The purpose of this document is to aid vendors interacting with payers, and other Trading Partners, in organizing end-to-end testing.
Timeline : 12 – 18 months from regulation implementation date
Level 1 of the end-to-end testing process includes the following Elements:
Planning
Establish Administrative Simplification project team.
Review new regulation(s) and become educated on the requirements. Look to professional associations for information and resources to help in understanding the impact of regulation or regulation change, e.g., Administrative Simplification and Affordable Care Act including CORE
Operating Rules (CAQH), and how to prepare.
Obtain updated publications and tools with new regulation changes.
Communicate changes with staff.
Develop Administrative Simplification Project Plan, Communication Plan, Project Budget, and
Risk Management Plan.
Assessment
Perform an assessment of the regulation or regulation change, e.g.; Administrative Simplification and Affordable Care Act including CORE Operating Rules (CAQH), for all applicable transaction(s).
Identify impact of regulation change to business processes and systems.
Identify and list all Trading Partner(s) (software vendors, clearinghouses, and payers) and identify what types of transactions are traded with each.
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High Level Vendor-to-Payer Administrative Simplification End-to-End Testing Document
Work with each payer to establish communication and obtain each payer’s Test Plan and implementation timeline.
Identify all transactions that could or will experience delays such as submitting claims, claim reimbursement, eligibility verification, etc.
Identify business contracts that need to be modified to comply with changes.
Evaluate staff and training needs.
Design
Review Standard Operating Procedures (SOPs). Develop new SOP(s) or update current SOP(s) as necessary.
Develop plan for claims received with dates of service incurred before October 1, 2014, which will be coded with ICD-9 codes and for claims received with dates of service incurred after
October 1, 2013, which need to run concurrently.
Verify and document the most recent version of external codes have been updated in all systems.
Create new or update current Business Requirements and Technical Specifications for all affected systems and processes.
Design programming changes and create or update data mappings.
Development
Perform necessary functions to complete needed database changes
Perform necessary functions to complete development including updated edits/audits, updating
Business Requirements and Technical Specifications.
Perform unit testing following established testing policies. Unit testing should confirm that data updates meet the individual component requirements as well as new edits/audits and business rules perform correctly.
Testing
Create a Quality Assurance Plan/tracking tool that can be used for each stage of testing. This plan will coordinate internal testing, testing with multiple Trading Partners, and track testing schedule, results, and communication.
Determine what percentage (%) of mission-critical external Trading Partner(s) will be tested with and document.
Work with each Trading Partner identified for testing to establish communication, plan and schedule testing, obtain a copy of each Trading Partner’s Test Plan, and trade updated
Companion Guides, if applicable.
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High Level Vendor-to-Payer Administrative Simplification End-to-End Testing Document
Work with each Trading Partner to formulate a backup plan in the event that one party is not ready to implement by the regulatory implementation date.
Create a Test Plan and test scripts that will verify the implementation of current or future regulation or regulation changes, e.g., Administrative Simplification and Affordable Care Act.
Perform Level 1 testing activities.
Transition
Create an Implementation and Migration Event Plan.
Determine when system/hardware changes will be finalized and evaluate against established timeline.
Develop plan for post implementation data analysis, focusing on identified high volume code/code categories.
Develop new or update existing procedural manuals and/or workflows.
Ensure staff is familiar with new upgrade and is knowledgeable with any new functionality.
Timeline : 6 – 12 months from regulation implementation date
Level 2 of the end-to-end testing process includes the following Elements:
Assessment
Work with each Trading Partner identified for testing to review and refine Test Plan.
Contact application vendor(s) (as necessary) if software upgrade for the regulation change has not been implemented. Determine each vendor’s delivery schedule(s) for the system upgrade(s).
Ensure system(s) are set-up with required test data meeting each Trading Partner’s requirements.
Review Risk Management Plan established in Level 1, to ensure adequate contingency is in place if unable to meet testing dates with Trading Partner(s).
Design
Create and/or update training documents, such as manuals.
Create Post Production Monitoring Plan (transaction denials and rejections, transactions coding accuracy, payments including diagnoses-related groupers (DRGs), Home Health Resource
Groups (HHRGs).
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High Level Vendor-to-Payer Administrative Simplification End-to-End Testing Document
Testing
Start Level 2 testing for each Trading Partner identified; perform end-to-end testing against the
Test Plan, review test results, document results, take corrective action, and retest as necessary.
If a "production-like" environment exists, plan on conducting a pseudo-production move, ensuring results are as anticipated.
Perform connectivity testing with each new Trading Partner; update results in Test Plan.
Obtain and retain documentation for completed and passed testing with each Trading Partner.
Before moving to Level 3 end-to-end testing, work with each identified mission-critical Trading
Partner(s) to determine the minimum number of test scenarios and test cycles.
Transition
Plan system migration; allow sufficient time to address unforeseen obstacles.
Plan production move and project timeline. Communicate both internally and externally
Identify what system upgrades need to be in place before the production move and schedule the upgrades as needed.
Review, finalize, and communicate System Migration Plan, lessons learned, and contingency plans.
Complete all identified staff training. Finalize future training plans of new staff, Trading
Partner(s) and customers, etc.
Plan post-implementation audit process to ensure compliance and monitor impact.
Timeline : 1 – 3 months from regulation implementation date
Level 3 of the end-to-end testing process includes the following Elements:
Planning
Revisit Implementation Plan to ensure:
All systems are ready
Contingency Plan is up-to-date
Post-Implementation Plans are documented
Revisit all business process change plans to ensure they are ready for implementation.
Finalize project documentation and Project Budget.
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High Level Vendor-to-Payer Administrative Simplification End-to-End Testing Document
Testing
Determine if there are any Errata updates that need to be included that have not been previously addressed.
Continue to complete testing with Trading Partner(s) and perform the following:
Document and communicate results using Test Plan
Refine Implementation Plan making necessary changes
Retest as needed
Obtain and retain documentation that testing has been completed and passed
Transition
Schedule and communicate implementation timeline.
Perform any production readiness testing.
Complete implementation tasks.
Perform post implementation internal testing before opening up systems to ensure the code move was successful and the system is operating as expected.
Implement Post Production Monitoring Plan and take corrective action as necessary.
Confirm new workflows, business processes, and office flow changes have been implemented.
Make adjustments as necessary.
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High Level Vendor-to-Payer Administrative Simplification End-to-End Testing Document
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