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.
