Data Quality Technical Architecture

Data Quality Technical Architecture Components

Contents Data Quality Best-in-Class Properties Data Quality Technical Architecture Core Functional Components Interfacing Components Non-functional Components Data Quality Invocation Flow Example Data Quality Technical Architecture Foundational Systems Data Quality Technical Architecture Products / Technologies Mapping of architecture concepts to Data Quality Technical Architecture

Data Quality Best-in-Class Properties High-performing Fast response times for human users and high throughput for non-human users within given service level agreements Reliable and recoverable All data and process changes are transactional secured and can be recovered to the last consistent state after any type of failure Uniform and consistent All similar processing is done in the same way and all processing leads to a consistent system state (including data and processes) Dynamically changeable and extensible Changes can be applied dynamically to accommodate new business as well as system requirements Minimal and simple As few as possible foundational systems and concepts as necessary to implement the overall functionality Conceptually sound All functionality is based on a conceptual model that reflects the business architecture goals and requirements

Data Quality Architecture Concepts Architecture Concept Service Workflow Business and Data Rules Data and Data Flow External services and workflows External Services Architecture Component Web Service Management Workflow Management Business Rule Management Data Management Packaged Application Management External Invocation Management The 1:1 relationship of architectural concepts and architectural components is intentional

DQ Technical Architecture – Core Functional Components Data Storage Data Replication Reference Data Data Flow Data Management Data Access Workflow Access Business Rule Access Packaged Application Management Service Definition Service Execution Service Choreography (Web) Service Management Service Registry Workflow Definition Workflow Execution Workflow Management Business Rule Definition Business Rule Automation Business Rule Management Gateway External Invocation Management Public Service Registry DQ External Interface Management Service Publication Case Management Policy Management

DQ Technical Architecture – Core Functional Components Data Storage Data Replication Reference Data Data Flow Data Management Data Access Workflow Access Business Rule Access Packaged Application Management Service Definition Service Execution Service Choreography (Web) Service Management Service Registry Workflow Definition Workflow Execution Workflow Management Business Rule Definition Business Rule Automation Business Rule Management Gateway External Invocation Management Public Service Registry DQ External Interface Management Service Publication Case Management Policy Management Fundamental Pillars of Production Systems

DQ Technical Architecture – Web Service Management System

DQ Technical Architecture – Workflow Management System

DQ Technical Architecture – Business Rule Management System

DQ Technical Architecture – Data Management System

DQ Technical Architecture – Packaged Application Management Integration of Crystal Report Software Integration of BO/DQ Software

DQ Technical Architecture – External Invocation Management

DQ Services - Components Member Provider Claim Subject Area: Other Service Area: Enrichment Profiling Other De-duping Data Area: Address Name Phone SSN Other TIN Tool Area: BO/DQ Project Crystal Report Other Rules Area: Mandated Rule Business Rule Technology Rule Industry Standard Rule Software Area: Shell Script JAVA Wrapper Other Method Area: Set() Throw() Get() Run()

DQ Rules – Mandated Rules At least one of member ids to access person id if the person id is related to more than one member id. The valid coverage contract (policy holder) must be establish before any member added for coverage. Provider can have only one license in a state. Provider must have TIN. If Paper Claim then Paper Claim = (Member) ID

DQ Rules – Business Rules Grievances are to be handled professionally and expeditiously to maintain member satisfaction Provider can only be par if he has official agreement with Delta If the coverage code changes from Family to Subscriber and Child (from some coverage code that includes spouse to one that eliminates the spouse), then the dropping of that spouse member should occur automatically with the termination date equal to the effective date for the new coverage.

DQ Rules – Technology Rules VSAM Structure as multiple occurrence of same record to accommodate record size can be one record in relational db. In short, duplicate record can stored as unique record in relational db. History Cross-check (HCC) Rules are rules that define if a procedure has frequency limits within a specific time period.

DQ Rules – Industry Standard Rules Dental Service of Massachusetts, Inc., (DSM) defines the privacy practices to protect personal health information. DSM is required by law to: Maintain the privacy of patient health information. Provide this notice of company duties and privacy practices. Abide by the terms of the notice currently in effect DSM Account Information is password-protected for patient privacy and security.

DQ Services – EEP E1 Invocation (As-is) requests executes using processes for has applies invokes invokes Conceptual Member Subject Area: Enrichment Service Area: Data Area: Address Method Area: Run() Tool Area: BO/DQ Project Tool End User Workspace Driver Rules Area: Mandated Rule Software Area: JAVA Wrapper Software Area: Shell Script

DQ Services – Address Standardization (To-be) Address standardization for member data to match zip code with city and state. Conceptual

DQ Services – Address Standardization (To-be) Address standardization for member data to match zip code with city and state. executes using processes for has applies requests invokes Conceptual Member Subject Area: Profiling Service Area: Data Area: Address Method Area: Get() Tool Area: Crystal Report Tool End User Workspace Driver Rules Area: Industry Standard Rule Software Area: Other (SQL)

DQ Services – Mixed Case (To-be) Convert all upper case name to mixed case name Conceptual Draft

DQ Services – Mixed Case (To-be) Convert all upper case name to mixed case name executes using processes for has applies requests invokes Conceptual Draft Provider Subject Area: Enrichment Service Area: Data Area: Name Method Area: Set() Tool Area: BO/DQ Project Tool End User Workspace Driver Rules Area: Business Rules Software Area: Shell/JAVA

DQ Services – Enrichment services Address – Street Address, City, State, Zip, Location Contact – Name, Phone Number Person – Last Name, First Name, Middle Name and Name Suffix, Social Security Number, TIN Other – TBD Data Cleansing Data Normalization For

Data Acquisition Type – Member Web – B2C EDI – B2C

DQ Services – Profiling services Exception Reporting Pre Cleansing Post Cleansing

DQ Services – De-duping services Address – Street Address, City, State, Zip, Location Contact – Name, Phone Number Person – Last Name, First Name, Middle Name and Name Suffix, Social Security Number, TIN, etc Other – TBD

Data Quality Technical Architecture

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