Challenge Overview
Project Overview
The Healthcare Fraud Prevention Partnership is a collaboration between government and private insurers to combat healthcare fraud. TopCoder is building an entire system for executing studies.
- A study is a plan for collecting data from the network of partners and analyzing the aggregated data to identify potential cases of fraud and waste.
- The data consists of records of reimbursement claims for medical treatment.
- The partners are healthcare insurers who store claim records in a wide variety of file formats, which is an obstacle to the goal of aggregating and analyzing the data.
The three major layers of the HFPP system are detailed on a wiki page. This contest deals with the new claim interchange format and the associated data conversion utilities. We are asking for a preliminary design of a new XML format and the architecture for an executable system module that demonstrates conversion into the format.
Module Requirements
In order to facilitate the exchange of claim data for fraud detection purposes, the HFPP project intends to supply partners with the following assets.
- a new standard for a healthcare claim interchange format
- software demonstrating the conversion of claim data into the new format
- documentation for third-party software vendors who will supply data conversion utilities to participants in the HFPP data exchange network
In this contest, we wish to define the first iteration of the new data format. We expect that refinements will be needed as we learn more about partner data. In addition to an immediately viable format and the architecture for an associated data conversion tool, we would like to see a road map for further development.
You have at your disposal the following materials:
- the Medicare Claims Processing Manual
- samples of anonymized claim data
Furthermore, attached in the contest forum is the winning proposal from an Idea Generation contest for a new data standard. The proposal persuades us that the new data standard should be based on XML. Accompanying the proposal are a tentative architectural diagram and a Ruby script demonstrating the conversion of a data sample into a simple format. Only the idea of using XML is definitive for our project. The other materials constitute a toy demonstration and do not impose any restriction on your module architecture.
Your architecture may call for any technology that is freely available, liberally licensed, and compliant with the client's stringent requirements for data security:
The new data format and the design specification for an executable data conversion module go hand in hand. The data conversion module proves the concept of the XML format and provides a model for third-party software vendors to follow when they implement data conversion on a network participant's premises.
Deliverables
- a working XML format
- Application Design Specification for an executable data conversion module
- succinct explanation of security compliance
- suggestions for further design and development
Final Submission Guidelines
- any freely available, liberally licensed software platform
- compliance with HIPAA and FISMAA