Claims Test Case | Health Care Domain

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Information about Claims Test Case | Health Care Domain

Published on April 26, 2014

Author: sumanh2k



Claims test case

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Job Oriented – Instructor Led – Face2Face – True Live Online I.T. Training for Everyone Worldwide || Claims Test Case Test Case Nam e Test Case Descriptio n Step Name (Numb er) Step Descrip tion Input Data Expected Result Subp rojec t Nam e pr oj ec t Appli catio n Test Pha se Claim Numb er Gro up Memb er Numbe r Cove rage Begi n Date Prod uct ID Verif y Out of Pock et Test BR1 Member has selected a HMO product;'A ctual Claim' processes with overridde n cost shares. Step 1 In test environ ment - Add test membe rs to a HMO produc t. 11111 1 HM O rrr5566 67788 1/12 /201 2 Zasd Yes Member will be added to HMO products and are eligible in Eligibility Inquiry. Facet s Claim s test Step 2 Add test claims to test membe rs. Validat e the membe r record at the claim level . the claim. Manual ly overrid e membe r copay, coinsur ance or The Claim processes per override criteria.

Job Oriented – Instructor Led – Face2Face – True Live Online I.T. Training for Everyone Worldwide || deducti ble Step 3 Run claims throug h adjudic ation batch. The adjudic ation batch should produc e EOB's Verify payment ran successfull y and produced data for EOB's and Provider Voucher Step 4 Validat e other payme nts associa ted with the claim. Validate the claim applied cost share based upon configurat ion.

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