Life Cycle of a Guideline

Life Cycle of a Guideline
TIBCO Foresight® Products
Life Cycle of a Guideline
June 2015
Two-Second Advantage®
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Contents
Purpose ........................................................................................................................ 2
Customized vs. Published Guidelines .......................................................................... 2
Birth of a Customized Guideline................................................................................... 2
Using a Customized Guideline with EDISIM ................................................................ 3
Using a Merged Guideline ............................................................................................ 4
Merging Guidelines ................................................................................................ 4
Using Merged Guidelines with Instream ................................................................ 5
Using Merged Guidelines with TIBCO Foresight Translator.................................. 5
Using Merged Guidelines with Transaction Insight ............................................... 6
Life Cycle of a Guideline
1
6/22/2015
Purpose
This document explains how a HIPAA guideline is created and then used in various TIBCO
Foresight products.
Customized vs. Published Guidelines
TIBCO Foresight products ship with published standards such as X12 and EDIFACT, and
industry guidelines such as HIPAA and VICS. ForesightStandardsSummary.pdf describes which
standards and guidelines go with each Foresight product.
With TIBCO Foresight® EDISIM® Standards Editor, you can create your own customized
guideline, using a published standard or guideline as a starting point.
Birth of a Customized Guideline
Customized guidelines start life in EDISIM® Standards Editor. Taking a published guideline, you
can modify the usage, codes, values, and other characteristics to define exactly how the data
should be. FSEditor.pdf and BusinessRules.pdf explain how to do this.
In this document, we base our customized guideline Our837P on 837-X222, a Foresight-supplied
5010 837P with HIPAA types 1 and 2 rules already built in. How did we know which guideline to
use as a base? We looked it up in ForesightHIPAAguidelinelist.pdf.
We make changes to codes, values, usage, notes, etc., based on instructions in FSEditor.pdf.
After saving, Our837P will have types 1,2, and 8 (our specifications are considered type 8).
Life Cycle of a Guideline
2
6/22/2015
Using a Customized Guideline with EDISIM
Once defined in Standards Editor, the guideline is actually a .STD file in EDISIM’s User
Files\Public Guidelines directory:
From there, it is available to all other EDISIM modules:
Export to SEF
OUR837P
Doc Builder
Test Data
Generator
Analyzer
Foresight
Validators
Standards
Reference
Comparator
Comparator, when in migration mode, can also modify the guideline or create a new one.
Life Cycle of a Guideline
3
6/22/2015
Using a Merged Guideline
Merging Guidelines
Since EDISIM can only handle HIPAA types 1, 2, and 8, we have to merge in types 3-7. These
are in special HIPAA guidelines that ship with TIBCO Foresight® HIPAA Validator Desktop®,
TIBCO Foresight® Instream®, TIBCO Foresight® Transaction Insight®, TIBCO Foresight®
Community Manager®, and other HIPAA-specific products.
We use GuideMerge for this.
GuideMerge ships in the Bin directory of EDISIM and Instream®.
We will merge Our837P with the corresponding types 1-7 guideline, which we look up in
ForesightHIPAAguidelinelist.pdf. This gives us a guideline with all HIPAA rules plus our own rules
from Our837P. We call it P_Our837P:
Our837P + PDSA5010837P = P_Our837P
This follows the custom of putting a P in front of the EDISIM guideline to identify it as the
“production” guideline -- the one to be used with the HIPAA products.
GuideMerge.pdf gives all the details. Let’s assume that we are doing the merge from a machine
that is running Instream. Here’s what we would do:
1. Copy Our837P from EDISIM’s User Files\Public Guideline directory to somewhere on
the Instream machine.
2. Run GuideMerge to create P_Our837P.std.
Life Cycle of a Guideline
4
6/22/2015
Using Merged Guidelines with Instream
Copy the resulting P_Our837P to Instream’s Database directory.
If you have made other changes associated with the guideline, such as changes to the validation
profile (APF), the customer error message file, external tables or databases, the $dir.ini, etc.,
include these in Instream too.
We now have guidelines and associated files in these places:
EDISIM
EDISIM
Machine
Instream
Our837P.std
P_Our837P.std
(Types 1, 2, 8)
(Types 1-8)
APF
CustomerFSBRErrs.txt
APF
CustomerFSBRErrs.txt
tables
tables
databases
databases
Using Merged Guidelines with TIBCO Foresight™ Translator
Copy the resulting P_Our837P to Foresight™ Translator’s Database directory.
Translator does not need the APF, customer errors file, etc.
EDISIM
Translator
Our837P.std
P_Our837P.std
(Types 1, 2, 8)
(Types 1-8)
APF
CustomerFSBRErrs.txt
tables
databases
Life Cycle of a Guideline
5
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Using Merged Guidelines with Transaction Insight®
The web portal machine must have an installation of Instream with the same guidelines and
related files that were used for validation.
After initial validation, the detail results file is imported into Transaction Insight. A TI user corrects
the data and it is sent to Instream to revalidate. Typically, the two instances of Instream are not
on the same server.
Instream
Validation
EDI
(P_Our837P,
APF, errors file,
etc.)
Transaction
Insight
DTL file
Instream
Revalidation
(P_Our837P,
APF, errors file,
etc.)
A more complete overview of a typical process like this might be:
Good
Translator
Docsplitter
EDI
Instream
validation
DTL file
Bad
Response
Generator
Transaction
Insight
999,
etc.
Life Cycle of a Guideline
6
6/22/2015
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