Testing Healthcare Applications – Tips and Important Test Scenarios (Part 2)

In the last article, we did some heavy lifting in terms of understand the healthcare domain. We are ready to put our “Tester’s hat” back on and now try to understand how to test the health care applications.

=> If you haven’t read part 1 please read it here: How to Test Health care application – introduction

We are now going to pick each application/system and come up with conditions that we are going to validate in each one of them.

This article is useful for the testers who are already in the healthcare domain or those who want to enter in this hottest career field.

Let’s get started!

Healthcare Application Testing – The Sample Test Scenarios for:

What You Will Learn:

Testing of Provider system:

1. Provider system should be let us enter, edit and save provider data.

2. Positive flow system testing- include scenarios to enter different types provider, change, save and inquire them.

3. Negative flow system testing- include scenarios to

4. System integration testing should include scenarios to

Testing of Broker system:

1. Broker system should be capable of the following,

2. Positive flow system testing should include scenarios to

3. Negative flow system testing should include scenarios to

4. System testing should include scenarios to

Testing of Member system:

Member system should be capable of the following,

  1. Enroll, terminate, reinstate and re-enroll a member
  2. Add and remove a dependent
  3. Generate premium bill
  4. Process premium payments

Enrollment:

In individual policy, a policy holder is added under a plan with an effective date from which he/she will be paying premium for the benefits provided by the insurer and from which he/she is eligible for submitting claims and receiving coverage.

In Group policy, a member is added to the group (which is already added under a plan) with an effective date of which he/she is eligible for submitting claims and receiving coverage.

Termination:

In individual policy, the policy is terminated with a termination date of which a policy holder will not be covered by the insurance plan

In group policy, either the member alone can be terminated with a termination date or the whole group can be terminated.

Reinstatement:

If a terminated member asks for the policy to be active again and the current date is within the grace period from the termination date then the member can be reinstated without a gap in coverage. The policy effective date will be the same old effective date and not the current date.

Re-enrollment:

If a terminated member asks for the policy to be active again and the current date is beyond the grace period from the termination date then the member can be re-enrolled with a gap in coverage. The policy effective date will be the current/future date and not be the same old effective date.

For example, A member is enrolled in a policy with an effective date as 1/1/2013 and terminated on 12/31/2013.let we take 30 days as the grace period fixed by the insurance company.

Case 1: If the member comes back at 1/15/2014 and wants the policy to be effective against then it is reinstatement if the member pays the premium for the period 12/31/2013 to 1/15/2014 then the policy effective date will be the same old 1/1/2013.

Case 2: If the member comes back at 2/1/2014 and wants the policy to be effective again then it is re-enrollment and the policy effective date will be 2/1/2014. Here there is a gap in coverage (1/1/2014 to 1/31/2014).

Positive flow system testing should include scenarios to

Negative flow system testing should include scenarios to

System integration testing should include scenarios to



Testing of Claims system:

Claims in healthcare have diagnosis code and procedure code for the claim to be in detail.

  1. Diagnosis code – Refers to the disease the patient have
  2. Procedure code – Refers to the treatment provided to the patient

Claims system should be capable of the following,

Positive flow system testing should include scenarios to enter, edit and process claims for member as well as dependent

Negative flow system testing should include scenarios to

System integration testing should include scenarios to validate the feed to downstream systems such as finance and provider portal

Testing of Finance system:

Finance system should be capable of writing pay checks and making EFT payments to the respective recipient by processing the feeds from various upstream systems such as claims, member, provider and broker system.

Positive flow system testing should include scenarios to check whether correct address or account number is chosen for the respective provider, member or broker for the payment.

Negative flow system testing should include scenarios to

System integration testing is not needed as this doesn’t have any downstream systems and the feeds from the upstream are validated in the system integration testing of respective systems.

Testing of Member portal:

Member portal should be capable of the following,

Positive flow system testing should include scenarios to

Negative flow system testing should include scenarios to

System integration testing is not needed as this doesn’t have any downstream systems and the feeds from the upstream systems are validated in the system integration testing of respective systems.

Testing of Provider portal:

Provider portal should be capable of the following,

Positive flow system testing should include scenarios to

Negative flow system testing should include scenarios to

System integration testing is not needed as this doesn’t have any downstream systems and the feeds from the upstream system are validated in the system integration testing of respective systems.

Testing of Broker portal:

Broker portal should be capable of the following,

Positive flow system testing should include scenarios to

Negative flow system testing should include scenarios to login with invalid credentials.

System integration testing is not needed as this doesn’t have any downstream systems and the feeds from the upstream are validated in the system integration testing of respective systems.

That’s it- that’s all the modules and the aspects we would test in them.

Important tips for Testing Healthcare software:

Tip#1. Dates are important and have to be accurate because a slight change in the date may cause a major defect to be un-noticed.

Tip#2. In healthcare, there are many test parameters such as different types of plan, members, providers, brokers, commission calculation method, etc., – so care should be taken while designing test cases by having a track of parameters covered and not covered.

Tip#3. Know the business users for the respective systems and think from their perspective to find any the best defects.

Tip#4. It is not needed to follow the same order for system testing and the scenarios provided here just cover the overall functionality of a healthcare application. You may also need to include some more scenarios (more hints at this and this post) based on the requirements you receive.

Tip#5. Health care is now moving towards a cost-effective way of providing the care. Thus they have introduced exchange model where the subscriber can have a view of plans given by all the insurers which increases the competitive nature of the insurers thereby indirectly stating the need for cost reduction.  As healthcare evolves, there will be a need for the change in software being used and there comes the revenue for IT by creation, modification and testing of software applications involved- which means we can anticipate more projects in this domain. So, keep a look out, if this interests you.

Tip#6. The key to success in health care application testing is claims – the complete knowledge of them and how they are adjudicated, etc.

Conclusion

Well, that covers the basics of healthcare domain and a way to test healthcare applications.

As testers, we know nothing is defect free. This article may also have some defects, if you find any defect or have a question please leave a comment. We welcome your valuable feedback on the article, as it will drive us towards excellence and improvement.

Wish you all the very best for your future endeavours as a healthcare tester. See you around!