1) Original Profile Route

This route represents the Original version of a profile where the claim affiliation to a LOB group is implemented using the Router component.

The route receives EDI files with NPI that is unique to each Provider. The NPI identifier must be valid (must be registered in the NPI government registry). The uniqueness of the NPIs allows the route to sort and group all the incoming claims by the Lines of Business (LOB) that have been defined based on your business needs. This route splits all the incoming claims into three groups: Group A, Group B, and Group Other by the NPI. The claims with invalid NPI are stored in a separate non-LOB folder.

Route Structure

Route Components Description

Component Name	Component Type	Description
JMS Inbound	FS Inbound	Receives 837 transactions from the JMS queue.
Validate and Split	Native Processing	Validates and splits the incoming claims by the provider. For each claim, the component extracts the provider’s NPI.
Check NPI	REST Client	For each claim, makes a RESTful request to https://npiregistry.cms.hhs.gov/api to verify the NPI.
Acks	FS Outbound	Stores acknowledgements on the file system.
Extract data from JSON	JSON Value Extractor	Extracts NPI verification results (result_count field) from the response JSON body. The value of the JSON field result_count 0 indicates that the NPI is invalid.
Aggregation	Aggregation	Aggregates original claim data and NPI verification results into a single message. The aggregation is complete as soon as the component Check NPI completes the work.
Is NPI Valid?	Router	Directs messages further down the route depending on whether the NPI is valid.
Not Valid	FS Outbound	Stores claims with invalid NPI.
LOB	Router	Directs claims to the corresponding group depending on the NPI number (group A: NPI 1952566184, group B: NPI 1508931353, group Other: all other NPIs).