Sample Duplication Check Real-World Example Profile Workflow

This profile picks up an 837 batch file from the file system. Then the route component XE Native splits the transaction, validates the data, and generates an LDNS report and acknowledgments. The main route directs the data to the component Duplication Check to see if there are any duplicates based on the following criteria:

Criterion Transaction Element
SUBMITTERID ISA06
CLAIMCOUNT Number of CLM segments within ST-SE
SERVICELINECOUNT Number of LX segments within ST-SE
RECORDCOUNT Number of segments within ST-SE
TOTALCHARGEAMOUNT Total of all CLM02 within ST-SE
FIRSTFIRSTNAME First firstname of Patient within ST-SE, else Subscriber
LASTFIRSTNAME Last firstname of Patient within ST-SE, else Subscriber
FIRSTLASTNAME First lastname of Patient within ST-SE, else Subscriber
LASTLASTNAME Last lastname of Patient within ST-SE, else Subscriber
FIRSTSUBSCRIBERID First subscriber id within ST-SE
LASTSUBSCRIBERID Last subscriber id within ST-SE
FIRSTLINEAMOUNT First CLM02 of ST-SE
LASTLINEAMOUNT Last CLM02 of ST-SE
FIRSTSERVICEDATE Inst: first 2400 DTP 472, else BHT04
LASTSERVICEDATE Inst: last 2400 DTP 472, else BHT04

The profile saves all the valid and unique claims on the file system and generates 999 Acknowledgment for the duplicate claims. The corresponding subroute aggregates all the validation and duplication check acknowledgments and converts the resulting data to the native format. The main route saves the merged acknowledgments on the file system.

This profile has the following routes:

This route picks up an 837 batch file and splits and validates the data. The route saves all the invalid transactions in the file system and checks the valid transactions for duplicates. The corresponding route component saves all the duplicate transactions in the file system. The route sends all the acknowledgments generated during data processing to the subroute for merging and saves the resulting file to the file system.

Route Structure

1 Inbound Processing

Route Components Description

Component Name Component Type Description
Inbound Batch FS Inbound Picks up the incoming 837 5010X222A1 batch file from the file system.
Nativ Processing XE Native Splits and validates the incoming transactions and generates an LDNS report and acknowledgments.
Duplication Check Tracking and Duplication Checks claims for duplicates based on specified parameters.
Bad Transactions FS Outbound Saves the invalid claims on the file system.
LDNS Report FS Outbound Saves the LDNS report to the file system.
Acks FS Outbound Saves acknowledgments on the file system.
Merge Acks Subroute Sends data for processing on the subroute.
Merged Acks FS Outbound Saves the merged acknowledgments on the file system.
Good Transactions FS Outbound Saves all the good transactions that have passed the duplication check in the file system.
Duplicated Transactions FS Outbound Saves all the transactions that have not passed the duplication check to the file system.
837 to 999 Translator Translates the duplicated transactions to 999 Acknowledgments based on the available map.
Duplication Acks FS Outbound Saves all the duplication check acknowledgments on the file system.

This subroute merges all the acknowledgments received from the parent route into a single file.

Route Structure

2 Merge Acks

Route Components Description

Component Name Component Type Description
Parent Route Input Parent Route Input Receives a trigger from the parent route to initiate data processing.
Validation Acks FS Inbound Picks up the validation acknowledgments from the file system.
Duplication Acks FS Inbound Picks up the duplication check acknowledgments from the file system.
Native Processing Native Processing Converts the incoming data to XData format.
Aggregation Aggregation Merges the incoming data into a single multimessage exchange.
XData Processing XData Processing Translates the incoming data to the native format.
Parent Route Output Parent Route Output Sends the resulting data back to the parent route.