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CBF Payment Current Process
Uncleansed PHO Registers
Register Merge Cleanse, enrich
and validatePaymentsInput file CBF Calculator Payments File
PHO Register Process Practice
Register Extract
E-SAM
NHI
Cleansed Register feedback loop
Practice Register feedback loop
Why NES?• improve health information management• improve the ability of general practices to manage patient information sets and
reduce national level duplication • improve the information which general practices use for long-term business and
patient care planning• enable DHBs to manage their funding allocations more efficiently, and • bring higher levels of accuracy and timeliness to aggregated data sets used by the
Ministry of Health for funding allocation purposes • support the reduction of the stand-down period for payment • reduce the risk of claw-backs via audit due to incomplete or inaccurate enrolment
forms• reduce time burden on practices to validate eligibility and entitlement
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NES Future
Page 4
Uncleansed PHO/Practice
RegistersValidate & cleanse
PaymentsInput file
ETL*
Enrolment Masterfile E-SAMHPI
VLCA/U6/U13
CSCHUHC
NHIE-SAM
HPI
NES enabled practiceReal-time query and
update
New
OPA
ba
sed
Paym
ents
Ca
lcul
ator
Payments file Outcome Reports
PHO Query and Reporting
NHIETL* = Extract, transform, load
Bulk Load
Exception process
PMS
Key transition issues requiring assurance - each will require agreed process and accuracy milestones to be met before progression to next step
1. OPA calculator accuracya) Ensure the OPA calculator produces the same result as the CBF calculation processb) Testing can be completed by running historical registers c) Current indications indicate 0.03% variance (due to rounding)d) Can be done pre “functional launch”
2. NES registry accuracya) Ensure rules applied in NES produce the same result as current process b) Any NHI driven variance is explainable (ie PMS driven demographics vs NHI driven demographicsc) Potential to do pre “functional launch”, most likely post-launch
3. PMS registry accuracya) Ensure PMS to NES (and vice versa) changes relating to addresses, registration and other demographics
are accurate. Clear business rules to establish which is the source of truthb) Must be done post “functional launch”, some pre-launch done in test environments
4. Abnormal Situationc) Changes to PMS and NES for one-off events such as buy and sell, exit, mergers, etc.d) Must be done post “functional launch”
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NES Future
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Uncleansed PHO/Practice
RegistersValidate & cleanse
PaymentsInput file
ETL*
Enrolment Masterfile E-SAMHPI
VLCA/U6/U13
CSCHUHC
NHIE-SAM
HPI
NES enabled practice
Real-time query and update
New
OPA
ba
sed
Paym
ents
Ca
lcul
ator
Payments file Outcome Reports
PHO Query and Reporting
NHIETL* = Extract, transform, load
Bulk Load
Exception process
Key functional
areas requiring
testing
PMS
Post functional launch: pre Go-Live
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Uncleansed PHO Registers
Register Merge
Cleanse, enrich and validate
PaymentsInput file
PaymentsInput file
Feedback loop
Compare
ETL
Payments file
OPA
bas
ed
Paym
ents
Ca
lcul
ator
Bulk load or load
Validate & cleanse
Enrolment Masterfile
“EEE”
Payments Outcome Reports
NHI E-SAMHPI
VLCA/U6/U13
CSCHUHC
NHIE-SAM
HPI
NES enabled practiceInitial upload, including delta
from register submission
TEST
OPA
ba
sed
Calc
ulat
or
Test Payments file
Test Outcome Reports
Compare
Payment Processing
Testing and Validation
Track adoptionValidate $% Variance and enrolment variance
Abnormal Path (eg mergers/sales
Post Go-Live: ongoing parallel processes as failsafe fall back
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Uncleansed PHO Registers
Register Merge
Cleanse, enrich and validate
PaymentsInput file
PaymentsInput file
Feedback loop
Compare
ETL
Backup Payments file
OPA
bas
ed
Paym
ents
Ca
lcul
ator
Bulk load Validate & cleanse
Enrolment Masterfile
“EEE”
BackupOutcome Reports
NHI E-SAMHPI
VLCA/U6/U13
CSCHUHC
NHIE-SAM
HPI
NES enabled practiceInitial upload, including delta
from register submission
TEST
OPA
ba
sed
Calc
ulat
or
Payments filePaymentsOutcome Reports
Compare
Backup/Fall-back
Payment Processing
If adoption >90%If variance <x%Pay from NES
NES Transition timeframes (proposed)
Current state
- Quarterly enrolment- 6+ week process from extract to load at MoH end
Functional launch NES: 1 July 2015
- NES functionality launched at MoH and PMS- Payments process unchanged- Adoption period
NES Go-Live: 1 Jan 2016
- Monthly enrolment- New business rules- Significant reduction in process time-
Page 9
Final Go-Live position
Uncleansed PHO/Practice
RegistersValidate & cleanse
PaymentsInput file
ETL*
Enrolment Masterfile E-SAMHPI
VLCA/U6/U13
CSCHUHC
NHIE-SAM
HPI
NES enabled practiceReal-time query and
update
New
OPA
ba
sed
Paym
ents
Ca
lcul
ator
Payments file Outcome Reports
PHO Query and Reporting
NHIETL* = Extract, transform, load
Bulk Load
Exception process
PMS
