eclaimlink GDRFA Integration Technical Specifications Version 1.0

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Edwin Augustine Atkins
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1 eclaimlink GDRFA Integration Technical Specifications Version 1.0

2 Table of Contents OVERVIEW 2 SCOPE 2 ABBREVIATIONS 2 IMPORTANT 3 HIGH LEVEL CYCLE 4 INVOLVED TRANSACTIONS 4 CYCLE 1 MEMBER DETAILS VALIDATION 5 CYCLE 1 BUSINESS PROCESS 5 CYCLE 1 DATA FLOW 7 CYCLE 2 MEMBER INSURANCE VALIDATION (GDRFA) 8 CYCLE 2 BUSINESS PROCESS 8 CYCLE 2 DATA FLOW 9 WEB SERVICE DOCUMENTATION 10 VALIDATEMEMBERUID 10 UPLOAD MEMBERREGISTER 11 WEB SERVICES RETURNED VALUES 14 MEMBER REGISTER INTEGRATION WEB SERVICES (WSDL) 14 1 P a g e

3 Overview Scope Dubai Health Authority in cooperation with the General Directorate of Residency and Foreigners Affairs Dubai (GDRFAD) are working towards ensuring the implementation of the mandatory Insurance Law No11 of 2013, which requires all Dubai residents to have medical insurance. The integration project will comprise of information sharing to ensure that health insurance system stores the correct insured member information, as well as enabling the Visa issuing staff from automatically checking the health insurance requirement electronically for the insured resident. The first objective of the project is to enable the health insurance companies from validating the member information at the point of applying to acquire medical insurance, keeping their records clean and in-sync with the Unified Identity Number utilized at the GDRFA and United Arab Emirates Ministry of Interior. The second objective of the project is to enable the GDRFA employees from validating the member insurance status at the point of issuing the visa through an automated electronic system. eclaimlink will facilitate the needed transaction and integration points between the healthcare insurance companies and the GDRFA systems. Abbreviations Below is a list of the abbreviations used within this document: Abbreviation DHA DHPO GDRFAD Payer Provider Receiver Sender Member/Resident Description Dubai Health Authority Dubai Health Post Office General Directorate of Residency and Foreigners Affairs Dubai Healthcare Service Payer (Insurance company) Healthcare Service Provider (Hospital, Clinic, Center, Pharmacy, Laboratory) Transaction receiver Transaction sender Person carrying or intending to acquire a Dubai residency visa 2 P a g e

4 Important The GDRFA validation will only happen for those members whose residency/visa is issued from the emirate of Dubai (Emirate = 4), members with residencies/visas from other emirates will not be validated but are still required to be uploaded to the Member Register. New and Renewal Visas The new process will be enforced on records related to members acquiring new and renewal visas: Payers are expected to validate, and upload correct MemberRegister records for these members in real time. The new validation and upload process will accommodate one record at a time to allow for performance and real time updates. The GDRFA team will validate the insurance validity using the new direct link to the eclaimlink. All insurance companies are expected to have new and renewed policies on the MemberRegister system using the new validation process starting January 15 th. Back Log and Bulk Updates A separate web service and process will be created to manage back logs and existing member records uploads to the new repository. A detailed circular and technical specifications document will be provided to explain the mentioned phase. 3 P a g e

5 High Level Cycle Below is a diagram representing the high-level cycles covered by the GDRFAD eclaimlink integration. Involved transactions Figure 1- eclaimlink - GDRFA full integration cycle The integration cycle consists of the transactions shown below: Transaction ValidateMemberUID MemberRegister Upload MemberInsuranceInformation DownloadTransactionFile Description Transaction submitted by the Payer to validate the member information from the GDRFAD through the DHPO. To be used for members with a Dubai residency/visa only. Transaction utilized by the Payer to upload the insured member details as per the eclaimlink published transaction schema, business and validation rules. Transaction utilized by the GDRFAD to validate the member s insurance coverage, from the DHPO. For GDRFA use only. Transaction utilized by the payer to download a given MemberRegister file. Details published in a separate document on eclaimlink 4 P a g e

Cycle 1 Member details validation The diagram below shows the first half of the cycle where the member is in the process of acquiring an insurance policy to comply with the Dubai residency visa

6 Cycle 1 Member details validation The diagram below shows the first half of the cycle where the member is in the process of acquiring an insurance policy to comply with the Dubai residency visa requirements. The cycle provides a detailed business process for the steps, checks and data flows taking place between the Payer, eclaimlink and GDRFA systems. Cycle 1 Business process Figure 2 - Member details validation cycle 1. Member visits the Payer to purchase an insurance policy. 2. Payer sends the member details to the DHPO for validation against the GDRFA database using the web service method ValidateMemberUID (web service documentation provided in a later section) 3. DHPO performs an initial check on the member details: Check 1: UID exists or not within the DHPO DB? Result 1.1: UID Exists Action 1.1: DHPO will perform Check 2. Result 1.2: UID does not exist. Action 1.2: DHPO will trigger Check 3. Check 2: Member details match the internal record? Member Details: o Date of birth o Gender o Nationality o Passport No o UID Result 2.1: All details match Action 2.1: DHPO returns confirmation to the Payer including the UID and Member details. Result 2.2: Details don t match Action 2.2: DHPO returns an error report to the Payer. 5 P a g e

7 4. GDRFA system verifies the member details: Check 3: Member details match GDRFA records? Result 3.1: Details match Action 3.1: GDRFA returns a confirmation to the DHPO including the UID. Result 3.1: Details don t match Action 3.1: GDRFA returns an error report to the DHPO. 5. DHPO returns a confirmation or error message to the Payer based on the checks 1, 2 or In case of a valid member, the Payer completes the policy sale and sends a MemberRegister transaction to the DHPO containing the insured member policy details. 7. Once the MemberRegister is uploaded to the DHPO, the DHPO will perform a check (with the GDRFA) to make sure all the details are matching. Check 2: MemberRegister details match the record of the GDRFA? Member Details: o Date of birth o Gender o Nationality o Passport No o UID Result 2.1: All details match Action 2.1: DHPO returns confirmation to the Payer MemberRegister is uploaded successfully. Result 2.2: Details don t match Action 2.2: DHPO returns an error report to the Payer MemberRegister upload fails. 8. The Payer provides the insured member with the policy material and insurance card. 6 P a g e

8 Cycle 1 Data Flow The below diagram shows the data flow between the Payer, DHPO and GDFRFA systems as per the cycle and business process mentioned above. Cycle 1 Member details validation August.2015 START Input member validation details Send to DHPO PAYER Generate ValidateMember XML Fix ValidateMember XML Generate MemberRegister XML Fix MemberRegister error END Send to DHPO Error report details Utilize valid member UID to generate MemberRegister XML Error report details MemberRegister upload confirmation Valid Schema? Invalid Send error report (schema error) (mismatch reason) Send error report eclaimlink (DHPO) Valid UID Exists in DHPO? Does not exist Send member details to GDRFA system Exists Does not match Member details match? Match Send member UID to Payer Invalid Valid Schema? Valid Member details match? Does not match Match MemberRegister XML Send Upload Confirmation GDRFA Member details match? Does not match Send error report (mismatch reason) Send member UID to DHPO Match Figure 3 - Member details validation data flow diagram 7 P a g e

Cycle 2 Member Insurance Validation (GDRFA) The diagram below shows the second half of the cycle where the member is in the process of issuing a visa/residency from the GDRFA, which in order to

9 Cycle 2 Member Insurance Validation (GDRFA) The diagram below shows the second half of the cycle where the member is in the process of issuing a visa/residency from the GDRFA, which in order to comply with the Dubai residency visa requirements the GDRFA will check if the member has medical insurance. The cycle provides a detailed business process for the steps, checks and data flows taking place between the Payer, eclaimlink and GDRFA systems. Cycle 2 Business process Figure 4 - Member insurance validation cycle 9. Member visits GDRFA to apply for the visa. 10. GDRFA sends member details to DHPO to validate for insurance coverage using the MemberInsuranceInformation transaction. 11. DHPO responds back with the validity of the member insurance coverage through the checks below: Check 1: Does UID exist in MemberRegister? Result 1.1: UID exists in MemberRegister. Action 1.1: DHPO will perform check 2. Result 1.2: UID does not exist in MemberRegister. Action 1.2: DHPO returns an error report to GDRFA. Check 2: Member information matching? Member information: o Date of birth o Gender o UID Result 1.1: UID + DOB + Gender match. Action 1.1: DHPO will perform Check 3. Result 1.2: UID + DOB + Gender mismatch. Action 1.2: DHPO returns an error report to GDRFA. 8 P a g e

10 Check 3: Member insurance coverage? Result 1.1: Member covered. Action 1.1: DHPO returns a confirmation message to GDRFA. Result 1.2: Member not covered. Action 1.2: DHPO returns an error report to GDRFA. Cycle 2 Data Flow The below diagram shows the data flow between the GDRFA and the DHPO as per the cycle and business process mentioned above. Figure 5 - Member insurance validation data flow diagram 9 P a g e

11 Web Service Documentation ValidateMemberUID Web service method: ValidateMemberUID Description: Web service method used by the Payer to check the member s UID number against the GDRFA database through the DHPO using a combination of fields to ensure accuracy. The web service will also be used to fetch the member s UID in case it is not available with the payer using the same set of fields. ValidateMemberUID method will only validate member s details for member s with a Dubai visa; no need to validate if visa is from any other Emirate. Signature: ValidateMemberUIDResponse ValidateMemberUID ( string payerlogin, string payerpwd, int gender, string dateofbirth, string nationality, string passportnumber, int visasource ) Input element payerlogin payerpwd gender dateofbirth nationality passportnumber visasource Description Payer user login name to connect to the DHPO Payer user password to connect to the DHPO Member s gender (1= male, 0 = female, 9 = unknown) Birth Date of the member Possible values: DD/MM/YYYY Member s nationality code as per the list published on the eclaimlink (GDRFA Nationalities) Member s passport number of the passport that has the UAE visa. Source of the member s visa (1 = Dubai, 2 = Other). Output element UID errormessage Description Unified Identity Number issued at the time of entry by the Ministry of Interior (MOI). Output parameter that contains the transaction status: Error: error message if something goes wrong; web service can also send warnings using this parameter; the parameter may be null or empty string if the web service returns zero, otherwise the error message is expected Successful: empty Return value: The web service may return values described in the section Web Services Returned Values. 10 P a g e

12 Upload MemberRegister Web service method: UploadMemberRegister Description: Web service method used by the Payer to upload the member details through a MemberRegister file to the DHPO. Signature: UploadMemberRegistrationResponse UploadMemberRegister ( string Login, string Pwd, byte[] filecontent ) Input element payerlogin facilitypwd filecontent Description Payer user login name to connect to the DHPO Payer user password to connect to the DHPO Content of the file to be uploaded. Field restrictions: 1 record per file. Output object: output response will be an object containing the below elements Element Result FileID ErrorMessage ErrorReport Description Result of the transaction; successful or failed. Original file name; this file name will be used later to show users the available files for download Output parameter that contains the transaction status: Error: error message if something goes wrong; web service can also send warnings using this parameter; the parameter may be null or empty string if the web service returns zero, otherwise the error message is expected Successful: empty Output parameter that contains byte array with the content of error report eventually generated by DHPO validation during file upload; the parameter may be null Return value: The web service may return values described in the section Web Services Returned Values. Below is a list of the fields utilized during the upload of the Member Register file to the DHPO, by the payers. No. Element Description Mandatory 1 Header Header element of the MemberRegister transaction 1.1 SenderID ID of the facility sending the MemberRegister 1.2 ReceiverID ID of the facility receiving the MemberRegister 11 P a g e

13 1.3 TransactionDate Date of the transaction Possible values: DD/MM/YYYY 1.4 RecordCount Number of members within the MemberRegister request 1.5 DispositionFlag To indicate the file type (TEST or PRODUCTION) 2 Person Person element of the MemberRegister transaction 2.1 FirstName Member s first name as spelled in the passport 2.2 SecondName Member s second name as spelled in the passport No 2.3 FamilyName Member s family/last/surname name as spelled in the passport 2.4 ContactNumber Member s primary mobile contact number No 2.5 dateofbirth Member s date of birth (DD/MM/YYYY) - for those official documents that are missing the values please fill in the following format: - Contains Year only: yyyy 2.6 Gender Member s gender (1 = male, 0 = female, 9 = unknown) 2.7 Nationality Member s nationality code as per the list published on the eclaimlink (GDRFA Nationalities) 2.8 PassportNumber Member s passport number of the passport that has the UAE visa, or if not available, the National ID (for example GCC Nationals) 2.9 MaritalStatus Member s current marital status (1 = unmarried, 2 = married) Member s personal address No 2.11 Emirate The Emirate from which the member's visa/residency is issued from. (4=Dubai, 2=Abu Dhabi, 6=Ajman, 9=Fujairah, 7=Ras Al Khaimah, 1=Sharjah, 5=Umm Al Quwain, 10=UAE national, 11=Dubai national, 12=GCC national, 13=Diplomat) 2.12 ResidentialLocation Member s actual place of residence. Use the corresponding 3-digit location code from the predefined DSC locations list published on eclaimlink DHD WorkLocation Member s actual place of work. Use the corresponding 3- digit location code from the predefined DSC locations list published on eclaimlink DHD Salary Member s salary bracket. (1 = less than 4000 AED/month, 2 = between 4001 AED and AED/month, 3 = more than AED/month, 4 = no salary; will be used for dependents or children that do not acquire a salary) 2.15 Commission Member s salary is commission based? (1 = yes, 2 = no) 2.16 EmiratesIDNumber Member s unique emirates ID number, when not available use: for National without card for Expatriate resident without a card for NewBorn without a card 12 P a g e

14 2.17 UIDNumber Member s UID number as issued by the MOI. When not available (only for non-dubai residency/visa holders), copy the member s passport number from the PassportNumber field. 3 Member Member element of the MemberRegister transaction 3.1 ID The patient's insurance member number, if the patient is claiming insurance. Otherwise, this field should be left empty. 3.2 Relation Member s relation (Principal, spouse, child, parent or other) 3.3 RelationTo The information about the MemberID of the principal member of the family. Member ID should be used if reported member is the principal beneficiary. 4 Contract Contract element of the MemberRegister transaction 4.1 PayerID The member s insurance DHA payer ID. 4.2 ProductOrigin Product origin (2 = Abu Dhabi, 4 =Dubai) 4.3 ProductCode ID of the insurance product as in the payer s literature 4.4 ProductID ID granted by the eclaimlink to the registered product yes 4.5 PolicyID ID of the insurance policy as registered in the payer s system 4.6 TopUpPolicy Any policy which provides benefits over and above the benefits provided under the main Dubai compliant policy. (1 = Top-Up Policy, 2 = Main Policy) 4.7 EnrollmentDate The day (at hours local time), month and year (dd/mm/yyyy) from which the Policy became effective for the Insured Member. 4.8 DeletionDate The Expiry Date of the policy unless the member has been removed prior to the expiry of the policy, in which case, enter the day at 00:00hrs local time, month and year (dd/mm/yyyy) on which the insured member's coverage ceases as the result of his/her deletion at the request of the PolicyHolder. 4.9 GrossPremium The amount in AED of the annualized premium payable for this insured member ActualPremium The amount in AED of the premium payable for this insured member if charged on a pro-rata basis related to period of coverage. If not charged on a pro-rata basis, then enter same figure as for GrossPremium. 5 Establishment Establishment element of the MemberRegister transaction 5.1 EntityType This is the type of the sponsoring entity. 1 = Resident 2 = Citizen (i.e. UAE locals, GCC locals) 3 = Establishment 4 = Property Owner 5.2 EntityID Official ID of the sponsoring entity 5.3 ContactNumber The primary contact number of the policy holder 13 P a g e No

15 5.4 The address of the policy holder Web Services Returned Values All DHPO MemberRegister services share the return value, so that client application can implement one handler to process the result of web service execution and share it with all web service calls. The supported returned values are shown below: Element Description UploadMemberRegister 0 Success: Transaction uploaded successfully -1 Login failed -2 Transaction validation failed with errors -4 Unexpected error occurred ValidateMemberUID 1 Match -1 Login Failed + Error Message: Wrong user credentials and/or wrong parameters data type. -2 Mismatch + Error Message: Member details does not match the record or visa is expired. -3 Visa source type 2, no need to validate. You can proceed by uploading the member s record. -4 Unexpected error occurred Member Register Integration Web Services (WSDL) GDRFA eclaimlink integration web services link Testing web service link: Each payer can utilize their own credentials for testing runs. 14 P a g e

eclaimlink MemberRegister Phase 1 MemberRegister Transaction Technical Specifications Version 1.0

eclaimlink MemberRegister Phase 1 MemberRegister Transaction Technical Specifications Version 1.0 Table of Contents OVERVIEW 2 SCOPE 2 ABBREVIATIONS 2 HIGH LEVEL CYCLE 3 PHASE 1 3 BUSINESS PROCESS 3 DATA