Exhibit_6_-_Technical_Specification_-_Premium_Billing_Service.pdf

DoD

Defense Manpower Data Center

Defense Enrollment Eligibility Reporting System/ Military Health System (DEERS/MHS)

Technical Specification for the

Premium Billing Service

Version 1.120 March 29April 1228, 2012

Technical Specification for the Premium Billing Service

DMDC iiVersion 1.2 Version 1.2 Version 1.1 Version 1.0 – April 28, 2012 April 28, 2012 April 12, 2012 March 29, 2012

Document History

Document Version Date Change(s)

1.0 March 29, 2012 Initial Draft.

1.1 April 12, 2012 Modified the exchange elements to Data Dictionary XML Tag names.

1.2 April 28, 2012 Updated business rules to relax rules with the Requested Past Due Payment Date.

Modified the description of errors 73001 and 73003.

Updated examples.

Changed the definition of requestedPaymentFiscalYearAmount.

Technical Specification for the Premium Billing Service

DMDC iiiVersion 1.2 Version 1.2 Version 1.1 Version 1.0 – April 28, 2012 April 28, 2012 April 12, 2012 March 29, 2012

Contents

1.0 DOCUMENT PURPOSE 1

2.0 REFERENCED DOCUMENTS 1

3.0 TECHNICAL PROCESS FLOW 1

4.0 SECURITY 2

5.0 COMMUNICATIONS 2

6.0 TECHNICAL REQUIREMENTS 2

7.0 IDENTIFICATION 3

8.0 PREMIUM BILLING SERVICE BUSINESS RULES 4

9.0 INPUTS: FROM CONTRACTOR TO DEERS 5

9.1 BILLING SERVICE INQUIRY MESSAGE 5

10.0 OUTPUTS: FROM DEERS TO CONTRACTOR 7

10.1 BILLING SERVICE RESPONSE MESSAGE 7

11.0 BILLING SERVICE TRANSACTION ERROR AND WARNING CODES 109

11.1 PLACEHOLDER ERROR AND WARNING CODES 1110

12.0 EXAMPLE SCENARIO 1311

12.1 BILLING AMOUNT REQUESTED FOR AN EXISTING POLICY 1311

12.2 BILLING AMOUNT REQUESTED FOR A NEW POLICY 1412

13.0 PROGRAMMING FOR THE INTERFACE 1513

APPENDIX: WSDL FOR THE PREMIUM BILLING WEB SERVICE 1714

DMDC 1Version 1.2 Version 1.2 Version 1.1 Version 1.0 – April 28, 2012 April 28, 2012 April 12, 2012 March 29, 2012

1.0 Document Purpose

This document defines the specifications for the new Billing Service that will return the Premiums owed for the period requested by the inquiry transaction. The intended audiences are Managed Care Support Contractors (MCSCs), Dental Contractors, and the Designated Providers (DPs), annotated throughout this document as “Contractors.” MCSCs and DPs may shall use this new Premium Interface to inquire on Premiums owed for periods effective 10/1/2012 and beyond.

2.0 Referenced Documents

This Technical Specification references and/or contains information from Chapter 3 of the TRICARE Systems Manual (TSM).

3.0 Technical Process Flow

DEERS is the repository for premium data. Once a policy is established in DEERS, Contractors can query DEERS for the amounts due based on their billing cycles and desired Paid Period End Dates (PPEDs). DEERS will look at the premiums already paid, applicable metadata like the monthly premiums for a plan, fee waivers, premium override data, and copayment factors and return to the Contractors the premiums due for the desired period. Contractor Systems will send a SOAP/XML message billing inquiry transaction with the policy information and the desired Paid Period End Dates. DEERS will process each inquiry transaction. In response, DEERS will send a SOAP/XML billing response message to the Contractor. If DEERS processed the inquiry transaction successfully, it will return a success return code with the requested outputs. If the processing failed, DEERS will return a failure return code. The following provides the high-level sequence of events for a given transaction:

1. The Contractor system creates the SOAP/XML billing inquiry message and sends it to DMDC/DEERS over the VPN using HTTP protocol.

2. If DEERS cannot parse the inquiry, DEERS will return a standard web service SOAP fault.

3. Upon receiving the inquiry message, DEERS pulls the policy information from the database and calculates the amounts due based on the inputs provided.

4. DEERS responds to MCSC system with a SOAP/XML billing response message indicating the DEERS processing result.

5. If DEERS returns a successful transaction, the SOAP/XML billing response message will contain a return code set to 00000.

6. If there is an error, the SOAP/XML billing response message will contain the appropriate error code as well as the contents of the Contractor inquiry message.

7. DEERS processes all transactions in real-time.

DMDC 2Version 1.2 Version 1.2 Version 1.1 Version 1.0 – April 28, 2012 April 28, 2012 April 12, 2012 March 29, 2012

Premium Billing Service Network Diagram

4.0 Security

The Contractor must send all Premium Billing Service transactions via HTTP over the Military Health System (MHS) Business-to-Business (B2B) gateway secured by Virtual Private Network (VPN). The VPN will use encryption to provide a secure channel for data transmission. The MHS administers the B2B gateway and VPN, including components that are physically located at the Contractor’s site. The Contractor must upgrade and comply with changes to the standard MHS VPN solution. The Contractor must provide information required to support the B2B Gateway to MHS. The requirements for the B2B Gateway may change over time, and the Contractor must upgrade and comply accordingly.

The goal of TMA security administration is to minimize maintenance of user IDs and passwords across the network and to accommodate future security strategies through current procedures.

The Contractor must comply with current DoD and MHS security requirements, as well as future enhancements based on technological advances that include, but are not limited to, Machine-to- Machine certification and authentication, Public Key Infrastructure (PKI), and other encryption options.

5.0 Communications

For monthly billing cycles, Contractors must send their billing inquiry transactions to DEERS during off peak hours (between 6:00 pm Pacific and 6:00 am Pacific) on pre-determined days of the month. DEERS will respond real-time to each inquiry transaction.

6.0 Technical Requirements

The Premium Billing Service is implemented as a Java API for XML Web Services (JAX-WS) web service. The Web Services Description Language (WSDL) document that describes the

DMDC/DEERS

MCSC/DP A

Server

MCSC/DP B

Server

MCSC/DP C

Server

Internet

Internet

DMDC

Server

Internet

VPN

VPN

VPN

NIPRNet

NIPRNet

B2B Gateway

B2B Gateway

B2B Gateway

NIPRNet