PL 009.pdf

TRA04 – The Integration Hub

Version 0.6 12/10/2019

Prepared by:

South Carolina Department of Health and Human Services (SCDHHS)

Enterprise Services (ES)

PL 009

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Table of Contents

1. Introduction

2. Architecture

3. Integration Hub Functions

3.1. Authentication and Authorization

3.2. Exposing and Consuming Web Services

3.3. Exposing and Consuming Files

3.4. Batch Processing

4. Inventory of Services

4.1. Private and Public Services

4.2. Service Definitions

4.3. Types of Services

5. Service Governance and Setup

5.1. Security and Authentication

5.2. Contract Management

5.3. Change Management

5.4. Service Level Agreements

5.5. Testing

6. Appendices

6.1. Acronyms

6.2. Referenced documents

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Table of Figures Figure 1. The integration hub in the MES

Figure 2. Integration hub architecture

Figure 3. Authentication and authorization for services

Figure 4. Exposing and consuming functionality

Figure 5. Batch processing

Table of Tables Table 1. Business and data services types

Table of Standards TRA04-S1. Access to the integration hub will conform to the TRA01.02 – Access Control and Identity Management supplement

TRA04-S2. The CMDB will maintain the inventory of integration hub services

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SCDHHS expressly restricts the distribution of this document to include only those SCDHHS staff, SCDHHS processing environment contractors, or any entity given explicit access to this document with SCDHHS executive or management approval.

Intended audience

The SCDHHS Technical Reference Architecture (TRA) audience includes SCDHHS staff, trading partners, and third-party vendors who will be implementing integrating, managing, or operating the SCDHHS Medicaid Enterprise System (MES). The SCDHHS TRA provides the reference model by which technologies and components of the SCDHHS MES will be measured for development and implementation.

This supplement uses the terms “service”, “service consumers”, and “service providers”. In the context of Medicaid operations, the terms “service providers” or “providers” typically describes vendors who provide services to members, for instance medical services or transportation services. However, in the context of the integration hub, the term “service” refers to the loosely coupled software components of the MES, including web services, managed file transfer (MFT) services, etc., and “provider” refers to the component that makes the service available for used by other components.

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1. Introduction Figure 1. The integration hub in the MES positions the integration hub at the heart of the South Carolina Department of Health and Human Services (SCDHHS) Medicaid Enterprise System (MES).

The integration hub is a concept, expressing the encapsulation of tools, technologies, and services used by the portal, the Enterprise Data Services (EDS), trading partners, systems (such as the member management system), etc., when interacting with each other. That is, the integration hub enables components to call services as if the integration hub itself provided the services, and trading partners do not need to know the implementation details to utilize the integration hub services.

The key to understanding the integration hub is knowing that the integration hub provides constituents access to all the MES functionality for which they are authorized. The integration hub masks the internal system architecture of the EDS and all other underlying MES components to enable a constituent to perform all their Medicaid business.

Some of the functionality allows constituents to perform business transactions, some to interact with data, and some to perform common system functions, such as data validation and process logging. Services provided by the integration hub perform:

• Business functions, such as provider enrollment, claim processing, eligibility determination, etc.

• Component functions (or helper functions), such as validating an address, process logging, etc.

• Data functions, such as create, read, update, delete (CRUD) records

Tasks launched from the portal typically invoke compounded functionality. For instance, the option on the provider portal for enrolling a provider calls:

• Services for a business function to execute the process and rules around enrollment

• Services for a data function to create a materialized provider record

• Services for common functions to call a Google service to validate an address

This supplement provides an overview of the integration hub components, functionalities, and

Figure 1. The integration hub in the MES

12/10/2019 SCDHHS - Confidential Page 6 of 16 service operations considerations. See the TRA02 – Shared services service-oriented architecture (SOA) supplement more information about the MES SOA architecture. See the TRA04.01 – Enterprise service bus (ESB), TRA04.02 – Web services, TRA04.05 – Extract, transform, and load (ETL), and TRA04.06 – Managed File Transfer (MFT) supplements for detailed information about the integration hub services.

2. Architecture The integration hub infrastructure (illustrated in Figure 2. Integration hub architecture) consists of the enterprise service bus (ESB) and exposed services.

The exposed services include:

• Services developed by Enterprise Services (ES), including:

o Data services o Common services o Business services

• Services provided by back-end technologies including:

o Managed file transfer

(MFT)

o Extract, transform, and load (ETL) o Web services

• Services provided by other MES components, such as Representational State Transfer

(REST) services provided by the EDS

The integration hub is a conceptual view of the exposed services that run on top of the ESB. The ESB facilitates the authorization of system components and other trading partners to access the services exposed by the integration hub. Some services may only be directly accessible to system components within the control of SCDHHS. For instance, the service that captures service log information and writes it to the EDS (e.g. AddProcessLog service) may not be directly accessible by any trading partner. However, any business service (e.g. the UpdateMemberAddress service) that is exposed by the integration hub would call the AddProcessLog service directly.

A constituent could launch a single business service, which may in turn launch the following

Figure 2. Integration hub architecture

12/10/2019 SCDHHS - Confidential Page 7 of 16 convoluted example of a set of services (for illustration purposes only):

1. A business service to request an eligibility file is exposed as a web service.

2. The business service invokes an ETL service that pulls all active eligible members and associated enrollments from the EDS.

3. The business service encapsulates the extracted data into the 834 format.

4. The business service waits for the ETL service to complete (synchronously) and utilizes MFT to transfer the file to the trading partner location as specified.

5. Finally, the business service sends an email stating that the active eligibility file has been delivered and states the number of records that it contains.

For details and guidelines on the use of the technology underlying the integration hub, see the TRA04.01 – Enterprise service bus (ESB), TRA04.02 – Web services, TRA04.05 – Extract, transform, and load (ETL), and TRA04.06 – Managed File Transfer (MFT) supplements.

3. Integration Hub Functions The integration hub core functions include:

• Authentication and authorization

• Exposing and consuming services

• Exposing and consuming files

• Batch processing

3.1. Authentication and

Authorization

Access to the integration hub is integrated with the enterprise identify management framework.

TRA04-S1. Access to the integration hub conforms to the TRA01.02 – Access Control and Identity Management supplement.

Figure 3. Authentication and authorization for services, illustrates the portal authenticating the constituent. As part of the authentication process, the identity provider (IdP) assigns a token to the user session. When the portal interacts with the integration hub, the portal passes the token in the request. The integration hub uses the token to authorize the request and invoke the service accordingly.

Figure 3. Authentication and authorization for services

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3.2. Exposing and Consuming Web Services

Through the integration hub, the MES can expose and consume functionality. For example, Figure 4. Exposing and consuming functionality shows the integration hub exposing the functionality to CMS that it calls to complete an account transfer. The figure also shows the integration hub consuming the National Plan and Provider Enumeration System (NPPES) service to look up the National Provider Identifier (NPI) for a specified provider.

The portal can call this service without knowing the implementation details.

In this example, the integration hub exposes the TransferAccount service for CMS to consume. The integration hub also consumes the NPPES API to search for provider information and in turn exposes its own service to make the provider data available in a format specific to SCDHHS processing.

See the TRA04.01 – Enterprise service bus (ESB) and TRA04.02 – Web services supplements for more information about exposing and consuming web services.

3.3. Exposing and Consuming Files

The integration hub leverages MFT to facilitate the transfer of files to and from applications, trading partners, and the EDS.

Examples of integration hub services involving files include:

• The MFT application monitoring a trading partner File Transfer Protocol (FTP) server and transferring files placed in that server to the ESB, where, for example, the integration hub utilizes services based on the file content to load the file data to the EDS.

• A system application, such as the member management system, placing a file in the FTP server embedded in the MES, and EDS processing the contents of the file into the raw data lake (RDL).

• An MES application, such as web services exposed by the ESB sending a file to the MFT and the MFT putting the file in the trading partner’s FTP server and notifying the trading partner that the file was placed in the FTP server.

See the TRA04.05 – Extract, transform, and load (ETL), and TRA04.06 – Managed File Transfer

Figure 4. Exposing and consuming functionality

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(MFT) supplements for further information about file based exchanges.

3.4. Batch Processing

The integration hub can perform functions without manual intervention. That is, the integration hub can execute a function based on an event or on a schedule. Typically, these batch processing functions do something to a mass of data, for example, automated address validation of all members, or month-end claims processing of all claims.

Figure 5. Batch processing shows a function that calculates quarterly totals of claims data. The function resides in the integration hub. Periodically, e.g., quarterly, the integration hub starts a batch job that calls the function. The function calculates the claims totals and exports the information to the appropriate data mart.

Once the integration hub starts a batch job, processing continues until the job finishes or until an error occurs. When the batch process terminates unexpectedly, the integration hub handles the error based on the predefined error-handling process.

4. Inventory of Services TRA04-S2. The CMDB maintains the inventory of integration hub services.

The configuration management database (CMDB) maintains the inventory of integration hub services authorized for use in the MES. The CDMB also specifies whether a service is accessible internally or externally to SCDHHS. The SCDHHS implementation of the Information Technology Infrastructure Library (ITIL) framework identifies the CMDB as a fundamental part of the Configuration Management process. (See the TRA09 – Project delivery framework supplement for more information on the SCDHHS ITIL implementation.)

4.1. Private and Public Services

The integration hub functions include private and public services. Only the MES and trusted partners can consume private services. The SCDHHS portal can consume public services.

For more information on how the consumers know about the services they can consume, and the definitions of those services, see the TRA03.02 – Portlet design, and the TRA04.02 – Web services supplement.

Figure 5. Batch processing

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4.2. Service Definitions

The MES IT service catalog identifies services SCDHHS provides. Each service defines the following data structures.

• Business information – information about the entity providing the services, such as name, description, contacts, and identifiers.

• Service information – information about the families of technical services, grouping services related to a business process or group of services.

• Binding information – technical information to determine the entry point and construction specifications, for example, the Uniform Resource Locator (URL).

• Service specifications – metadata about the specifications implemented by a service.

4.3. Types of Services

Table 1. Business and data services types lists the types of services the MES provides to trading partners. The ES and the trading partner select the service based on characteristics, such as frequency of requests, payload size, need for real time data, and type of operation.

Table 1. Business and data services types

Service Type Real time Frequency Payload size

Initial load of eligible member file

ETL No One High

Submit claims data EDI No Periodic High

Get member data WS Yes High Low

Monthly member data update MFT No Periodic High

5. Service Governance and Setup The MES performs all South Carolina Medicaid business functionality through the coordinated execution of services defined in the SCDHHS implementation of the ITIL framework. The SCDHHS ITIL framework defines guidelines for adding, modifying, and using services in the MES IT service catalog.

The TRA08 – Architecture Governance supplement describes the architecture governance and the process to change the architecture. The TRA09 – Project delivery framework supplement

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The SCDHHS process to implement the exposure or consumption of integration hub services includes defining the legal, technical, business, and data sharing agreements between SCDHHS and the trading partner. Typically, the terms of the agreements include notification of updates to the services and making the updated services available to the partner, including the availability of an environment with data to test the services.

5.1. Security and Authentication

SCDHHS follows information security policies that establish a common information security framework across South Carolina state government agencies and institutions. The integration hub also plays a critical role in enabling security standards, such as authentication, authorization, and role-based security, and guards against breach of information.

5.2. Contract Management

Access to integration hub services and the data that it exchanges, are governed by the contractual agreement between SCDHHS and the trading partner. The legal, technical, business, and data sharing agreements that govern the data exchange are outside of the scope of this supplement, but are important considerations to ensure that system content is restricted to only those trading partners that are appropriately authorized.

5.3. Change Management

SCDHHS implementation of the ITIL framework defines the process for identifying, requesting, analyzing, reviewing, escalating, communicating, implementing, monitoring, measuring, and reporting SCDHHS changes in a defined, consistent, and repeatable manner.

Trading partners use the change management process to request a new service or changes to existing services. All Requests for Change (RFC) forms are prioritized, implemented, and reported as explained in the TRA09 – Project delivery framework supplement.

Creating, updating, or sunsetting services that are exposed to external trading partners requires additional communication considerations.

5.4. Service Level Agreements

Service level agreements (SLAs):

• Describe the services provided and consumed by a trading partner

• Document service level targets

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• Specify the responsibilities of the SCDHHS and trading partner

SCDHHS follow SLA best practices, including the following:

• Create separate SLAs for each service that has a unique target and measurements

• Define a SLA qualitative and authoritative

• Ensure each SLA is measurable

• Require periodic review and adjustments

• Account for usual and unusual exceptions

5.5. Testing

Testing ensures that a new or changed service satisfies its requirements. For services testing, both the service provider and the service consumer need to have a common platform and understanding. The service acceptance criterion (SAC) explains SCDHHS and the trading partner how to test a service and the requirement of the service to pass the test.

SCDHHS testing standards are in line with the Service Validation and Testing (SVT) process, defined in the SCDHHS implementation of the ITIL framework. SVT critical components that establish common understanding/standards between SCDHHS and a trading partner include:

• Test and data environment – SCDHHS and the trading partner have access to a fully functional test environment that has the latest version code base and infrastructure replica/simulation to run business processes and different test scenarios.

• Issue classification and support channels – well-defined classification for issues raised and respective support channels to respond/resolve.

Please refer to the TRA07 – Validation and risk management supplement for details about tools, techniques, and procedures for testing.

6. Appendices

6.1. Acronyms

Acronym Meaning

CMDB Configuration management database

CMS Centers for Medicare and Medicaid Services

CRUD Create, Read, Update, and Delete

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Acronym Meaning

DASO Dental Administrative Service Organization

ECMS Enterprise Content Management System

EDI Electronic Data Interchange

EDS Enterprise Data Services

ES Enterprise Services

ESB Enterprise service bus

ETL Extract, transform, and load

FTP File Transfer Protocol

IdP Identity provider

IT Information Technology

ITIL Information Technology Infrastructure Library

MASO Medical Administrative Service Organization

MES Medicaid Enterprise System

MFT Management file transfer

MMRS Member Management Replacement System

NPI National Provider Identifier

NPPES NPI Registry Public Search

OAUTH Open Authorization

ODS Operational data store

PASO Pharmaceutical Administrative Service Organization

QA Quality Assurance

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Acronym Meaning

RDL Raw data lake

REST Representational State Transfer

RFC Request for Change

SAC Service Acceptance Criteria

SAML Security Assertion Markup Language

SCDHHS South Carolina Department of Health and Human Services

SLA Service level agreement

SOA Service-Oriented Architecture

SVT Service Validation and Testing

TRA Technical Reference Architecture

URL Uniform Resource Locator

XML Extensible Markup Language

6.2. Referenced documents

Referenced document title Document location and/or URL

TRA – Technical Reference Architecture Overview of the SCDHHS Medicaid Enterprise System Architecture. Defines the SCDHHS strategy, major components of the MES and standards that govern its implementation.

TRA01.02 – Access control and identity management

Definition of identity management implementation across portal, database, and service assets. Defines the use of service accounts that make component-to-component calls.

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TRA04.01 – Enterprise Service Bus Overview of the ESB role in the SOA and the implementation guide utilizing the Oracle Service Bus.

TRA04.02 – Web services Development guide for web services and integration into the ESB.

TRA04.03 - Authentication Guide for authentication of web services including requests from internal and external components.

TRA04.05 – Extract, Transform and Load

(ETL)

Standards on ETL processing, ETL integration in the ESB and expectations on data that leave the DMZ.

TRA04.06 – Managed File Transfer (MFT) Standards and guidelines governing transferring files securely; both inbound and outbound.

TRA05 – The Enterprise Data Services (EDS) framework

Overview of the data architecture and the data flow.

TRA05.02 – Raw Data Lake (RDL) Overview of the Raw Data Lake (RDL) and how the MES ingests and processes raw data.

TRA05.03 Operational Data Store (ODS) Overview of the Operational Data Store (ODS) and how the MES ingests, materializes, delivers, and consumes data.

TRA07 – Validation and Risk Management Overview of risk management by functional, performance, and vulnerability testing.

TRA08 – Architecture governance The governance model to be followed should any of the TRA components (architecture, major systems components, and standards) require change.

TRA09 – Project delivery framework Overview of ITIL, the project lifecycle, and SDLC

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