System Architecture-Script Push & Pull Flow - Oracle
From Authoring – Control-Execution-Data Sources & Outputs
Audit Name Sampling Frequency Reference to Sampling Logic (Code) Sampling Source ETL Method
Amisys_PrePay_Measurement_MKP_Target Daily Amisys_PrePay_Measurement_MKP_Target.ipynb Amiown Python Script
PRN Amisys Medicaid PaidOverBilled Claims Daily Amiown Python Script
Amisys-Strata5-Medicare Daily Nightly%20Loads/Nightly%20Runs/[Link] Amiown Python Script
Amisys-Strata5-Medicaid Daily Nightly%20Loads/Nightly%20Runs/[Link] Amiown Python Script
Amisys-Strata5-Marketplace Daily Nightly%20Loads/Nightly%20Runs/[Link] Amiown Python Script
Amisys-Strata4-Medicaid Daily Nightly%20Loads/Nightly%20Runs/[Link] Amiown Python Script
Marketplace Paid Over Billed Daily Nightly%20Loads/Nightly%20Runs/[Link] Amiown Python Script
Amisys-PFP-MMP-COB-FTC Daily Nightly%20Loads/Nightly%20Runs/[Link] Amiown Python Script
Amisys-PFP-MMP-COB-Rework Daily Nightly%20Loads/Nightly%20Runs/[Link] Amiown Python Script
AmisysCACommercialAllAuditTypes Daily Amiown Python Script
AmisysCACommercialAllAuditTypes Daily Amiown Python Script
Amisys-Medicaid-Prepay-FL Daily Nightly%20Loads/Nightly%20Runs/[Link] Amiown Python Script
Amisys Marketplace All Markets Multi-Birth Script Daily Ami_MKPL_TA_Pre_MultiBirth.ipynb Amiown Python Script
Amisys All Products All Markets Vertex Script Daily 1_Vertex_Script.ipynb Amiown Python Script
MMP Target Audit Reporting Daily Amisys%20MMP%20Target%20Audit/01_MMP_Target_Audit_Pricing.ipynb Amiown PBI Oracle Connection
Certification Program Daily Amiown Python Script
Dual MMP COB Daily Amiown PBI Oracle Connection
NV SCA Daily Amiown Python Script
Behavioral Paid Over Billed Daily Amiown Python Script
Amisys Medicaid All Markets Pre Auth Unit Daily Amisys_MCD_All_Pre_Auth.ipynb Amiown/EDW Python Script
Amisys Medicaid All Markets Pre Auth Pricing Daily Amisys_MCD_All_Pre_Auth_Pricing.ipynb Amiown/EDW Python Script
IN- Facility ER Autopay Audit Weekly 01_IN_ER_Facility.ipynb Amiown/Web URL PBI Oracle Connection
Texas Fee Schedule Bi-Monthly Amiown/Web URL PBI Oracle Connection
Tables Used
SERVICE_X
CLAIM
RPT_CLAIM
CLAIM_LOCK (in UAT)
Oracle (Pull From) Outputs (Push To)
PROVIDER
AFFILIATION
Publish
SES_DATA • CWS Auto bulk intake via email.
PREADJ_HDR Python Script
ALTCARRIER_LIAB AmiOwn Publish
CLXREF • Panic Reports (Duals)
RPT_NOTE
System Architecture-Script Push & Pull Flow – EDW/Teradata
From Authoring – Control-Execution-Data Sources & Outputs
Audit Name Sampling Reference to Sampling Logic (code) Sampling ETL Method
Frequency Source
Certification Program - Amisys_Pfp Weekly EDW Python Script
Certification Program - Facets_Pfp Weekly EDW Python Script
Certification Program -Amisys_CA_Dauntless Weekly EDW Python Script
Prime Case Classification Daily Appeals Team [Link] PBI PBI Oracle Connection
Prime Agency Packet Review Monthly Appeals Team [Link] PBI PBI Oracle Connection
Prime Research Monthly Appeals Team [Link] PBI PBI Oracle Connection
ICare Path Case Classification Daily Appeals Team [Link] PBI PBI Oracle Connection
ICarePath Agency Packet Review Monthly Appeals Team [Link] PBI PBI Oracle Connection
ICare Path Research Monthly Appeals Team [Link] PBI PBI Oracle Connection
Facets Case Classification Daily Appeals Team [Link] PBI PBI Oracle Connection
Facets Agency Packet Review Monthly Appeals Team [Link] PBI PBI Oracle Connection
Facets Research Monthly Appeals Team [Link] PBI PBI Oracle Connection
ICare Path Clinical Weekly Appeals Team [Link] PBI PBI Oracle Connection
TrueCare Clinical Weekly Appeals Team [Link] PBI PBI Oracle Connection
Audit the Auditor all Subtypes Monthly Appeals Team [Link] PBI PBI Oracle Connection
Appeals Reporting Daily Appeals [Link] PBI PBI Oracle Connection
Sunset by Q1 Oracle (Pull From) Outputs (Push To)
2027,
replacement
pending Python Script Publish
Snowflake CQI Datamart • Single-source PowerBI
SQL Query
MANDAOWN
PBI Oracle Connector
System Architecture-Script Push & Pull Flow – Access DB
From Authoring – Control-Execution-Data Sources & Outputs
Audit Name Sampling Frequency Reference to Sampling Logic (code) Sampling Source ETL Method
Correspondance Audit - ABS-Postpay-Corr Weekly EDW Python Script
Sunset by Q1 Oracle (Pull From) Outputs (Push To)
2027,
replacement
pending Python Script Publish
Snowflake ABS Access Database • CWS
System Architecture-Script Push & Pull Flow - Xcelys
From Authoring – Control-Execution-Data Sources & Outputs
Audit Name Sampling Frequency Reference to Sampling Logic (code) Sampling Source ETL Method
Certification Program - Xcelys_Pfp Weekly Xcelys Python Script
Certification Program - Xcelys_Pfp_ccu Weekly Xcelys Python Script
Certification Program - Xcelys-PFP-PCS Weekly Xcelys Python Script
Sunset by Q1 Oracle (Pull From) Outputs (Push To)
2027,
replacement Python Script
pending (SAS-based) Publish
Snowflake Xcelys • CWS (Audit: Auto Bulk Intake)
System Architecture-Script Push & Pull Flow – Misc.
From Authoring – Control-Execution-Data Sources & Outputs
(Pull From)
Outputs (Push To)
SQL Query
PIX
API Call Publish
Optum • Claims Quality Intelligence (Databricks)
API Call
Prisim
System Architecture-Script Push & Pull Flow - Snowflake
From Authoring – Control-Execution-Data Sources & Outputs
Future
replacement for
Oracle,
MandaOwn,
CWS_COLO
(Teradata)
Tables Used
SERVICE_X
CLAIM
RPT_CLAIM
Oracle (Pull From) Outputs (Push To)
CLAIM_LOCK (in UAT)
PROVIDER
AFFILIATION Python Publish
SES_DATA Script
Snowflake/PBI • CWS
PREADJ_HDR
ALTCARRIER_LIAB
CLXREF
RPT_NOTE