Test Scenario
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Test Cases
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1.
Access to providers system
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·
Provider system should let us enter,
edit and save provider's data
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2.
Positive flow system testing
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·
It includes scenarios to enter
different types of provider, change providers details, save and inquire them
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3.
Negative flow system testing
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·
Allows to save a provider information
with incomplete data, contract's effective date, entering details about
existing providers in the system
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4.
System integration testing
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·
Validate the feed to members system,
finance system, claim system, and provider portal. Also, validate if the changes
from provider portal are entered into the respective provider's record
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5.
Positive flow providers portal
testing
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·
Login and view providers details,
claim status, and member details
·
Make change request to change the
name, address, phone number, etc.
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6.
Negative flow providers portal
testing
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·
View the member details with an
invalid ID
·
Login with invalid credentials
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7.
Positive flow Broker portal testing
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·
Login and view details about broker
and commission payment
·
Make request to change the name,
address, phone number, etc.
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8.
Negative flow Broker portal testing
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·
It should include scenarios to login
with invalid credentials
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Sr#
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Test Scenario
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Test Cases
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1)
|
Broker
System
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·
It should be capable of edit, enter
and save broker data
·
Broker commission calculation based
on the premium payment details from member system
|
2)
|
Positive
Flow System Testing
|
·
Enter, save and edit brokers record
for different types of broker
·
For active brokers calculate the
commission by creating feed file with the respective record for members with
different plan
|
3)
|
Negative
flow System Testing
|
·
Enter a broker record with incomplete
data and save for different types of broker
·
By creating the feed file with the respective
record for members with different plan calculate the commission for the
terminated broker
·
By creating the feed file with the
respective record for members with different plan calculate the commission
for the invalid broker
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4)
|
System
Testing
|
·
To downstream system such as finance
system, broker portal and member system validate the feeds
·
Validate if the changes from broker
portal are incorporated in the respective broker record
|
Sr#
|
Test Scenario
|
Test Cases
|
1)
|
Member system
|
·
Enroll, reinstate and terminate a
member
·
Remove and add a dependent
·
Generate premium bill
·
Process premium payments
|
2)
|
Positive Flow System Testing
|
·
With current, past and future effective
dates enroll different types of members
·
Inquire and change members
·
Produce premium bill for an active
member for following month
·
Terminate an active member with past,
current and future termination dates greater than effective date
·
Re-enroll a terminated member with
current, past and future effective dates
·
Reinstate a terminated number
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3)
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Negative flow system testing
|
·
With insufficient data enroll a
member
·
For a terminated member produce a
premium bill for following month
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4)
|
System Integration Testing
|
·
Validate the feed to downstream
systems such as provider portal, broker portal, finance system and claim
system
·
Validate if the alterations from
member portal are incorporated in the respective member record
·
Process the payment of premium bill
generated with feed from members portal that has details of payment made
|
Sr#
|
Test Scenarios
|
Test Cases
|
1)
|
Claim System
|
·
Claims in health-care should edit,
enter and process claims for member as well as dependent
·
For invalid claims, it should throw
errors when incorrect data is entered
|
2)
|
Positive Flow System Testing
|
·
It should include the scenario to
edit, enter and process claims for member as well as dependent
|
3)
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Negative Flow System Testing
|
·
It should validate and enter a claim
with invalid procedure code and diagnosis code
·
Validate and enter a claim with
inactive provider ID
·
Validate and enter a claim with
terminated member
|
4)
|
System Integration
|
·
It should include scenario to
validate the feed to downstream systems such as provider and finance portal
|
Sr#
|
Test Scenarios
|
Test Cases
|
1)
|
Finance System
|
·
Enroll, reinstate and terminate a
member
|
2)
|
Positive flow system testing
|
·
It should check whether correct
account number or address is chosen for the respective member, provider or
broker for the payment
|
3)
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Negative flow system testing
|
·
Verify whether payment is done for
invalid member, provider or broker ID by creating respective record in the
feed
·
Verify whether payment is done for
invalid amount for the member, provider or broker by creating respective
records in the feed
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Sr#
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Test Scenarios
|
Test Cases
|
1)
|
User's Authentication
|
·
Using verification method to ensure
that correct users get login and deny to others
|
2)
|
Information Disclosure
|
·
Authorizing access to information is
based on user's role and patient limitation
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3)
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Data Transfer
|
·
At all transfer points ensure that
data is encrypted
|
4)
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Audit Trail
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·
All transactions and all attempts to
access data with a proper set of audit trail information are recorded
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5)
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Sanity Testing related to regulatory
body
|
·
Perform sanity testing and verify the
encryption of the data is done in particular areas like EPHI ( Electronic
Protected Health Information)
|