Integration details for HCX Sandbox

Context

The main objective of this document is to provide a guideline to the integrators on how to onboard and integrate with Swasth's Sandbox HCX environment.

This document is prepared considering only the below integrators or participants of the HCX Gateway.

• Provider
• Payer

Background

HCX is envisioned for data exchange between healthcare providers and insurance providers (referred to as payers).

The detailed background for HCX can be found here

Overall sandbox functionality

1. A participant (provider or payer) system can register with the HCX by following the onboarding process. In the current phase, this is a manual step.
2. Once registered, the participant will get access to the HCX Protocol APIs.
3. The participant should generate an access token using a username and password to use the HCX Protocol APIs.
4. The provider (system) will have the access to execute the below business flows.
   • Raise a cashless claim's Coverage Eligibility Check with the Payer (system) through the HCX Gateway.
   • Submitting the Pre-auth and Claim request to the Payer (system).
   • Acknowledging the Payment notification request from the Payer (system).
   • Initiating or responding to the Communication request.
   • Fetch the Claim Status at any stage of the Claim cycle (from the HCX or Payer).
5. The Payer (system) will have the access to execute the below business flows.
   • Respond to a cashless claim's Coverage Eligibility Check request from the provider (system).
   • Respond to the Pre-auth and Claim request from the provider (system).
   • Send a Payment Notification request to the provider (system).
   • Initiating or responding to the Communication request.

Prerequisites

• Please ensure that you have read the Tech and Domain Specifications before starting the integration.
• Familiar with OpenAPI 3.0
• Know what FHIR is and how to create FHIR objects for the API calls.
• Familiar with Postman as an API testing tool.

Please understand and follow the below steps to onboard and integrate with Swasth's HCX Sandbox Environment.

1. Onboarding to Sandbox
2. Key flows
   • As a provider
   • As a payer
   • As an HIU/ISNP - TBD
   • Important APIs
3. Typical integration architecture - TBD
4. Managing payloads
   • Processing incoming payloads (Key steps to perform when an encrypted payload is received)
   • Formulating outgoing payloads (Key steps to create and send the callback response to an incoming call)
5. Testing the integration
   • Standalone testing using postman collection(s)
   • Testing Incoming APIs
     • Testing via HCX Sandbox
       • With mock counterparty
       • With actual counterparty
   • Testing outgoing APIs
     • Testing via HCX sandbox
       • With mock counterparty
       • With actual counterparty
6. Resources
   • Tools (JWE library, FHIR resources etc.)
   • Seeking help (Issue resolution)