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Reimbursement of Healthcare Claims

other UNCEFACT Projects

Project Details

Domain
Project Identifier
P1064
Bureau Decision #
#1802055
Project Proposal Status

Draft

Project Page

TBD

Supporting VC

TBD

Project Lead
HoD Support
ES / DE / TBD
StatusInitiated
Version
2.0
Submitted date
2018-01-22
Draft Development Completion
2018-08-19
Publication Date
2019-11-19

Project Purpose

The project’s purpose is to facilitate cross border exchange of data between health care providers and private health insurance for the reimbursement of claims. The Insurance has already submitted a wide range of insurance-related objects to the Core Component Library and this project build on this foundation. These components are closely related to the insurance work in other areas such as transport means and cargo insurance; this project will facilitate the use of our standards in the principle of ‘semantic hub’ by global insurance companies providing the missing elements for health insurance. The project will prepare a submission of CCs and models of building blocks for Health Insurance in the field of reimbursement of claims.

Project Scope

Over the last few years, the insurance domain in UN/CEFACT has developed a complete set of core components for the administration of contracts. The focus was on private property and casualty insurance and on motor insurance for private vehicles and commercial fleets. Now the insurance domain will extend its development to cover private health (full or additional) insurance policies to support the exchange of data in the field of reimbursing claims. This project is closely related to work which has been done in CEN (Comité Européen des Normes) under TC445. This project goes beyond the work of this CEN group aiming to bring it to the international level and integrate the requirements of economies outside the European area.

Project Deliverables

• BRS to cover the business process scenario • Submission of core components (ACC, BCC, ASCC) to the UN/CEFACT Core Component Library. • CCBDA Message Assemblies

Exit Criteria

• BRS to cover the business process scenario • External Review Log showing all comments have been addressed • Submission of core components (ACC, BCC, ASCC) to the UN/CEFACT Core Component Library. • Data elements corresponding to the BRS submitted ready for publication • CCBDA Message Assemblies • CCBDA corresponding to the BRS submitted ready for publication

Project Team Membership and Required Functional Expertise

The project team is open to experts with broad knowledge and experience in the area of transport, logistics and related mobile communication messaging activities as well as in modelling techniques. In addition, Heads of Delegations may invite technical experts from their constituency to participate in the work. Experts are expected to contribute to the work based solely on their expertise and to comply with the UN/CEFACT Code of Conduct and Ethics

Geographical Focus

The geographical focus of the project is global.

Initial Contributions

• eEG7 Data Model • CCL

Resource Requirements

No additional secretariat resources will be required.