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Core Components and data exchange models for Health Insurance in the field of reimbursement of healthcare claims

Reimbursement of Healthcare Claims

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Project Details

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Domain
Project Identifier
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P1064
Bureau Decision #
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#00000#1802055, #1907017; #2003087; #2006001; #2101079
Project Proposal Status

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dateJan 22, 2018 14:32Jul 09, 2019 13:44
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Project Page

TBDReimbursement of Healthcare Claims

Supporting VC
Project Lead

Proposed Project Leader: Dr. Youngkon LeeMichel Bormans

HoD Support
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Mr.ES Christian/ HuemerDE (Austria) Mr. Lee Jung Gu (Korea) Mr. Hisanao Sugamata (Japan)/ GR
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selectedInitiatedIn development
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  • In development
  • Completed
Version
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12.0
Submitted date
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20162018-0501-0422
Draft Development Completion
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20182020-08-1930
Publication Date
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20192020-11-1915

Project Purpose

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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

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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 deliverablesOver 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

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The project deliverables are:
Business Requirements Specification (BRS) asto defined duringcover the business requirementsprocess gatheringscenarioRequirementsSubmission 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 defined duringcover 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 projectNo additional secretariat resources will be prepared in between Forums, principally using conference call facilities.

Project Leadership

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Proposed Project Leader: Dr. Youngkon Leerequired. 

Project Proposal Files

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