Core Components and data exchange models for Health Insurance in the field of reimbursement of healthcare claims
other
Project Details
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
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 deliverablesProject Deliverables
The project deliverables are: • Business Requirements Specification (BRS) as defined during the business requirements gathering • Requirements Message Specifications (RSM) • UN/EDIFACT messages (to be defined or updated) • XML schema of the required messages • Guideline - Guideline document.Exit Criteria
The exit criteria will be: • Business Requirements Specification (BRS) as defined during the business requirements gathering o External Review Log showing all comments have been addressed • Requirements Message Specifications (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 addressedProject 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 EthicsGeographical Focus
The geographical focus of the project is global.Initial Contributions
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) projectResource Requirements
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
Proposed Project Leader: Dr. Youngkon LeeProject Proposal Files