Download about this guide - CVS Caremark Online Applications

Telecommunications External Access to
Caremark Database Information
About This Guide
Intended Audience
This document is designed for authorized business partners who wish to access the
Caremark computer system, and for Caremark staff who support the external user
interfaces. It explains the telecommunications options and communications protocols
available for accessing Caremark data.
Contacts
Please feel free to call Caremark to discuss connectivity. A telecommunications
analyst is available to assist you Monday through Friday, 6:00 am to 4:00 PM,
Mountain Standard Time.
Phone: (480) 391 – 4914
Phone: (972) 813 - 3888
Contents
Section 1: Service and Application Overview - Introduces the telecommunication
services and most frequently used computer applications Caremark makes available
to its business partners.
Section 2: Eligibility/Enrollment Data Submission and Claims/Billing
Connectivity Options - Describes the interface options for sending
Eligibility/Enrollment Data or receiving Claims/Billing services.
Section 3: OLDI Connectivity Options - Provides information for accessing the OnLine Database Inquiry/Update (OLDI) service.
Table of Contents
TELECOMMUNICATIONS EXTERNAL ACCESS TO CAREMARK DATABASE INFORMATION ................ 1
ABOUT THIS GUIDE ....................................................................................................................................................... 1
TABLE OF CONTENTS ................................................................................................................................................... 2
SECTION 1 – SERVICE AND APPLICATION OVERVIEW ...................................................................................... 2
SECTION 2 — SUBMITTING OR RECEIVING ELIGIBILITY/ENROLLMENT OR CLAIMS/BILLING ........ 3
2.1 CAREMARK ONLINE SERVICES (CLIENT WEB SITE)..................................................................................................... 3
2.2 SECURE TRANSPORT OVER THE INTERNET .................................................................................................................. 3
2.3 DIRECT NETWORK CONNECTIVITY .............................................................................................................................. 6
2.4 CONNECTIVITY THROUGH THE ADVANTIS NETWORK ................................................................................................. 8
2.5 INTERNET ACCESS VIA THE VIRTUAL PRIVATE NETWORK .......................................................................................... 9
2.6 CONNECTIVITY THROUGH THE UNIFIED NETWORK ................................................................................................... 10
SECTION 3 — ONLINE DATA INQUIRY OPTIONS ................................................................................................ 11
3.1 OLDI CONNECTIVITY THROUGH CAREMARK ONLINE SERVICES (CLIENT WEB SITE)............................................... 11
3.2 OLDI CONNECTIVITY THROUGH WEB 3270/WEB 5250 .......................................................................................... 11
3.3 OLDI DIRECT CONNECTIVITY — FRAME RELAY ...................................................................................................... 12
3.4 OLDI CONNECTIVITY THROUGH THE ADVANTIS NETWORK ..................................................................................... 13
3.5 INTERNET ACCESS VIA THE VIRTUAL PRIVATE NETWORK ........................................................................................ 14
3.6 OLDI DIRECT CONNECTIVITY — SNI ....................................................................................................................... 15
3.7 OLDI CONNECTIVITY THROUGH THE BCBS UNIFIED NETWORK .............................................................................. 16
Section 1 – Service and Application Overview
Caremark offers its business partners a wide variety of telecommunications
connectivity options and communications protocols with which to access its computer
system.
Caremark is able to provide its business partners with the following major services
and applications:

Eligibility/Enrollment Data Submission

Claims and Billing Activity

On-Line Database Inquiry/Update (OLDI)
Each service and application is briefly described in the sections that follow.
Section 2 — Submitting or Receiving
Eligibility/Enrollment or Claims/Billing
This section describes the options available for connecting to Caremark to send
Eligibility/Enrollment Data and receive Claims and Billing services. Several interface
options are available for connection directly to Caremark, through the Advantis
Network, and through the Blue Cross Blue Shield Unified Network.
Record layout specifications can be obtained from your Caremark Representative.
2.1 Caremark Online Services (Client Web Site)
This overview is provided to help you learn more about submitting batch eligibility
(enrollment) files through the Internet and prepare you for submitting your first file
through the Internet. If you are sending custom formatted files, please contact us
prior to submitting your first file so we can review and verify the file.
Within the batch eligibility option of the Client Web Site, the following features are
available:
 Upload your member enrollment files to Caremark in a secure environment.
 View history of files sent to ensure your file has successfully loaded on the
Caremark system.
The following are the file requirements for any member enrollment files uploaded to
Caremark through this Internet site:
 File must be an ASCII Text file.
 File must conform to the Caremark Standard Record Layout (as specified by the
Enrollment department).
 File must include a Header and Trailer record.
 Zipped file is supported.
 Files that are encrypted or password protected are NOT supported. (This Internet
site meets HIPAA and HICFA security requirements, so it is not necessary to encrypt
or password protect files.)
 Only member files are accepted at this time.
 File naming conventions will be specified by the Enrollment department.
2.2 Secure Transport Over the Internet
Tumbleweed SecureTransport is a secure, enterprise-class file transfer product. It
enables transfer of valuable or sensitive information over the Internet in a
confidential, guaranteed, and provable manner. Secure Transport is client-server
software that is built on industry-standard technologies including SSL, FTP, and
HTTP. Clients can choose either an FTP Client that transfers files to the Secure
Transport server using standard FTP functionality or a web browser client, which
requires no client installation.
Note: Secure Transport is a HIPAA certified application.
Secure File Transfer
The core functionality of Secure Transport is the ability to transfer data securely.
Using either a Secure Transport client or a Web-Browser. Client users can initiate
upload, download and file system commands.
Security is provided by:

Encrypting the connection between the Secure Transport Client and Server

User authentication using user ID and password

Use permissions specified by the Secure Transport administrator.”
When a user logs in to the Secure Transport Server using a Secure Transport Client
(or Web browser), Secure Transport opens a secure session between the client and
the server so that important information, such as user ID, password, commands, file
names, and data are encrypted. The file transfer functionality in Secure Transport is
based on industry-standard protocols: FTP and HTTP.
When using the Secure Transport Client the following enterprise-class features make
file transfers more robust, reliable, and efficient:

Checkpoint Restart

Data Integrity Checking
Restart/Data Integrity Checking
The Secure Transport Client offers automatic restart, which will re-establish a broken
connection and will resume the file transfer at precisely the point the transfer was
terminated. For example, if a 4 MB file fails after 3 MB has already been transferred,
the restarted transfer transmits only the remaining 1 MB. This saves time, improves
performance, and uses less bandwidth.
This feature is available only in the SecureTransport Client and in most IE Web
Browsers that support ActiveX controls. This feature is not available in Netscape
Web Browsers.
When transferring business data, the integrity of the file is paramount. For example,
you need the assurance of knowing that the data values are correct and that you
have received the whole file, not just a portion of it. SecureTransport takes an MD5
checksum of the transmitted file and compares it to the original to insure the data
integrity of the transfer. If the file is incomplete, the SecureTransport Client re-starts
the transfer.
Like Restart, the data integrity-checking feature is standard in the SecureTransport
Client and in most IE Web Browsers utilizing ActiveX controls.
Secure Transport Security
A key component of the SecureTransport security model involves user authentication
and user permissions. User authentication and permissions specify who is allowed to
use the system, what actions they can take, and which directories and files they are
allowed to view and manipulate. Before a user can upload or download files from a
SecureTransport Server, the system requires the user to provide identification
credentials. (SecureTransport does not allow anonymous access, like a standard
FTP server.)
User Permissions
After the SecureTransport Server checks the user’s credentials, it determines what
the user should be allowed to do.
1. Client communicates to the server and initiates a secure connection via the
Secure Transport FTP Client.

Compliant with the FTP standard; RFC 959

RSA RC4 128 bit SSL encryption
2. Client presents credentials over secure SSL connection, and server gives
client access to SecureTransport commands, directories, etc. according to
the user’s permissions.
3. Sign on to Secure Transport with logon ID and password provided by
Caremark.
4. Client initiates file transfer over secure connection.
5. Incoming streaming agent/script is initiated.
6. File is passed through our firewall into our secure network.
7. File is written to the Secure Transport file system.
Requirements
Secure Transport Client is supported on the following platforms:

Solaris 7, 8

RedHat Linux 6.2, 7.0

HP-UX 10.20, 11.02.2001

AIX 4.3

Windows NT, 2000, 98, 95, XP

IBM MVS OS/390
2.3 Direct Network Connectivity
Caremark Recap clients (i.e., organizations managing pharmacy benefit plans) can
connect directly to the Caremark network to send Eligibility/Enrollment Data or
receive Claims/Billing services through switched or leased line facilities. Details on
each connectivity option follow.
Network Job Entry (NJE)
Caremark supports IBM's Network Job Entry (NJE) for the Recap system, which
supports peer IBM system-to-system job submission
To use this connectivity option, the client network and host-operating environment
must be based on the IBM SNA network architecture and support NJE. Caremark
has the necessary software — SNA Network Interconnection (SNI) — to allow SNA
networks to interface.
If the client also has SNI installed the Caremark and client SNI products can easily
be configured to interface with one another. Note that the Caremark Job Entry
Subsystem 2 (JES2) can interface with a client's JES2 or JES3 system.
To obtain SNI interface specifications, refer to the IBM International System Center
Guide, SNI Planning and Design.
Note: There is a 251 record length restriction when using NJE. Toll-free access is
not supported by Caremark.
Note: NJE is available for Recap clients only.
Connect:Direct (NDM) File Transfer
Connect:Direct file transfer capability is a connectivity option that moves information
between the Caremark IBM mainframe and other mainframes. To use this option, the
client's network and host operating environment must be based on the IBM SNA
network architecture and have Connect:Direct. Caremark will provide the necessary
software configurations. If operating in an IBM environment, an SNI network interface
is required.
Caremark supports both switched and leased line facilities for this interface type.
Transmission speeds of 9600 to 56000 bps are supported for switched facilities.
There are no record length restrictions when using Connect:Direct.
Note: Clients who prefer leased line configurations are responsible for
leased line costs and modems or Digital Service Units (DSUs) on
both sides of the interface.
FTP via Frame Relay/Direct Dialed Connection
Clients can connect directly to the Caremark network through the existing Caremark
AT&T Frame Relay Network, or they can have a frame circuit installed at the
Caremark site through another carrier.
Note: Clients will be able to obtain the most advantageous pricing through AT&T
due to Caremark's tariff with the carrier.
Clients are required to have a router (Cisco is preferred), a DSU that supports the
line speed of the frame relay circuit ordered, and any cables that may be needed to
connect to the client's host. Caremark can provide assistance with router
configuration.
Note: Clients who choose to use a carrier other than AT&T will also need
to purchase a router and DSU for the Caremark site.
Caremark should be consulted prior to ordering any kind of circuit to ensure the
optimal method for establishing connectivity to the client host. See “Contacts” at the
front of this document for the phone number to call.
2.4 Connectivity Through the Advantis Network
Caremark clients can connect to the Caremark network to send Eligibility/Enrollment
Data or receive Claims and Billing services through the Advantis Network. The
options that are available include NJE and Connect:Direct. Details on each
connectivity option follow.
Note: There are no charges for application-to-application traffic through the Advantis
Network for Caremark clients.
Network Job Entry (NJE)
In order to use this option, the client network and host operating environments must
be connected to the Advantis Network. Clients should contact their local IBM
representative to establish this connection if one is not already in place.
Advantis supports leased line facilities. Transmission speeds from 9600 to 56000
bps are supported.
Caremark and the client must define the appropriate NJE and VTAM definitions to
their systems, and then authorize system access through Advantis. This is done by
both parties submitting authorization letters to their local Advantis representatives.
Note: NJE is available for the Recap system only.
Connect:Direct through Advantis
Section 2.1 (see page 2-3) discussed the available Connect:Direct options, through
which clients can directly interface with Caremark. These options are also available
when using the Advantis Network, and represent an application-to-application
connection.
Caremark and the client define the appropriate Connect:Direct and VTAM definitions
to their systems, and then authorize system access through Advantis. This is done
by both parties submitting authorization letters to their local Advantis representatives.
2.5 Internet Access Via the Virtual Private Network
This section describes the Caremark Virtual Private Network (VPN), which provides
access over the Internet to selected Caremark applications.
The Caremark Virtual Private Network (VPN) provides convenient Internet access to
many Caremark applications while maintaining state-of-the-art security protection.
The VPN that is established between an individual business partner and Caremark
represents a secure “tunnel” through which passes encrypted data streams. All data
is encrypted at the highest encryption level available, 128 bits, which is reserved for
health, banking, and e-commerce applications. Further, the addition of unique
Internet digital certificates to all user transmissions adds yet another level of
protection to user confidentiality and to the data.
Please contact your Caremark representative for information on the applications that
may be accessed via VPN and the hardware and software requirements.
2.6 Connectivity Through the Unified Network
Caremark clients who have Blue Cross Blue Shield (BCBS) plans can connect to the
Caremark network for the Eligibility/Enrollment Data Submissions and Claims and
Billing services through the BCBS Unified Network. The options that are available
include NJE and Connect:Direct. Details on these connectivity options follow.
Network Job Entry (NJE)
In order to use this option, the client network and host operating environments must
be connected to the BCBS Unified Network. Blue Cross Blue Shield clients must
contact the BCBS Association in Chicago to establish this connection if one is not
already in place.
Note: NJE is available for Recap clients only.
The Unified Network supports leased line facilities, with transmission speeds from
19.2 to 56000 bps supported.
Connect:Direct through the BCBS Unified Network
Section 2.1 (see page 2-2) discussed the available Connect:Direct options, through
which clients can directly interface with Caremark. These options are also available
to Blue Cross Blue Shield (BCBS) plans when using the BCBS Unified Network, and
represent an application-to-application connection. Blue Cross Blue Shield clients
must contact the BCBS Association in Chicago to establish this connection if one is
not already in place.
The Unified Network supports leased line facilities.
Section 3 — Online Data Inquiry Options
This section describes the options available to connect to the Caremark On-Line
Database Inquiry/Update (OLDI) service. Several interface options are available —
connection directly to Caremark, through the Advantis Network, through the Blue
Cross Blue Shield Unified Network, Internet, or using AT&T switched facilities.
3.1 OLDI Connectivity Through Caremark Online
Services (Client Web Site)
The Client Web Site is available to provide online services featuruing self-service
tools. Through this Web site, you’ll be able to serve your members better, manager
your plan efficiently and stay informed with the latest industry news and Caremark
information. Within the client web site you can:
 Search for a member
 View and update eligibility
 Order Caremark Cards
 View Claims
3.2 OLDI Connectivity Through WEB 3270/WEB 5250
The Client Online Access product is available for Caremark clients to retrieve
member data and communicate with Caremark via a java 3270 or java 5250
interfaces. The Client Online Access application requires a browser that is Java 1.1
compliant (minimum of Internet Explorer 5.0 or Netscape 4.5). Client Online Access
allows approved clients the ability to access the Caremark email system or perform
online eligibility updates.
Access to the Client Online Access application is restricted to approved clients of
Caremark.
There are two booklets that provide the client with instructions and pc requirements
for the web 3270 and 5250 internet access. Please contact your Caremark
Representative to obtain copies.


Client Online Access Installation Guide
Obtaining a Digital Certificate
3.3 OLDI Direct Connectivity — Frame Relay
Caremark business partners can connect directly to the Caremark network through
the existing Caremark Frame Relay Network, or they can have a frame circuit
installed at the Caremark site through another carrier.
Business partners are required to have a router (Cisco is preferred), a DSU that
supports the line speed of the frame relay circuit ordered, and any cables needed to
connect to their host. Caremark can provide assistance with router configuration.
Additional detail on the basic requirements for this connectivity option follow.
Caremark should be consulted prior to ordering any kind of circuit to ensure the
optimal method for establishing connectivity to the user hosts. See “Contacts” at the
front of this document.

Valid TCP/IP addresses

Infrastructure for all PCs that will connect to the Caremark host system

Router to connect to the client LAN infrastructure

Lease circuit between the two sites (Frame Relay), and DSUs

Software that will support TCP/IP.
Note: Business partners who choose to use a carrier other than AT&T will
also have to purchase a router and DSU for the Caremark site.
3.4 OLDI Connectivity Through the Advantis Network
As an alternative to direct connectivity to Caremark for the OLDI service, Caremark
business partners can communicate through the Advantis Network.
In order to use this option, the client network and host operating environments must
be connected to the Advantis Network. Business partners should contact their local
IBM representative to establish this connection if one is not already in place.
Advantis supports switched facilities. Transmission speeds from 9600 to 56000 bps
are supported.
Any client SNA network attached terminal can access the Caremark database if
authorized by Advantis. Business partner VTAM definitions are required in order to
define the Caremark application to their network. Advantis requires the terminal
names from which the client plans to access the Caremark application. Advantis also
assigns user IDs and passwords, as needed.
Caremark must authorize system access through Advantis by submitting an
authorization letter to the business partner's Advantis representative or Advantis
Account Support.
Note: A business partner account ID and Advantis contact is required by Caremark
for the authorization letter.
3.5 Internet Access Via the Virtual Private Network
This section describes the Caremark Virtual Private Network (VPN), which provides
access over the Internet to selected Caremark applications.
The Caremark Virtual Private Network (VPN) provides convenient Internet access to
many Caremark applications while maintaining state-of-the-art security protection.
The VPN that is established between an individual business partner and Caremark
represents a secure “tunnel” through which passes encrypted data streams. All data
is encrypted at the highest encryption level available, 128 bits, which is reserved for
health, banking, and e-commerce applications. Further, the addition of unique
Internet digital certificates to all user transmissions adds yet another level of
protection to user confidentiality and to the data.
Please contact your Caremark representative for information on the applications that
may be accessed via VPN and the hardware and software requirements
3.6 OLDI Direct Connectivity — SNI
With an SNI interface option for direct 3270 connectivity to Caremark, the business
partner's network and host operating environment must be based on the IBM SNA
network architecture. Caremark has the necessary software — SNA Network
Interconnection (SNI) — to allow SNA networks to interface.
When Caremark and the business partner both have SNI installed, their products can
easily be configured to interface with one another. This SNI configuration is known
as a back-to-back or null network. This interface supports Eligibility/Enrollment Data
Submissions processing as well as OLDI.
Caremark supports both PU Type 4 switched and leased line facilities for this
interface. Transmission speeds ranging from 9600 to 56000 bps can be
accommodated.
For SNI interface specifications, refer to the IBM International System Center Guide,
SNI Planning and Design.
Note: Business partners preferring a leased line configuration are responsible for
leased line costs and modems or Digital Service Units (DSUs) on both sides of the
interface.
When ordering the leased line, digital rather than analog facilities are preferable.
3.7 OLDI Connectivity Through the BCBS Unified
Network
As an alternative to direct connectivity to Caremark for the OLDI service, Blue Cross
Blue Shield (BCBS) plans can communicate through the BCBS Unified Network.
The client network and host operating environments must be connected to the
Unified Network. Business partners should contact the Blue Cross Blue Shield
Association in Chicago to establish this connection if one is not already in place.
The Unified Network supports leased line facilities only.
Any client SNA network attached terminal can access the Caremark database if
authorized by the BCBS Unified Network. Business partner VTAM definitions are
required in order to define the Caremark application to their network.