In the preceding piece, we plunged into the terrain of healthcare, acquiring an all-encompassing acquaintance of its complexities. Now, it’s time to don our “Examiner’s cap” once more and unravel the approach to productively test healthcare applications.
Prior to jumping in, ensure to read Part 1 if you missed it.
Recommended IPTV Service Providers
- IPTVGREAT – Rating 4.8/5 ( 600+ Reviews )
- IPTVRESALE – Rating 5/5 ( 200+ Reviews )
- IPTVGANG – Rating 4.7/5 ( 1200+ Reviews )
- IPTVUNLOCK – Rating 5/5 ( 65 Reviews )
- IPTVFOLLOW -Rating 5/5 ( 48 Reviews )
- IPTVTOPS – Rating 5/5 ( 43 Reviews )
At this point, let’s dissect each application or system and identify crucial factors to authenticate each one.
This piece is especially beneficial for examiners currently employed in the healthcare sector or those looking to enter this swiftly burgeoning arena.
Let’s embark on our journey!
Your Learning Outcomes:
Healthcare Application Testing – Illustrating Test Scenarios
Here are assorted test scenarios for each application/system:
Examination Of Provider System
#1) Authenticate the ability to input, alter, and store provider details.
#2) Conduct system examination for positive flow scenarios, certifying the ability to input varying kinds of providers, adjust their details, conserve modifications, and question them.
#3) Execute system examination for negative flow scenarios, considering instances where:
- A provider record is stored with incomplete data.
- A provider’s contract effective date precedes their license date.
- Details for a provider that already exists in the system are entered and conserved.
#4) Conduct system integration testing to validate:
- Certified feeds to downstream systems like the Member system, Provider portal, Claims system, and Finance system.
- Integration of alterations made from the Provider portal into the specific provider record.
Examination Of Broker System
#1) Authenticate the ability to input, alter, and save broker details in the system.
#2) Execute system examination for positive flow scenarios, encompassing:
- Inputting, altering, and conserving broker records for different types.
- Calculating commissions for active brokers based on premium payment specifics from the member system.
#3) Perform system examination for negative flow scenarios, like:
- Inputting a broker record with deficient data for different broker types and conserving it.
- Calculating commissions for terminated brokers based on premium payment specifics from the member system.
- Calculating commissions for invalid brokers based on premium payment specifics from the member system.
#4) Conduct system testing to authenticate:
- Feeds to downstream systems such as the Broker portal, Finance system, and Member system.
- Inclusion of alterations made from the Broker portal into the specific broker record.
Examination Of Member System
The Member System should be adept at:
- Enrolling, terminating, reinstating, and re-enrolling members.
- Adding and eliminating dependents.
- Generating premium bills.
- Processing premium payments.
Enrollment: In an Individual Policy, a policyholder is incorporated under a plan with an effective date from which they initiate paying a premium and become eligible for claim submission and coverage.
In a Group Policy, a member is incorporated into the group (which is already incorporated under a plan) with an effective date from which they become eligible for claim submission and coverage.
Termination: In an Individual Policy, the policy is revoked with a termination date, leading to the policyholder being excluded from the insurance plan.
In a Group Policy, either the member alone can be terminated with a termination date or the entire group can be terminated.
Reinstatement: If a terminated member requests to reactivate the policy within the grace period, they can be reinstated without a gap in coverage. The policy’s effective date will remain identical as before, not the current date.
Re-enrollment: If a terminated member requests to reactivate the policy beyond the grace period, they can be re-enrolled with a gap in coverage. The policy’s effective date will be the current or future date, not the prior effective date.
For instance:, a member is enrolled in a policy with an effective date of 1/1/2013 and terminated on 12/31/2013. Let’s assume a grace period of 30 days set by the insurance company.
Case 1: If the member returns on 1/15/2014 and wishes to reactivate the policy, it is considered a reinstatement. If the member pays the premium for the period from 12/31/2013 to 1/15/2014, the policy’s effective date will remain the same, 1/1/2013.
Case 2: If the member returns on 2/1/2014 and wishes to reactivate the policy, it is considered a re-enrollment. The policy’s effective date will be 2/1/2014. In this case, there is a gap in coverage from 1/1/2014 to 1/31/2014.
System Testing for positive flow should incorporate scenarios such as:
- Enrolling diverse types of members with past, current, and future effective dates.
- Altering and querying about member information.
- Generating premium bills for active members in the next month.
- Terminating active members with past, current, and future termination dates that are greater than the effective date.
- Re-enrolling terminated members with past, current, and future effective dates.
- Reinstating terminated members.
System Testing for negative flow should incorporate scenarios such as:
- Enrolling a member with incomplete data.
- Generating premium bills for terminated members in the next month.
Implement System Integration Testing to:
- Authenticate feeds to downstream systems, such as the Member portal, Provider portal, Broker system, Claims system, and Finance system.
- Verify inclusion of alterations made from the Member portal into the specific member record.
- Process payments based on generated premium bills using feeds from the Member portal containing payment details.
Examination Of Claims System
The Claims System entails diagnosis codes and procedure codes to provide exhaustive data about the claim:
- Diagnosis Code: Symbolizes the patient’s illness.
- Procedure Code: Portrays the treatment administered to the patient.
The Claims System should be adept at:
- Inputting, altering, and processing claims for members and dependents.
- Generating errors for invalid claims based on incorrect data entry.
Carry out System Testing for positive flow scenarios, encompassing:
- Entering, altering, and processing claims for members and dependents.
Execute System Testing for negative flow scenarios, such as:
- Entering and validating claims with invalid diagnosis codes and procedure codes.
- Entering and validating claims with deactivated provider IDs.
- Entering and validating claims with terminated members.
Implement System Integration Testing to:
- Authenticate feeds to downstream systems like Finance and Provider portal.
Examination Of Finance System
The Finance System should be adept at generating paychecks and executing electronic fund transfer (EFT) payments to recipients based on feeds from upstream systems such as claims, member, provider, and broker systems.
Execute System Testing for positive flow scenarios to verify the precise selection of addresses or account numbers for payments to providers, members, or brokers.
Carry out System Testing for negative flow scenarios, including:
- Checking if payments are made for invalid member, provider, or broker IDs based on the respective records in the feed.
- Checking if payments are made for invalid amounts (zero or negative) to members, providers, or brokers based on the records in the feed.
System Integration Testing is not required for the Finance System as it lacks downstream systems. Feeds from upstream systems are authenticated during the System Integration Testing of corresponding systems.
Examination Of Member Portal
The Member Portal should offer the following functionalities:
- Inspecting policy particulars and claim statuses.
- Submitting alteration requests for policy particulars.
- Making premium payments.
Execute System Testing for positive flow scenarios, including:
- Logging in and inspecting policy particulars and claim statuses.
- Submitting alteration requests to update addresses, names, phone numbers, etc.
- Making premium payments.
Carry out System Testing for negative flow scenarios, such as:
- Logging in with incorrect credentials.
- Paying for already compensated premium bills.
- Paying with incorrect checks.
System Integration Testing is not required for the Member Portal as it lacks downstream systems. Feeds from upstream systems are validated during the System Integration Testing of corresponding systems.
Examination Of Provider Portal
The Provider Portal should offer the following functionalities:
- Inspecting provider particulars, member particulars, and claim statuses.
- Submitting alteration requests for provider particulars.
Execute System Testing for positive flow scenarios, including:
- Logging in and inspecting provider particulars, member particulars, and claim statuses.
- Submitting alteration requests to update addresses, names, phone numbers, etc.
Carry out System Testing for negative flow scenarios, including:
- Logging in with incorrect credentials.
- Inspecting member details with an incorrect member ID.
System Integration Testing is not required for the Provider Portal as it lacks downstream systems. Feeds from upstream systems are validated during the System Integration Testing of corresponding systems.
Examination Of Broker Portal
The Broker Portal should offer the following functionalities:
- Inspecting broker particulars and commission payments.
- Submitting alteration requests for broker particulars.
Execute System Testing for positive flow scenarios, including:
- Logging in and inspecting broker particulars and commission payments.
- Submitting alteration requests to update addresses, names, phone numbers, etc.
Carry out System Testing for negative flow scenarios, such as:
- Logging in with incorrect credentials.
System Integration Testing is not required for the Broker Portal as it lacks downstream systems. Feeds from upstream systems are validated during the System Integration Testing of corresponding systems.
Crucial Suggestions For Testing Healthcare Software
Tip#1: Concentrate thoroughly on dates and ensure their precision, as even minor anomalies can lead to significant unnoticed defects.
Tip#2: Given the numerous parameters involved in healthcare like plan types, members, providers, brokers, and commission calculation methods, thoughtfully craft test cases to encompass all pertinent parameters.
Tip#3: Position yourself in the place of the business users of the relevant systems and test from their viewpoint to pinpoint potential defects.
Tip#4: Bear in mind that the sequence of system testing and the scenarios detailed here are not rigid. These scenarios offer a comprehensive perspective of healthcare application functionality. You may need to include supplementary scenarios based on the specific requirements you receive. For more guidance, refer to this post on ready-to-run test cases.
Tip#5: Recognize that healthcare is shifting towards cost-effective care delivery. This has instigated the introduction of exchange models where subscribers can inspect plans from numerous insurers, initiating competition and accentuating the need for cost reduction.
As the healthcare industry keeps evolving, software employed in this arena will demand adaptation and enhancements. This proffers opportunities for IT professionals to create, adjust, and test software applications. Stay on the lookout for future projects in this arena if it intrigues you.
Tip#6: Claims are key in healthcare application testing. Understand the claims process and how they are adjudicated thoroughly to guarantee comprehensive testing.
Summing Up
We’ve outlined the fundamentals of the healthcare domain and offered a testing framework for healthcare applications.
As examiners, we comprehend that no system is devoid of defects, and this piece might also harbor defects. If you come across any or have queries, feel free to drop a comment. We value your input and strive for excellence and growth.
Best wishes for your future ventures as a healthcare examiner. Hope to see you soon!