Characteristics of a Good Test Case

Suppose we will write a test case of CT Scan. In order to write a test case for CT scan, the first thing we need to know what CT scan means. Secondly, we need Test Plan and the requirements document for the concerned Health Insurance Plan. A requirement document is popularly known as BRD.  If we know what CT scan means and the Test Plan and the BRD are available, we will follow the steps given mentioned to write a good test case.

1. Proper coding: We have to use valid diagnosis, CPT codes. For example, we will use CPT code 74263 for Ct colonography screening and diagnosis code ICD10 Z83.71. Most companies will supply you valid codes. Most health insurance companies have template for scenarios but it is generic. The designer needs to customize as per his/her requirements.

2. Benefits: We have to check whether CT Scan applies contract benefits or it is under Wellness/Preventive services. In case of Non-grandfather plan, 100% benefit is given by the insurance companies for Wellness/Preventive services. Even some Grandfathered plans pay 100% benefit for Wellness/Preventive services. In "Expected", we must mention coinsurance rate/copayment, deductible amount. We will also need to mention whether coinsurance rate/copayment, deductible will accumulate to OOP bucket.

3. Providers: We have to check what type of providers can perform CT Scan for the plan participants. It should be radiological or lab or hospital. Again we have to check whether provider should be network providers or out of network providers. In most cases, benefits are highest for network providers and sometimes benefits are disallowed in case of out of network providers.

4. Authorization: We have to check whether CT Scan service needs prior authorization or not. If prior authorization is required, but service is provided without prior authorization, the insurance company may deny the claim or reduce benefits or apply a percentage of penalty.

5. Place of Services: If place of service is not included in the test case, it may create confusion during test case execution. Invalid defect may be logged which will be rejected by the developer. This is very disgraceful for a tester.

6.Test Data: Appropriate test data such as providers, members, COB information etc,

are very vital for a good test case. Designer will create test data in case of need.

7. Excel Sheet and QC/ALM: Generally, the designer uses excel sheet to write test cases . When test cases are completed, sometimes peer review is performed and loaded into QC/ALM. Insurance companies create  project wise folders and path in QC/ALM. It is available to the designers. If this path is not written properly in excel sheet, test cases cannot be exported from excel sheet to QC or ALM.

8. Designer's Mental Alertness: A person who writes test cases is known as a designer. His mental alertness plays a very vital role in writing good test case. As part of healthcare reform and other regulatory requirements, health care industry is in a state of continuous changing. So  Insurance companies have to update codes, providers etc. frequently. So if the designer is not mentally alert, he may miss vital information for the test case.