Reimbursement of Healthcare Claims
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Project Details
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Project Purpose
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The project’s purpose ofis thisto projectfacilitate iscross theborder specificationexchange of the business requirements and essential data itemsbetween suitablehealth tocare beproviders transferredand usingprivate mobilehealth technologiesinsurance duringfor the deliveryreimbursement of transport servicesclaims. AThe transportInsurance serviceshas provider (carrier or freight forwarder) when contracted by a transport services buyer (consigner or consignee) is committed to deliver the contracted consignment to a designated consignee via any named contractual locations. In reality, as a result of the diversified nature of the modern intermodal, synchromodal and multimodal transport infrastructures, the actual routes deployed often vary from the contractual arrangements. The reasons for these deviations are very varied but most often result from operational considerations. However, changes in itineraries during transport movements can also be pointers to security and other risks of interest to cross-border agencies. In both cases, the tracking of the trade items is made more difficult with every operational route change and all the parties concerned are needing new methods by which they can be informed of all such changes in safer, more precise and prompt ways. Modern communication methods such as those based on mobile technologies can assist in providing real-time information to keep all interested parties up to date along the transport chain. However, these new communications methods are not suitable for exchanging large-scale amounts of data and therefore the key data requirements need to be identified to support short, sharp efficient data deliveries at regular intervals. This project will base its work on the Multi Modal Transport (MMT) reference model and will analyse the required subset business process scenario and identify the relevant data items and structures needed for supporting real-time mobile technologies. |
Project Scope
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.
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Project Scope
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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. | ||||
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The scope of this project is limited to:
- specifying real time and geographical data items to be useful to exchange in order to increase transparency, reliability and completeness during the transport movements of consignments;
- developing BRS based on the MMT high-level BRS;
- developing an RSM to help users apply the identified data items in standardised message structures.
- Develop a guideline for implementing the scenario defined in the BRS and RSM deliverables
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Project Deliverables
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The project deliverables are: • Business Requirements Specification (BRS) asto defined duringcover the business requirementsprocess gatheringscenario • RequirementsSubmission Messageof Specifications (RSM) • UN/EDIFACT messages (to be defined or updated) • XML schema of the required messages • Guideline - Guideline document.core components (ACC, BCC, ASCC) to the UN/CEFACT Core Component Library. • CCBDA Message Assemblies |
Exit Criteria
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The exit criteria will be: • Business Requirements Specification (BRS) asto definedcover during the business requirementsprocess gatheringscenario o• External Review Log showing all comments have been addressed • RequirementsSubmission of Messagecore Specificationscomponents (RSM) o External Review Log showing all comments have been addressed • XML schema of the required messages o External Review Log showing all comments have been addressed • Guideline document o External Review Log showing all comments have been addressedACC, 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
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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
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The geographical focus of the project is global. |
Initial Contributions
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The following contributions are submitted as part of this proposal. It is understood that these contributions are only for consideration by the Project Team and that other participants may submit additional contributions in order to ensure that as much information as possible is obtained from those with expertise and a material interest in the project. It is also understood that the Project Team may choose to adopt one or more of these contributions “as is”. • T&L's Multi-Modal Transport Reference Data Model (project p1023) • BRS IFTM International Forwarding and Transport • UN/CEFACT Modelling Methodology (CEFACT/TMG/N093) • UN/CEFACT ebXML Core Components Technical Specification Version 2.01 • Artefacts from the South Korea Electronic Bill of Delivery for Logistics (eBOD) project • eEG7 Data Model • CCL |
Resource Requirements
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Participants in the project shall provide resources for their own participation. The existence and functioning of the project shall not require any additional resources from the UNECE secretariat. The project will be prepared in between Forums, principally using conference call facilities. |
Project Leadership
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Proposed Project Leader: Dr. Youngkon LeeNo additional secretariat resources will be required. |
Project Proposal Files
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