PPA+UC+1+-+Functional+Requirements

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= The content within this page has been incorporated into the PPA UC 1 - Provider Registration =

**An editable copy can also be found **


 * NOTE: The content developed and displayed on this page will be inserted into the Use Case document in the highlighted sections below: **

= = =11.0 Functional Requirements= Functional Requirements identify the capabilities a system playing a role must have in order to enable interoperable exchange of the healthcare data of interest. They provide a detailed breakdown of the requirements in terms of the intended functional behaviors of the application. The Functional Requirements include Information Interchange Requirements and System Requirements.

11.1 Information Interchange Requirements
//Information Interchange Requirements define the systems’ name and role and specify the actions associated with the actual transport of content from the sending system to the receiving system. Information systems participating in this Use Case must meet certain functional requirements based on their role. Functional requirements are of two types: information interchange requirements and internal system requirements. Note: The steps below are not outlined in a sequential order.//
 * ** Initiating System ** ||   || **Information Interchange Requirement Name** ||   || **Receiving System** ||
 * Registration Requestors Information System || Send || Registration Information || Receive || Payer Gateway Information System ||
 * Payer Gateway Information System || Send || Registration Information || Receive || Payer Information System ||
 * Payer Information System || Send || ESI Query || Receive || Provider Directory ||
 * Provider Directory || Send || ESI Query Response || Receive || Payer Information System ||
 * Payer Information System || Send || Registration Request Response || Receive || Payer Gateway Information System ||
 * Payer Gateway Information System || Send || Registration Request Response || Receive || Registration Requestors Information System ||

11.2 System Requirements
//System Requirements lists the requirements internal to the system necessary to participate successfully in the transaction. System requirements may also detail a required workflow, essential to the Use Case.//
 * **System** || **System Requirement** ||
 * Registration Requestors Information System || * Able to compile information required for registration
 * Have internal controls to ensure all necessary registration information is compiled/properly packaged prior to sending to Payer Information System ||
 * Agent /Access Information System || * Have internal controls to ensure all necessary registration information is compiled/properly packaged prior to sending to Payer Information System
 * Translate /transform information between provider and industry standard transactions ||
 * Payer Gateway Information System || * Translate /transform information between payer and industry standard transactions ||
 * Payer Information System || * Receive electronic registration request
 * Validate provider information
 * Query Provider Directory for ESI
 * Validate and formulate response to provider registration request ||
 * Provider Directory || * Provide demographic and ESI information in the required format to the requestor
 * Provide appropriate error messages
 * Select appropriate provider based on query parameters
 * Return provider demographic in ESI or appropriate error message ||

11.3 Dataset Requirements
**//Section Description://** //This table lists the data elements and data element sets) that will be available within the message or document. Historically, the optional/required nature of each data element is deferred to the discussions during the harmonization phase. Each data element listed below is necessary for some aspect of the Use Case; however, the table does not specify exactly how they may be used together. All data element sets may contain multiple data elements unless otherwise stated. For the purposes of this section, **do not** assume that any data elements are inferred. Be sure to provide elements at their most granular level. For example, if it is necessary to specify a zip code, do not use the less specific data element set, ‘address’.//


 * //Registration Request://**
 * **Section** || **Data Element** || **Multiple Values (yes/no)** || **Data Element Description** || **Additional Notes** ||
 * Unique Transaction ID || Unique Transaction ID || No || Unique ID for this transaction || Transaction IDs must be globally unique across all payers and able to accommodate expected transaction volumes (Eg. UUID) ||
 * Provider Organization || Demographics
 * Organization Name (XYZ health system)
 * Organization Address
 * City
 * State
 * Zip Code || No || The organization’s name, street address, city, state, and zip code || As registered with NPI or alternative ID ||
 * ^  || Signature Artifact || No ||   ||   ||
 * ^  || Public Digital Certificate || No || X.509 Token Profile || Signed by trust authority ||
 * ^  || NPI || No || NPI issued to this provider organization or organization sub-part by NPPES ||   ||
 * ^  || Alternate ID (if no NPI) || No || ID issued to this provider organization or organization sub-part by Alternative ID issuer ||   ||
 * ^  || __ Contact information __
 * Telephone Number
 * Email || Yes || Information used to contact the organization by telephone or email ||  ||
 * Individual Provider || Demographics
 * First Name
 * Middle Name
 * Last Name
 * Address
 * City
 * State
 * Zip code || No || The individual’s name, street address, city, state, and zip code || As registered with NPI or alternative ID ||
 * ^  || Signature Artifact || No ||   ||   ||
 * ^  || Public Digital Certificate || No || X.509 Token Profile || Signed by trust authority ||
 * ^  || NPI || No || NPI issued to this provider by NPPES ||   ||
 * ^  || Alternate ID (if no NPI) || No || ID issued to this provider by Alternative ID issuer ||   ||
 * ^  || __ Contact information __
 * Telephone Number
 * Email || Yes || Information used to contact the individual by telephone or email ||  ||
 * Request Information || NPI to register (one of the two possible above) || No || NPI to register (must be either the organization or individual NPI if it exists) || If both organizational NPI and individual NPI are included above, this is the NPI to register ||
 * ^  || Alternative ID (if required) || No || Alternative ID to register (must be either the organization or individual Alternative ID if the NPI does not exist) || If both organizational Alternative ID and individual Alternative ID NPI are included above, this is the NPI to register ||
 * ^  || Service || No || Service for which the provider is registering || Current Use Case: Registering for eMDR – need code set ||
 * ^  || Options || Yes || Options required / allowed for the Service ||   ||
 * Provider Directory Information || Provider Directory ID || No || Unique Id of the provider directory ||  ||
 * ^  || Provider Directory Address || No || URL of the provider directory ||   ||
 * ^  || Unique Organization ID || No || Unique Organization ID in the PD || Optional ||
 * ^  || Unique Provider ID || No || Unique Individual Provider ID in the PD || Optional ||
 * ^  || ESI ID || No || Unique ESI ID in the PD || Optional ||
 * ^  || ESI Integration Profile || No || Integration Profile to use || Optional ||
 * Message Encryption || Public Digital certificate of transmitter || No || X.509 Token Profile || Signed by trust authority ||
 * ^  || Encrypted hash of message || No || Encrypted Digest of this message ||   ||

Individual Provider information
 * //Registration Request Response://**
 * **Section** || **Data Element** || **Multiple Values (yes/no)** || **Data Element Description** || **Additional Notes** ||
 * Payer Organization || Unique Payer ID || No || Unique ID for the Payer || Examples are NACI and potentially Health Plan Identifier (HPID) ||
 * ^  || Demographics
 * Name
 * Address
 * City
 * State
 * Zip Code || No || The organization’s name, street address, city, state, and zip code ||  ||
 * ^  || * Signature Artifact || No ||   ||   ||
 * ^  || * Public Digital Certificate || No || X.509 Token Profile || Signed by trust authority ||
 * ^  || Contact information
 * Telephone
 * Email Address || Yes || Information used to contact the organization by telephone or email ||  ||
 * Information From Original Request || Organization Information
 * First Name
 * Middle Name
 * Last Name
 * Address
 * City
 * State
 * Zip Code
 * NPI / Alternate ID || No || The individual’s name, street address, city, state, and zip code || Return information from original request. ||
 * ^  || Transaction ID || No || Unique ID from the registration request ||   ||
 * Request Information Processed || NPI || No || NPI to register (must be either the organization or individual NPI if it exists) || If both organizational NPI and individual NPI are included above, this is the NPI to register ||
 * ^  || Alternative ID || No || Alternative ID to register (must be either the organization or individual Alternative ID if the NPI does not exist) || If both organizational Alternative ID and individual Alternative ID NPI are included above, this is the NPI to register ||
 * ^  || Service || No || Service for which the provider is registering || Current Use Case: Registering for eMDR – need code set ||
 * ^  || Options || Yes || Options required / allowed for the Service ||   ||
 * Provider Directory Information || Provider Directory ID || No || Unique Id of the provider directory || Provider Directory ID ||
 * ^  || Provider Directory Address || No || URL of the provider directory || Provider Directory Address ||
 * ^  || ESI ID || No || Unique ESI ID in the PD || Optional ||
 * ^  || ESI Integration Profile || No || Integration Profile to use || Optional ||
 * Request Status || Unique Registration ID || No || Unique ID generated by payer for this registration request ||  ||
 * ^  || Success or Failure || No || Status of Request: Success, Failure, Pending ||   ||
 * ^  || Failure Reason(s) || Yes || If Request fails, need code set for failure reason(s) || Need code set for failure reasons ||
 * Message Encryption || Public Digital certificate of transmitter || No || X.509 Token Profile || Signed by trust authority ||
 * ^  || Encrypted hash of message || No || Encrypted Digest of this message ||   ||

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