Aggregation Strategies Profile Workflow

This Inbound Processing route in this profile receives an 837 Claim Payment Professional transaction with numerous claims. The route component Native Processing splits the incoming file into separate claims and validates the data. The route aggregates the individual claims based on the following conditions:

  • If the Aggregation component receives all three individual claims, the batch is complete.
  • If the Aggregation component receives an XEServer message with the LastMessage property as "true", the batch is complete.
  • If the Aggregation component's timeout expires, the batch is complete.

The route stores batches in the file system.

Route Structure

Route Components Description

Component Name Component Type Description
In 837P FS Inbound

Picks up an 837 Professional Claim Payment batch from the file system. Sets the following properties on the output data:

  • CorrelationID = {GUID}: Uses a GUID to correlate claims that belong to the same original batch.
  • DirName = {MD_File_NameNoExt}: This property is used by the file system outbound component Out Aggregated to create a folder with the name of the original file (without extension) and to store smaller claim batches in the folder.
Native Processing XE Native

Splits the batch into individual claims and sends good claims to the route component Aggregation through the output split.good.

After the last individual claim goes through the output split.good, the component directs the original 837 Professional Claim Payment batch through the output original and sets the following two message properties:

  1. ErrorCount = {DN[dns.cnt.re]}: The number of errors that have occurred during the processing of the original transaction.
  2. LastMessage = true: A marker property that is used to notify the route component Aggregation that the last message has been received and the aggregation is complete.
Aggregation Aggregation

Receives individual claims and aggregates them into smaller batches using the following strategies:

  • The component's Number of message received option. If the component receives three individual claims before the timeout expiration, the batch is complete and compoent sends the batch further down the route. This is a base strategy that is used to produce batches with 3 claims.

  • The component's Custom expression option. If the component receives an XEServer message with the property LastMessage "true", the component forcibly completes the batch, regardless of the current quantity of accumulated claims. This strategy is used to submit the last batch that is incomplete (19 claims make 6 complete (x3) and one incomplete (x1) batches).

    In this scenario, after sending separate claims, XE Native sends the original transaction through the output original and sets the LastMessage equal to true>.

  • If the component's timeout expires, the component completes the batch, regardless of the current quantity of accumulated claims. This strategy is used to submit the last incomplete batch if the component does not receive a message with the property LastMessage.

To aggregate several claims into a batch, the component uses the HIPAA Merger strategy to merge individual HIPAA Claims into one EDI document.
Router Router Receives the original 837 Professional Claim Payment Batch, and if the incoming data has no errors (ErrorCount property is 0), the component directs the message with the property LastMessage to the route component Aggregation to forcibly complete the batch. If the original data contains errors, the route component Aggregation receives no data and completes the batch based on timeout expiration.
Out Aggregated FS Outbound Stores smaller batches on the file system. For every 837 Professional Claim Payment document received by the route, the component creates a folder with the name of the original file.