Zeus Enrollment Platform
The primary objective of the Zeus Enrollment Platform is to be able to consume the 834 EDI files that are received from the HIX Marketplace and process the individual enrollment transactions received in the file and adjudicate them for enrollment into the health plan. The high level features of the Zeus platform is outlined below.
Consume the raw EDI file received from the marketplace.
Perform TA1 validations on the EDI file received and generate the TA1 acknowledgments
Convert the transaction data from the EDI format into a JSON format.
Perform 999 validations on the transaction and generate the necessary 999 validations.
Process the transaction through business rules to identify any issues present in the transaction that can cause exceptions during processing.
Retrieve the account information of the members in the transaction from the member management system, if the members are already present and identify the updates that have to be made to the account.
If the members are new to the health plan, then create a new account in the member management system.
The member enrollment will be confirmed based on the premium payment rules and a confirmation will be sent out to the marketplace if needed.
The platform is also equipped to handle any demographic and financial changes that have to be made to the account, along with processing any kind of cancellations, terminations and reinstatements of member enrollments.
The platform also has a User Interface that can be used the view the transactions that are processed in the system, view the accounts from member management and perform some basic administration activities.
Zeus Architecture
The Zeus Enrollment Platform is combination of several individual microservices that come together to achieve the overall objective outlined for the platform. The technology stack of the Zeus Enrollment Platform is provided below
Stack | Technology |
Microservice Implementation Language | Java 17.0 |
Microservice Framework | Spring 6.0 and Spring Boot 3.0 |
Database | MySQL and MariaDB |
Asynchronous Communication Service | Apache Kafka |
Security Implementation | Spring Security |
Front End Framework | Angular 12 |
Container Technology | Docker |
Architecture Diagram
The high level architecture diagram of the microservices and their interaction is provided below.
Microservices
The table below lists all the microservices in the Zeus Platform. Click on the respective microservices to learn more about the individual service.
Microservice | Short Description | Github Repository |
Manages member accounts and enrollment spans | ||
Orchestrates the processing of the transaction that are received | ||
Processes the changes for an account or creates a new account based on the transaction received. | ||
Manages the EDI file received from the marketplace and also assigns the Zeus File Control Number that uniquely identifies the file across the platform. | ||
Stores the raw file received from marketplace along with the ZFCN created for the file | ||
Creates the transaction from the file data received from marketplace and assigns Zeus Transaction Control Number that uniquely identifies the transaction across the platform. | ||
Stores the individual transaction as received from the marketplace along with the ZTCN created for the transaction. | ||
Transforms the transaction data received from marketplace into internal reference data values and performs some basic data validations. | ||
Executes the rules on the data provided based on the rules that are configured in the rule service. | ||
Manages the trading partner configuration. | ||
Manages the reference data that is used within the platform. | ||
Manages the various plans that are offered within a geographic location and the rates for each of the plans based on member's demographics information. | ||
Manages all the rules that are configured for an account and transaction. | ||
The gateway service through which all the internal APIs are exposed to the user interface. |
Transaction Message Processing Flow
The sequence diagrams provided below show the flow of the transaction received within the platform and how it is transmitted through the various microservices and is updated in the member management service.
Transaction Origination to Transaction Manager
The below sequence diagram show how the transaction once it is originated in Transaction Origination Service is transmitted to Transaction Manager.
Transaction Manager to Account Processor
The below diagram shows the sequence of steps taken in Transaction Manger to process the transaction received and send it to Account Processor service.
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Account Processor to Member Management
The below diagram shows the sequence of steps taken in Account Processor to make the necessary updates to the account based on the transaction and send it to Member Management service.
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