Introduction

Reusing existing assets speeds the development of high-quality business solutions and reduces the cost and time involved in building highly customizable and adaptable CBSs. WebSphere Business Services Fabric provides an SOA platform to model, assemble, deploy, manage, and govern business services and to deliver dynamic and flexible business process management (BPM) capabilities to the enterprise. It provides the design-time tooling, runtime environment, and optional prebuilt industry SOA content to build more flexible and responsive business solutions based on BPM. WebSphere Business Services Fabric also supports externalizing business policies and metadata from the business processes and associating them to reusable business services that are easy to publish, discover, and modify.

One of the major components of WebSphere Business Services Fabric is the industry content pack, which consists of prebuilt assets that you can use as is or for building solutions or assets. Using these assets facilitates reuse and serves as an accelerator to develop, deploy, and manage business services. Moreover, these assets are built on industry standards and industry best practices. They provide a framework to build industry-specific and standards-compliant SOA solutions. The key asset types of industry content packs are:

• Capability and process maps
• Business service templates
• Service interfaces
• Business glossary
• Common services
• Business object model
• Knowledge assets

There are content packs for different industries and domains, including:

• Insurance Property and Casualty
• Healthcare Payor
• Banking Payments
• Telecom Operations

All of these adhere to their respective industry standards (in this case, ACORD, HL7, ISO 20022, and NGOSS SID).

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Case study

The case study used in this article is from the healthcare industry. SABU Health Corporation is a leading health insurance company. It has a network of providers who submit claims. An existing legacy system deployed at SABU Health Corporation deals with claim processing, responding to claim status queries, and generating remittance advice for a claim. This article focuses on the claim status enquiry process.

Because the current claim status application is a legacy system, it requires a transformation that lets providers submit and check the status of the claims through different channels (Web, FTP, e-mail). There's a great demand in the healthcare insurance industry to provide an interface for claim submitters to find out the status of their claims. A solution that aligns to the business' goals has to be developed as quickly as possible.

Solution

A simple CBS (for claim status) provides the solution to this problem. It's built using SOA and meets the following business requirements:

• The CBS can receive and process claim status requests from different channels.
• The CBS can bring up the new system in a phased manner by reusing the existing resources.
• The system is flexible enough to add new providers easily.
• The CBS is in compliance with Health Insurance Portability and Accountability (HIPAA) standards.

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IBM SOA life cycle

The following list describes the tasks involved in the different phases of the SOA life cycle (illustrated in Figure 1). In this case, these phases are applied in the CBS development:

• Model: Gather and analyze business requirements. Design, simulate, and optimize the business processes.
• Assemble: Assemble new and existing services to form the business processes and optimize them.
• Deploy: Deploy the business processes.
• Manage: Manage and monitor these business processes from both an IT and business perspective.
• Governance: Feed information gathered during the manage phase back into the life cycle to enable continuous process improvement.

(See a larger version of Figure 1.)

This article series is divided into three parts, each covering a phase of the life cycle in detail:

• Part 1 covers the model phase.
• Part 2 covers the assemble and deploy phases
• Part 3 covers the manage and governance phases

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Claim status CBS: asset development

This section details the steps involved in developing a claim status CBS using the assets of the Healthcare Payor Content Pack from WebSphere Business Services Fabric.

In the use case, the following tasks are identified for the different phases.

Model phase

1. Identify the various competencies of a business, and capture the hot components from the heat map using the Component Business Modeling (CBM) methodology.
2. Identify the business processes for the hot components in the heat map.
3. Define the process flow for the identified processes using IBM WebSphere Business Modeler.
4. Explore the capability map and process map assets provided by the Healthcare Payor Content Pack.
5. Identify all the business services to implement the business process by following the Service Oriented Modeling and Architecture (SOMA) methodology.

Assemble and deploy phases

1. Explore the Business Service Template (BST) identified in the modeling phase and extend it to realize the claim status CBS.
2. Implement the service interfaces in the BST.
3. Create a WebSphere Business Services Fabric project and import the relevant namespaces.
4. Deploy the claim status CBS.
5. Test the business process using the test component of IBM WebSphere Integration Developer.
6. Use the WebSphere Business Services Fabric dynamic assembly component to route dynamically.
7. Use content-based assertion for routing claim requests.

Manage and governance phases

1. Create subscriptions in WebSphere Business Services Fabric to control the access to different business services and provide necessary enrollments and role assignments.
2. Demonstrate governance capabilities for the sample CBS developed.

As mentioned earlier, this first article in the series covers the model phase in detail.

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Model phase

CBM and SOMA methods are used during the modeling phase of the SOA implementation; this is based on IBM's SOA implementation approach.

CBM methodology

IBM's CBM methodology provides a framework for viewing the business as a network of individual components. The decomposition of an enterprise into well-bounded and discrete business components enables a straightforward understanding of a complex enterprise and facilitates the realization of business intent by information technology. Knowing the business value associated with each component makes it easier to set transformational priorities.

The CBM map for SABU Health Corporation is created by identifying all the business competencies for the organization and mapping the business activities into discrete, manageable components, which are grouped under the suitable business competencies and accountability levels (direct, control, and execute). Evaluation criteria, such as cost, revenue potential, and alignment with business, are applied to all the components, and the areas of competitive differentiation and priority (hot components) are identified. Claims management and claims processing have been categorized as the hot components for SABU Health Corporation.

The identified hot components have the following processes related to them:

• Adjudicate claim
• File claim
• Inquire claims
• Manage fraudulent claims

For now, let's focus on InquireClaims (ClaimStatusAndVisibility). The following are the requirements to be met for realizing the process ClaimStatusAndVisibility.

• Track claims throughout the claim life cycle.
• Initiate inquiries into the claim status after the claim has been accepted by the payor for adjudication.
• Request additional documents supporting the claim.

Define the business process using IBM WebSphere Business Monitor

The next step is to identify the business process flow for ClaimStatusAndVisibility that meets the above requirements. The business process should validate the electronic data interchange (EDI) requests and send the status of the claim back to the provider. Figure 3 illustrates the process flow.

Explore the capability and process maps

Alignment of IT goals to business goals enables your business to meet its objectives in an efficient and cost-effective way. The Healthcare Payor capability and process maps asset of the IBM Healthcare Payor Content Pack allows for the following:

• Mapping a process to a capability
• Mapping Healthcare Payor processes to business services.

This mapping:

• Provides proper alignment of business and IT strategies.
• Provides traceability for the business objectives identified in the modeling phase.
• Gives business executives a clearer understanding of what IT does.
• Aligns the business services being developed to the business objectives.
• Ensures adherence to industry standards.

Healthcare Payor capability maps provide the foundational layer of the required business capabilities that the healthcare industry performs across the healthcare industry value chain. Healthcare process maps serve as the taxonomy for business processes for the healthcare industry to help align business services. There are typically capability maps and process maps specific to an industry, and they're based on industry standards and best practices. The models for capability and process maps are represented using the Unified Modeling Language (UML) notation inside a modeling tool, such as IBM Rational® Software Architect.

In the capability map, the capabilities that meet the requirements of the solution to be implemented are identified and mapped to the suitable business process in the process map. Later, the business services required to implement the process are identified and mapped accordingly.

The following steps describe this procedure in detail. This example uses Rational Software Architect and IBM WebSphere Integration Developer with the WebSphere Business Services Fabric Tool Pack installed.

1. Open Rational Software Architect in the modeling perspective.
2. Import Project Interchange<Fabric Installation path>\HealthCare\Payor\models\cpm\healthcare-payor-cpm-model-project-interchange.zip (see Figure 4).
   
   Figure 4. Import Project Interchange
   
   
   
3. Import Project Healthcare Payor Capability Process Model V6.1 into the workspace. It includes business capabilities and process maps.
4. Open the Healthcare-Payor-Capabilites::Capability Map in the above project.

   In the case study, the solution that needs to be implemented comes under the ClaimsManagement capability whose parent capability is ClaimsOperations. The relationship between these two capabilities is already present in the capability map. If there are any new capabilities, you can add them in this capability map and extend them as per the respective business requirements. Figure 5 shows the relationship between the capability and the subcapability.

   
   
   Figure 5. Capabilities map
   
   
   
5. Open the Healthcare-Payor-Processes::Process Map

   ProcessClaims is one of the processes under which AdjudicateClaim, FileClaim, InquireClaims, and ManageFraudulentClaims are the subprocesses. This relationship is shown in the process maps. The InquireClaims process performs the claim status check, which is used for the sample CBS.

   
   
   Figure 6. Process map
   
   
   
6. Now the ProcessClaims process is mapped to the ClaimsManagement subcapability (see Figure 7).
   
   Figure 7. Capability and process map
   
   
   

   The mapping of business services to the business process will be covered in the Part 2 of this series. This mapping between processes and capabilities provides a way to trace the areas that are impacted due to a change. For example, if there's any change at the business capability level, you can easily trace it to find out what the affected subcapabilities and processes are, and vice versa. This kind of traceability is extended to business services and endpoint levels, which will also be addressed in the next installment of this series.

SOMA methodology

The next step in the modeling phase of CBS is to create a service model that realizes the business process. SOMA methodology is followed to create a service model.

SOMA is an end-to-end method for SOA solution implementation. It's an analysis and design method for the design and construction of SOA to enable target business processes.

The following activities of SOMA are carried out:

• SOMA identification
• SOMA specification
• SOMA realization

These activities are explained in the next few sections.

SOMA identification

As a part of the identification phase of SOMA, the following services have been identified to implement the ClaimsStatusAndVisibility process:

• Validation
• Debulking
• Error extraction
• Send to payor
• Display EDI
• ClaimsStatusAndVisibility process interface

During the existing assets analysis phase of SOMA identification, any existing assets that are present are checked to see if they can be reused as they are. The WebSphere Business Services Fabric assets have been analyzed, and the following services have been identified from the assets of the IBM Healthcare Payor Content Pack for which the implementation is already provided and which can be used as is. Table 1 illustrates this.

To view the contents of the HealthCarePayorCommonServices, import the project interchange HealthcarePayorCommonServices.zip, which is in the <IBM Healthcare Payor Content Pack Installation Path>/Payor/projects/libraries directory.

Figure 8 shows the Web Services Description Language (WSDL) files in the library. This case study uses the interfaces for edi_debulking, edi_error_extractor, and edi_validation. All the services present have the implementation provided by the content pack.

The service model has been identified. The next phase of SOMA is service specification.

SOMA specification

In this section, the service specification is provided for the services that have been identified as a part of the SOMA identification phase. The operation name, input parameter, and output parameter for each of the services is specified in Table 2. The services that have been identified as existing assets don't participate in this phase.

SOMA realization

The realization phase of the SOMA methodology determines whether the service is realized as a functional or a technical component.

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Conclusion

This article summarized the different phases of the IBM SOA life cycle and covered the modeling phase in detail. It focused on various business competencies, captured the hot components, identified the business processes, and defined the process flow. You learned how the capability and process maps accelerated the development of CBS. Stay tuned for the next article in this series, which will cover the assemble and deploy phases. You'll explore the business service template and service interfaces, which are part of the content pack.

Resources

Learn

• Learn more about Component Business Modeling.
  
  
• Learn more about IBM WebSphere Business Services Fabric.
  
  
• Read "Creating flexible service-oriented business solutions with WebSphere Business Services Fabric, Part 1: Overview" (developerWorks, Apr 2007).
  
  
• Check out the articles in this four-part IBM WebSphere Developer Technical Journal series for information on the end-to-end process of creating composite business services with WebSphere Business Services Fabric:
  • "Developing adaptive composite business services using WebSphere Business Services Fabric, Part 1: Introducing IBM's new platform for business service modeling, assembly, and deployment" (developerWorks, Apr 2007)
  • "Developing adaptive composite business services using WebSphere Business Services Fabric, Part 2: Analyzing the business requirements " (developerWorks, May 2007)
  • "Developing adaptive composite business services using WebSphere Business Services Fabric: Part 3: CBS modeling, ontology editing, and policy simulation" (developerWorks, Jun 2007)
  • "Developing adaptive composite business services using WebSphere Business Services Fabric: Part 4: Service assembly with the Dynamic Assembler SCA component" (developerWorks, Aug 2007)
  
  
• Read "Service-oriented Modeling and Architecture" (developerWorks, Nov 2004).
  
  
• Read "Getting Started with IBM WebSphere Business Services Fabric V6.1," one of many helpful IBM Redbooks®.
  
  
• The SOA and Web services zone on IBM developerWorks hosts hundreds of informative articles and introductory, intermediate, and advanced tutorials on how to develop Web services applications.
  
  
• Play in the IBM SOA Sandbox! Increase your SOA skills through practical, hands-on experience with the IBM SOA entry points.
  
  
• The IBM SOA Web site offers an overview of SOA and how IBM can help you get there.
  
  
• Stay current with developerWorks technical events and webcasts.
  
  
• Browse for books on these and other technical topics at the Safari bookstore.
  
  
• Check out a quick Web services on demand demo.
  
  

Get products and technologies

• Download a trial version of Rational Software Architect.
  
  
• Download IBM product evaluation versions and get your hands on application development tools and middleware products from DB2®, Lotus®, Rational®, Tivoli®, and WebSphere®.
  
  

Discuss

• Participate in the discussion forum.
  
  
• Get involved in the developerWorks community by participating in developerWorks blogs.
  
  

About the authors

Balraj D. Goulikar is an associate IT architect at the IBM Global Business Solutions Center (GBSC) in Hyderabad, India, which develops SOA-based solution assets. He has been involved with SOA asset development using IBM WebSphere Business Services Fabric in the healthcare domain for the last two years.

K.L.P Srinivas is a technical lead for the Healthcare CBS in the IBM Global Business Solutions Center in Hyderabad, India. He has three years of development experience in SOA technologies. He has used IBM WebSphere Business Services Fabric and the Healthcare Content Industry Pack for the CBSs. His core expertise is in model, design, and development of J2EE-based enterprise applications and reusable assets for SOAs. His Interests include software modeling and learning upcoming technologies and new products in SOA.

Umadevi Samudrala is an application developer for the IBM Global Business Solutions Center in Hyderabad, India. Her expertise is in development of J2EE applications and reusable assets for SOAs, and she has delivered assets for the Provider Collaboration Suite of Healthcare CBS.

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Table of contents

• Introduction
• Case study
• IBM SOA life cycle
• Claim status CBS: asset development
• Model phase
• Conclusion
• Resources
• About the authors
• Comments

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