Claims Test Case | Health Care Domain

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Information about Claims Test Case | Health Care Domain
Education

Published on April 26, 2014

Author: sumanh2k

Source: slideshare.net

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Claims test case

Job Oriented – Instructor Led – Face2Face – True Live Online I.T. Training for Everyone Worldwide www.H2KINFOSYS.com || Training@H2KInfosys.com H2kInfosys H2K Infosys provides online IT training and placement services worldwide. www.H2KINFOSYS.com USA- +1-(770)-777-1269, UK – (020) 3371 7615 Training@H2KINFOSYS.com / H2KInfosys@gmail.com DISCLAIMER H2K Infosys, LLC (hereinafter “H2K”) acknowledges the proprietary rights of the trademarks and products names of other companies mentioned in any of the training material including but not limited to the handouts, written material, videos, power point presentations, etc. All such training materials are provided to H2K students for learning purposes only. H2K students shall not use such materials for their private gain nor can they sell any such materials to a third party. Some of the examples provided in any such training materials may not be owned by H2K and as such H2K does not claim any proprietary rights for the same. H2K does not guarantee nor is it responsible for such products and projects. H2K acknowledges that any such information or product that has been lawfully received from third party source is free from restriction and without any breach or violation of law whatsoever.

Job Oriented – Instructor Led – Face2Face – True Live Online I.T. Training for Everyone Worldwide www.H2KINFOSYS.com || Training@H2KInfosys.com 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 www.H2KINFOSYS.com || Training@H2KInfosys.com 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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