Qualifacts EDI Project

1
Qualifacts EDI Project

• Adam Davie
• Clark Bedsole
• Tim Jansen
• Robert Jones

2
CareLogic

• Web-based application created by Qualifacts and
  used by the mental health services to organize
  patient claims
• Claims are approved and sent to insurance
  companies
• Batch files are created and uploaded to the
  payers site

3
EDI

• Electronic Data Interchange
• The method by which information is exchanged
  between patients, mental health facilities, and
  insurance companies.

4
EDI (cont.)

• Helps save a company money
• More effective than paper systems
• Give a company the ability to store and
  manipulate data electronically with the cost of
  manual entry or scanning

5
CareLogic File Format Example
1744John Doe3/27/781239.00

• Each field represents some data for forms/records
• Different symbols represent text formatting
• The formatting is used to generate printed
  documents
• In this example
• characters represent tabs
• characters represent new line

6
Current CareLogic System Structure

• Changes to the format of one type of file do not
  propagate to the various sites using the
  CareLogic system
• The various files and formats are not organized
  and labeled
• The payers determine how their files are
  formatted and structured
• Currently no standardized method of formatting

7
Project Requirements

• Construct a library of files for the EDI
• Automate the management of EDI files
• Addition, deletion, and editing
• Create a system that automatically propagates
  changes to the files in the library to all
  clients that have implemented CareLogic

8
Databases

• Structured collection of data stored in a
  computer system
• Database Management Systems (DBMS) include dBase,
  Paradox, Oracle
• Systems allow user to create, update, extract
  information from their databases
• Relational DBMS
• Relationship among data is stored in form of
  tables
• Ex. Matching employee to the department
• Ex. Employees personal info matched to the
  specific employee
• Hash tables are used to gain access to specific
  data
• Ex. First last name

9
Oracle

• Oracle database 10g version 10.2.0.1.0
• Not the newest version
• Provides the most stable environment
• Performance
• Efficient for working with large amounts of data
• Security
• Built-in encryption algorithms for protection

10
PL/SQL

• Procedural Language/Structured Query Language
• Programming language designed by Oracle for use
  with their database systems
• 4th Generation Programming Language
• Qualifacts has created a library of functions in
  PL/SQL that automate the generation of HTML

11
Source Code Access

• Connect to Qualifacts code for CareLogic using a
  Virtual Private Network (VPN) connection
• Allows us to work on project away from
  Qualifacts office
• Brad Bills is setting up user accounts for each
  of us on Qualifacts network

12
Revision Control Software

• Used to manage the editing of source code during
  a software development project
• Allows users to check out code modules and check
  in code revisions
• We will be using Subversion (SVN)
• Industry leading version control software
• Available for free