Indiana Health Coverage Programs

Transcription

1 Indiana Health Coverage Programs Standard Companion Guide Transaction Information Communications Guide Companion Guide Version Number: 3.2 Revision Date: April 2017 April

2 Preface The Health Insurance Portability and Accountability Act (HIPAA) adopted standard transaction sets for Electronic Data Interchange (EDI) of health care data. Covered entities must adhere to the content and format requirements as defined in the ASC X12N Implementation Guides. The Indiana Health Coverage Programs (IHCP) has developed this document to serve as a companion document to provide guidance and clarification as it applies to the IHCP. It is not intended to modify, contradict or reinterpret the rules established by the ASC X12N Implementation Guides. April

3 Table of Contents 1 INTRODUCTION Overview Connectivity Options CAQH CORE WEB SERVICES Functionality at a glance Connecting to the Server CAQH CORE Service Types FILE EXCHANGE FTP over SSL FTP over SSH Security Manual Connectivity CHANGE SUMMARY April

4 1 INTRODUCTION 1.1 Overview This document is intented for software vendors who wish to develop applications to exchange electronic transactions with the Indiana Health Coverage Programs (IHCP) file delivery and retrieval systems that are maintained by DXC Technology for the purpose of uploading and downloading HIPAA compliant transactions. 1.2 Connectivity Options IHCP connectivity interfaces support the most commonly used channels of communication, giving clients a variety of interfaces to develop robust interchanges solutions. Batch and interactive submission options are available. FTPS and SFTP using: CAQH CORE complian web services used for batch and interactive 270/271 and 276/277 transactions and 835 remittance advice transactions File Exchange used for batch transactions The table below identifies submission options available for all transactions. Transaction 837I Health Care Claim Institutional 837P Health Care Claim Professional 837D Health Care Claim Dental CAQH CORE Services Batch and Interactive File Exchange Batch x x x 835 Remittance Advice (RA) x x 270/271 Eligibility Benefit Inquiry and Response x x 276/277 Claim Status Request and Response x x 278 Prior Authorization (PA) Request for Review and Response x 834 Managed Care Member Enrollment Roster x 820 Managed Care Capitation Payment Reporting x April

5 2 CAQH CORE WEB SERVICES IHCP s CAQH CORE complian web services are built around ACA 1104 Phase I, II and III rules which can be found at CAQH CORE compliant Envelope Specifications using Message Enveloping Standards can be found in the Phace II CORE 270: Connectivity Rule document. IHCP s CAQH CORE compliant web services are capable of exchanging 270/271 and 276/277 batch and interactive transactions and returning 835 remittance advice transactions using either of the two HTTP/S envelope standards: MIME-Multipart form data and SOAP+WSDL. Each envelope must conform to the CAQH CORE requirments as listed in the CORE Phase I and Phase II rules referenced above for envelop version NOTE: The SOAP security header must not contain the attribute: mustunderstand= true 2.1 Functionality at a glance HTTP/S supports a request-response message pattern, meaning that the sender must submit a message and wait for a response from the recipient. This usage pattern applies to batch and interactive ASC X12 transactions. The response message varies based on wheter the sender s message was an interactive request, batch submission, or batch response retrieval request. 2.2 Connecting to the Server Users can connect to the web service using a network connection that provides access to the public internet. User requests using SOAP 1.2 should use: User requests using MIME-multipart form data HTTP should use: April

6 2.3 CAQH CORE Service Types Processing Modes Batch Interactive Interactive Payload Types Request PayloadTypes (sent by trading partner) X12_270_Request_005010X279A1 X12_276_Request_005010X212 Response PayloadTypes (returned by IHCP) X12_271_Response_005010X279A1 X12_277_Response_005010X212 Batch Payload Types Batch Upload Request PayloadTypes (sent by trading partner) X12_270_Request_005010X279A1 X12_276_Request_005010X212 X12_999_SubmissionRequest_005010X231A1 o This payload type only logs that the submitter is acknowledging receipt of a requested download Batch Upload ResponseTypes (returned by IHCP) X12_Response_ConfirmedReceiptReceived For the submission of an X12_999_SubmissionRequest_005010X231A1 X12_BatchReceiptConfirmation For the submission of an X12_270_Request_005010X279A1 and X12_276_Request_005010X212 Batch Download Request PayloadTypes (sent by trading partner) X12_005010_Request_Batch_Results_271 X12_005010_Request_Batch_Results_277 X12_005010_Request_Batch_Results_835 X12_999_RetreivalRequest_005010X231A1 Batch Download Response PayloadTypes (returned by IHCP) X12_271_Response_005010X279A1 X12_277_Response_005010X212 X12_835_Response_005010X221A1 X12_999_RetreivalRequest_005010X231A1 X12_005010_Response_NoBatchResultsFile April

7 3 FILE EXCHANGE File Exchange is an application provided by the IHCP for secure file processing, storage, and transfer of batch transaction files. File Exchange is designed to safely and securely collect, store, manage, and distribute sensitive information between IHCP and its trading partners. Web browsers and no- or low-cost secure FTP clients, who are required to transfer files, can quickly, easily, and securely exchange files with File Exchange over encrypted connections using the FTP over SSL (FTPS), FTP over SSH (SFTP), and HTTP over SSL (HTTPS) protocols. Typically, trading partners that wish to interact systematically with File Exchange (via a batch script) will choose one of the two FTP methods listed above. All HIPAA transaction files must be uploaded to the /Distribution/HIPAA Transactions folder. All filenames must adhere to the filenaming convention policy listed below. Files that do not adhere to the policy will receive an error message during the upload process to File Exchange and will not successfully upload until corrected. In addition to accepting normal text files, File Exchange can also accept compressed files submitted in ZIP format. The file name that is submitted must have.zip at the end of the file name. The zip file can contain a single file or multiple files. When these files are processed, File Exchange will extract all files from the ZIP archive and process them as though they were submitted individually. Inbound Filenaming Convention Policy: 1. All inbound filenames must have an extension. For example: <filename>.txt or <filename>.x12 2. All inbound filenames must not contain invalid characters from the list below / / " ' < > :? *, { } [ ] ~ ( ) # & ^! % = + ; ` 3. All inbound filenames must not contain any spaces All outbound files available for download are created individually with the following naming conventions: 999: ######_######_Trading Partners Inbound Filename_Tracking ID.999.txt TA1: ######_######_Trading Parnters Inbound Filename_Tracking ID.TA1.txt 271: ######_######_Trading Parnters Inbound Filename_Tracking ID.271X12BATCH.dat 277: ######_######_Trading Parnters Inbound Filename_Tracking ID.277X12BATCH.dat 835: Trading Partner ID.835.X.HHMMSS.Julian Date.dat Outbound files are not available in a compressed or ZIP format. All outbound files will be placed in the trading partner s home folder. These files will remain available for retrieval for 30 days after they first become available unless they are explicitly deleted from File Exchange by the trading partner. April

8 3.1 FTP over SSL The first File Exchange batch transmission option is FTP over SSL. The following documentation is designed to assist developers with customizing secure FTP clients using FTP over SSL to enable connectivity to File Exchange. File Exchange fully supports a large number of secure FTP clients using FTP over SSL including the following: AS/400 native FTPS client C-Kermit (command-line, v8.0+, VMS, Linux, Unix, Solaris, and so forth.) Cute FTP Pro (GUI, version 1.0 and higher) Glub FTP (GUI, Java 2.0 and higher) IP*Works SSL (API, Windows, version 5.0) LFTP (command-line, Linux, Unix, Solaris, and so forth.) MOVEit Buddy (GUI) MOVEit Freely (command line) NetFinder (GUI, Apple) NetKit (command-line, Linux, Unix, Solaris, and so forth.) OpenIT (Unisys V-Series, A-Series, Clearpath) SmartFTP (GUI, version 1.0 and higher) SurgeFTP (command-line, Solaris, and so forth) WS_FTP Pro (GUI, version 7.0 and higher) The important pieces of information that are needed no matter which FTP over SSL client is used are listed below. Consult the documentation for your specific FTP client to determine how to configure these settings. If the machine that is initiating the FTP connection resides behind a firewall, the firewall must be configured to allow outbound traffic on any of the ports listed below. Host Control Connection Ports 990 if using implicit encryption (recommended) 21 if using explicit encryption Data Connection Ports (any port in this range) Transfer mode Passive (Active mode transfers will not be accepted) The following examples were tested using the MOVEit Freely command-line client in a Windows environment. Note that in these examples, the mput, mget and mdelete commands were used with a file mask to process multiple files at a single time. Not all secure FTP clients support these commands. It is recommended that the FTP client used to communicate with File Exchange support these commands. If an FTP client that does not support these multiple file commands is used to communicate with File Exchange, then the sample scripts will need to be modified to create multiple put, get, and delete statements that are input into the FTP client. Check the documentation for the specific FTP client being used for more information on commands supported by the FTP client. Figures and are examples of data file submission and retrieval using FTPS. April

9 Figure Data File Submission Using File off rem * Example DOS batch script that will copy all files rem * containing a certain file mask from rem * a local directory to File Exchange. rem * (via secure FTP over SSL using MOVEit Freely) rem * rem * Usage: rem * "putfiles (username) (password) (filemask)" rem * ex. putfiles john123 mypass *.* echo cd "/Distribution/HIPAA Transactions" > temp.txt echo prompt >> temp.txt echo mput "C:\temp\upload\%3" >> temp.txt echo quit >> temp.txt ftps -e:implicit -a -user:%1 -password:%2 -s:temp.txt sftp.xin.dcs-usps.com/ del temp.txt Figure Data Retrieval Using off rem * Example DOS batch script that will get all files rem * containing a certain file mask from a user's rem * File Exchange home directory and save them to rem * the current local directory. rem * (via secure FTP over SSL using MOVEit Freely) rem * rem * Usage: rem * "getfiles (username) (password) (filemask)" rem * ex. putfiles john123 mypass *.* echo cd /Home/%1 > temp.txt echo prompt >> temp.txt echo mget %3 >> temp.txt rem ** Optional: Uncomment line below to delete the files from File Exchange rem ** after they are retrieved rem echo mdelete "%3" >> temp.txt echo quit >> temp.txt ftps -e:implicit -a -user:%1 -password:%2 -s:temp.txt sftp.xin.dcs-usps.com/ del temp.txt April

10 3.2 FTP over SSH Another File Exchange batch transmission option is FTP over SSH. The following documentation is designed to assist developers with customizing secure FTP clients using FTP over SSH to enable connectivity to File Exchange. File Exchange fully supports the most popular secure FTP clients using FTP over SSH including the following: F-Secure SSH (command-line, Client for Unix) OpenSSH SFTP (command-line, Unix) OpenSSH for Windows (command-line, Windows) PSFTP/PSCP (command-line, Windows) SSH Communications SSH Secure Shell FTP (GUI, Windows) WS_FTP (GUI, Windows) The important pieces of information that are needed no matter which FTP over SSH client is used are listed below. Consult the documentation for your specific FTP client to determine how to configure these settings. If the machine that is initiating the FTP connection resides behind a firewall, the firewall must be configured to allow outbound traffic on the port listed below. Host Port 22 (this is the default SSH port) The following exmples were tested using the PSFTP/PSCP command-line client. Note that the standard commands included with FTP over SSH clients do not include the multiple file commands (mput, mget, and mdelete) used in the SSL examples above. To retrieve or send multiple files at a time, use the Secure Copy (SCP) feature of SSH. Figures and are examples of data file submission and retrieval using SCP. Figure Data File Submission Using off rem * Example DOS batch script that will copy all files rem * containing a certain file mask from rem * a local directory to File Exchange. rem * (via secure Copy over SSH using PSCP) rem * rem * Usage: rem * "putfiles (username) (password) (filemask)" rem * ex. putfiles john123 mypass *.* pscp -sftp -l %1 -pw %2 -batch -q C:\upload\%3 sftp.xin.dcs-usps.com:/distribution/hipaa Transactions April

11 Figure Data File Retrieval Using off rem * Example DOS batch script that will get all files rem * containing a certain file mask from a user's rem * File Exchange home directory and save them to rem * the a local directory. rem * (via secure Copy over SSH using PSCP) rem * rem * Usage: rem * "getfiles (username) (password) (filemask)" rem * ex. putfiles john123 mypass *.* pscp -sftp -l %1 -pw %2 -batch -q sftp.xin.dcs-usps.com:/home/%1/%3 C:\download To delete all file retrieved from File Exchange, the script must create a text file with the delete command for each file that was retrieved. Figures and are examples of text files and the scripts to execute the delete commands. Figure Example Test File with FTP Delete Commands del del del Figure Data File Deletion Using off rem * Example DOS batch script that will execute FTP rem * commands contained in a text file against files in a user's rem * File Exchange home directory. rem * (via secure FTP over SSH using PSFTP) rem * rem * Usage: rem * "delfiles (username) (password) (command_file)" rem * ex. delfiles john123 mypass C:\download\delete.txt psftp -l %1 -pw %2 -batch -b %3 sftp.xin.dcs-usps.com April

12 3.3 Security By logging on to File Exchange, the trading partner agrees to adhere to the password requirements of File Exchange including changing passwords every 90 days. File Exchange will prompt the trading partner to change the password beginning 5-days before expiration at every log-in attempt. The Trading Partner will not be able to log-in until the password is changed. This may cause any automated connection scripts to fail. When the password is manually changed in File Exchange, the same change must be applied to any automated scripts to ensure uninterrupted service. The account will be deactivated at 90-days if the password is not changed. The Trading Partner will need to contact Trading Partner support at to reactivate the account. 3.4 Manual Connectivity If a trading partner intends to interact with File Exchange in a manual, or ad-hoc manner, the HTTPS method using the internet is available. The IHCP secure File Exchange website is located at All trading partners can log on to File Exchange using the same ID and password that is used to access File Exchange in the FTP methods listed above. Accessing File Exchange via the internet allows each trading partner to pick up or drop off files outside of an automated script. April

13 4 CHANGE SUMMARY Version DDI CO CO Name Revision Revision Revision Page Numbers / Change / Update Details Completed Date Status by 2.0 March 2013 New CAQH CORE Systems Dec ,5,6 CAWH CORE Phase III Systems 3.0 Sept 2016 Implemented Implementation of IN CoreMMIS System Updates Systems 3.1 Jan 2017 Implemented Pg 6 - Updates to Web Service URLs Systems 3.2 April 2017 Implemented Updated throughout document Hewlett Packard Enterprise (HPE) to DXC Technology Systems Companion Guide copyright 2013 by DXC Technology Address any comments concerning the contents of this manual to: DXC Systems Unit 950 North Meridian Street, Suite 1150 Indianapolis, IN Fax: (317) April