generic Batch Receipt Confirmation ITS-CORE supports the use of the following PayloadTypes with the Generic Batch Receipt Confirmation Transaction. Use of any other PayloadType will result in an error response. X12_Request_ConfirmReceipt Generic Batch Submission with Batch Payload and Synchronous Payload Receipt Confirmation ITS-CORE does not currently support any PayloadTypes for this transaction Change Healthcare Operations LLC. All rights reserved. Page 9

10 Error Codes and Messages 4 Error Codes and Messages Error Code Error Message Resolution UserCredentialsInvalid User credentials are invalid Either the username or the password submitted in the transaction is invalid. Supply the proper credentials and submit the transaction again. AccountDisabledResult * Account for user xxx is disabled Contact Customer Support and request that the account be reenabled. ServiceNotAuthorizedResult * InvalidBatchProcessingModeUse ProcessingModeIllegal InvalidRealTimeProcessingModeUse ProcessingModeRequired PayloadTypeIllegal PayloadTypeIllegalForTransactions PayloadTypeNotSupported PayloadTypeRequired PaylaodLengthIllegal PayloadIDRequired User xxx is not authorized for requested service ProcessingMode is invalid for a RealTime transaction ProcessingMode is invalid ProcessingMode is invalid for a Batch transaction The field ProcessingMode is required but was not provided PayloadType is invalid PayloadType is invalid for this transaction PayloadType is not currently supported by Change Healthcare. The field PayloadType is required but was not provided PayloadLength must be greater than or equal to zero The field PayloadID is required but was not provided Verify use of the correct Payload Type, otherwise contact Customer Support and request authorization for the requested service RealTime transactions require the use of the RealTime ProcessingMode The ProcessingMode must be RealTime for RealTime transactions or Batch for Batch transactions Batch transactions require the use of the Batch ProcessingMode. correct value is specified for PayloadType The value specified as the PayloadType is not supported for this transaction. See Section 3 of this guide. The value specified as the PayloadType is a valid CORE PayloadType, but is not currently supported by Change Healthcare. See Section 3 of this guide. Check the request to insure that a proper value is used for PayloadLength. When using the SOAP+WSDL interface, these errors will be returned as SOAP Faults Change Healthcare Operations LLC. All rights reserved. Page 10

11 Error Codes and Messages PayloadIDIllegal TimeStampRequired TimeStampIllegal SenderIDRequired SenderIDIllegal ReceiverIDRequired ReceiverIDIllegal Error Code Error Message Resolution CORERuleVersionRequired CORERuleVerionIllegal PayloadRequired PayloadIllegal CheckSumRequired CheckSumMismatched ContentTypeInvalid PayloadID does not conform to ISO UUID standards The field TimeStamp is required but was not provided TimeStamp is invalid The field SenderID is required but was not provided SenderID exceeds the maximum length The field ReceiverID is required but was not provided ReceiverID exceeds the maximum length The field CORERuleVersion is required but was not provided CORERuleVersion is invalid The field Payload is required but was not provided Payload is not properly Base64 encoded The field CheckSum is required but was not provided The checksum value, xxx, computed on the recipient did not match the value, xxx, that was sent in the envelope ContentType value, xxx, is not valid for this application PayloadID value is correctly formatted. TimeStamp value is correctly formatted The SenderID value must not exceed 50 characters in length. The SenderID value must not exceed 50 characters in length. The CORERuleVersion value must be For a RealTime transaction, the Payload must be Base64 encoded. Insure that the CheckSum provided in the request is correct for the Payload specified. For a HTTP Mime Muiltipart request, the value of the ContentType header must include multipart/form-data; boundary= Change Healthcare Operations LLC. All rights reserved. Page 11

12 Change Summary 5 Change Summary Date Version Change Description Not Published Published Chaned description of Payload field in Realtime Transaction, Section Re-branded for Change Healthcare 2015 Change Healthcare Operations LLC. All rights reserved. Page 12