Job Description :
Description:
Candidate Name: DTS DMHF Senior EDI Support Engineer
1.0 Executive Summary
The Department of Technology Services (DTS) supports the daily operation and development efforts for the 5010 Electronic Data Interchange (EDI) Service Oriented Architecture (SOA) which is comprised of a variety of Oracle middleware technologies, Oracle databases, JAVA programs, and BASH scripts under Linux. The 5010 EDI SOA IS operated by DTS for the Division of Medicaid Health and Financing (DMHF) under the Department of Health.
The 5010 EDI SOA environment is the claims processing gateway which handles over 2.1 billion 2,100,000.000.00) dollars in claims payments and 20 billion dollars 20,000,000,000.00) in overall submitted claims volume annually. It IS highly complex both in terms of business logic and implemented software. The 5010 EDI SOA environment is considered a legacy system which is due to be replaced by the Provider Reimbursement Information System for Medicaid (PRISM PRISM has an EDI processing environment as part of its design, and at some future point in the project schedule. development on the replacement for the 5010 EDI SOA will begin. The PRISM project has encountered delays in the development schedule which necessitates the continued operation of the legacy 5010 EDI SOA environments until December 2020.
This business case is in support of retaining contract personnel to ensure continuity of operations for the legacy system. Support for 5010 EDI SOA must continue until PRISM is certified by Federal authorities from the Canters for Medicare and Medicaid Services (CMS
2.0 Problem I Opportunity Statement
The original schedule for PRISM planned for the legacy environments to cease operation during 2016. Therefore, minimum staff levels were assigned to support the 5010 EDI SOA platform. In order to maintain the systems until the certification of PRISM, DTS will need to retain a qualified expert resource to work with State personnel.
Without expert support on this complex system, interruptions in service may occur which could result in reduced access to care for Utah''s vulnerable population of Medicaid recipients. This is unacceptable as the resulting failure to service this population directly Impacts an individual’s quality of life. Therefore, DMHF expects DTS to provide adequate levels of qualified personnel to cover the support activities of regular maintenance, implementation of new Federal mandates, and emergency system failures.
5010 EDI SOA is a highly complex system comprised of several smaller subsystems. each in turn managing specific business rules, and claims transfer logic. 5010 EDI SOA shares Integrated data feeds with MMIS and MMCS which comprise the other two major systems in Utah''s implementation of Medicaid at the State and Federal levels. The integration between the two major internal systems, MMCS and MMIS, and the external EDI interfaces to Utah Health Information Network (UHlN), represent daily operational challenges which must be addressed.
3.0 Current Environment
The current 5010 ED! SOA environment has the following sub-functions which require support''
System - Subsystem/F unction
5010 837 Professional Fee for Service
501D 837 Institutional Fee for Service
5010 837 Dental Fee for Service
5010 837 Professional Encounter
5010 837 Institutional! Encounter
5010 837 Dental Encounter
5010 820 Payment Order/Remittance
5010 834 Benefit Enrolment
5010 835 Health Care Claim Payment
5010 270 Benefit Inquiry (Batch)
5010 271 Benefit Inquiry Response (Batch)
5010 270 Benefit inquiry (Real Time)
5010 271 Benefit inquiry Response (Real Time)
5010 276 Health Care Claim Status (Batch)
5010 277 Health Care Claim Status Response (Batch)
5010 276 Health Care Claim Status (Real Time)
5010 277 Health Care Claim Status Response (Real Time)
5010 277CA Claims Acknowledgement
5010 277CA Encounter Claims Acknowledgement
These subsystems/functions are currently programmed in a mixture of programming languages such as such as JAVA, Oracle PL/SQL, BPEL, XPATH, and SOA composite design. The skill set sought in a Senior EDI Support Engineer will need to encompass these technologies.
4.0 Future Environment
4.1 PRISM
The PRISM product, which is a replacement for 5010 EDI SOA environments, is due to deliver in Winter 2020. Once this product IS certified by CMS, all legacy systems will be shut down. The Senior EDl support engineer role sought in this business case may terminate with the legacy system shutdown.
5.0 Solutions Analysis and Estimations
5.1 Solutions Analysis
To meet the immediate requirements of continued system support for 5010 EDI SOA, DTS must engage a high-quality Senior EDI Support Engineer with specific experience in DMHF operations. Since the flow of data IS constant into the system and the calculated outcomes of the data impact Medicaid recipients directly, deep experience and familiarity with the system IS required. The Senior EDI Support Engineer must have experience in Utah''s Implementation of 5010 EDI SOA (minimum of two (2) years
Retaining a Senior EDI Support Engineer will allow for the significant decrease in the overall response time needed to resolve emergency issues. Current State staff will be able to maintain the expert knowledge base to improve support for the legacy environments.
Alternatives to this solution include:
1) Extend the existing contract With the Smith Johnson Group, the current contractor providing current EDI support resources This is not viable as the purchasing guidelines approved by the legislature have restricted adding additional money to the current contract beyond year end. The active contract also lacks enough built-in renewal extensions to cover the remaining support period needed without additional amendments. The Senior EDI support engineer must on staff until winter 2020.
2) Attempt to hire new State staff and train them on the system. Given the complexes of the systems, unqualified resources involved in the process of on the Job training will create Significant time penalties in support of the systems. DMHF IS not in support of training staff for a legacy system for which a replacement is due in three (3) years. DMHF is also concerned about the financial risk to the State from Federal fines should access to care be interrupted to Medicaid patients from unintentional mistakes from under qualified personnel. Considering the remaining usable life of the legacy systems, both alternatives represent risk factors to daily DMHF/DTS operations which cannot be mitigated either quickly or cost effectively.
Scoring Criteria:
10% Quality of experience3 with Developer
20% Quality of experience with BPEL
30% Quality of experience with SOA Development
10% Quality of experience with EDI Development
30% Cost