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A Java & award winning project
CM has more than 4,5 million members and is therefor the largest healthcare insurance organization in Belgium. CM offers a large range of services to its members from the distribution of ‘SIS-cards’ and social assistance to developing projects for a more healthy life style.
The REFAC project is a project undertaken by the Catholic Health Service (CM/MC) to streamline the treatment of the invoices from third parties. In a first phase this concerns the invoices from hospitals, but in a later phase this should as well cover the invoices from pharmacists, general practitioners and home nursing.
The project aims at receiving as much as possible fault-free invoices that can pass through the system without human intervention. This will be realized by greatly improving the validations that are done on the invoices, both on the technical as on the business level, and by providing a digital rejection file to the originator of the invoice in case of disputes on certain medical provisions in the invoice.
The project furthermore aims at streamlining the contacts between the hospitals and the Catholic Health Service administration by providing a unique contact point (UCP) for each hospital in case of disputes. The UCP therefore will need to have access to all relevant data of the invoices of the hospitals it has been assigned, even if it concerns members affiliated to another regional office of the Catholic Health Service than the one where the UCP is situated.
Together with Tobania the Catholic Health Service (CM/MC) has defined a new Enterprise application to load, validate and monitor the invoices from the hospitals. The system is composed of a back-end Java Enterprise application on the one hand and a number of JSF based web-applications for the front office and back-office monitoring and handling of the invoices.
The back-end application contains a workflow that governs the different steps that are needed to validate an invoice. The application also contains most of the actual validation steps except for the validation of the actual invoiced cost for each medical provision, which is regulated by the Belgian Health Institution (RIZIV/INAMI), and for which a separate Expert System (XPS) has been set up by the Catholic Health Service (MC/CM).
The back-end application is deployed on an Oracle OC4J J2EE container and makes use of the EJB 3.0 specification with Oracle Top link as the JPA provider. The application uses JBPM as a workflow engine and Oracle Advanced Queuing for message based services. Furthermore several standalone Java applications are foreseen for those validation steps in the workflow that are very time and resource consuming.
The front-end part of the application consists of three different web-based applications which can be used to monitor the advancement of the invoice through the validation workflow and see the validation status of the invoice, manage invoices that have been stopped in the workflow due to a validation problem and manage rejections of medical provisions on a health service member level.
How we helped?
During the design phase of the project Tobania has been involved in the project in its ‘Professional Services’ capacity with up to 5 consultants in support of the Catholic Health Service (CM/MC). During this phase, which took little under two years, Tobania assisted the Catholic Health Service in defining the technical architecture on the one hand and in describing the Use Cases on the other hand. During this phase two technical consultants of Tobania were involved in developing several ‘Proof Of Concept’ projects on emerging technologies or technologies that were previously not used by the Catholic Health Service, to back-up the decisions concerning the technical architecture of the REFAC system.
After a successful conclusion of the design phase, Tobania was requested by the Catholic Health Service to realize the REFAC system as a fixed price project. In order to minimize the risks and retain the possibility to adapt the requirements during realization, the project has been split up into three releases, with the first release being split-up further into four deliveries. The first release is planned to take a little over two and a half years and at the end of this release all the necessary functionalities will be implemented to put the REFAC system in production. The subsequent releases will concentrate more on reporting and data-warehouse capabilities of the system and on adding other third parties besides the hospitals to the REFAC system.