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
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 AssembliesExit 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