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1 | CCRS.zip\CCRS\CCRS-BUSRULES-v1.5.3.zip\CCRS-BUSRULES-v1.5.3-436e6fff1115001d614ccd45b469ad60a9bdb27b\testing\Test Cases | Team 4 Tester files Sprint 4 12062017.xlsx | Tue Apr 10 06:18:41 2018 UTC |
2 | CCRS.zip\CCRS\CCRS-BUSRULES-v1.5.3.zip\CCRS-BUSRULES-v1.5.3-436e6fff1115001d614ccd45b469ad60a9bdb27b\testing\Test Cases | Team 4 Tester files Sprint 4 12062017.xlsx | Fri Jun 15 15:31:27 2018 UTC |
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1 | SHEET: Tim ely Filing Rule 180 Days | ||
2 | TC4- CS010 - refact oring busi ness Rules for Timel y Filing , | ||
3 | Update eac h type dat es, | ||
4 | Test objec tive:,Veri fy the inv oice claim is receiv ed within the timely filing pe riod, so t hat the cl aim is APP ROVED if the date o f service is within the pre-de fined peri od of time and other wise denie d, | ||
5 | Roles impa cted:, | ||
6 | Test setup /Precondit ions:,Time ly Filing business r ules are c ompleted. 180 days c laims are identified in the da tabase and setup to used for t his test, | ||
7 | Requiremen t or Chang e, | ||
8 | APPROVEDan ce Criteri a,All rule s are impl emented - All types of claims are impact ed, | ||
9 | |||
10 | Assumption s:, | ||
11 | Test Case #,164407, | ||
12 | TS4- CS010 - 593878 - Mature a nd Refacto ring busin ess Rules for Timely Filing - Profession al Claim l ine, | ||
13 | Step numbe r,Descript ion,Expect ed results , | ||
14 | 1,Query fo r a claim with Start Date of m ore than 1 80 days ov er the Cla im Service _Date_from by using a query of a specifi c batch,Cl aim line w ith First Date of Se rvice of more than 180 days o ver the Cl aim Servic e_Date_fro m is avail able,Start Date of t he claim / Service_d ate_from, | ||
15 | 2,Select f ew of the claims and update th eir Receiv ed_date to be a NULL value,Cai ms with NU LL Service _Date_from are avail able, | ||
16 | 3,Run batc h rule pro cessing jo b using th e same bat ch ID as p revious st ep,Batch p rocessing job is com pleted, | ||
17 | 4,Query th e RULE_OUT COME table ,Query re sults are displayed, | ||
18 | 5,Verify t hat claim with no S ervice_Dat e_from hav e "Service _Date_from is blank, unable to validate timely fil ing" messa ge display ed,Message is displa yed, | ||
19 | 6,Verify t hat the cl aims with NULL Servi ce_Date_fr om are DEN IED,Claims are DENIE D, | ||
20 | 7,Verify t hat for th e claims t hat have m ore than 1 80 days ra nge betwee n Claim Se rvice_Date _from and Date of Se rvice have "Claim Se rvice_Date _from %s i s greater than allow ed range f rom Date o f Service %s",Messag e is displ ayed, | ||
21 | 8,Verify t hat the cl aims of mo re than 18 0 days ran ge has a s tatus of D enied ,Cla ims have DENIED sta tus, | ||
22 | 9,Verify t hat the cl aims are a nnotated w ith the CA RC/RARC ap propriate reason num ber,Claims are annot ated with the CARC/R ARC approp riate reas on, | ||
23 | 10,Using a query loc ate claims with Date of Servic e is 180 d ays on or before the Claim Ser vice_Date_ from,Invoi ces with First Date of Servic e of less than 180 d ays from t he Claim S ervice_Dat e_from are available , | ||
24 | 11,Verify that claim s that are 180 days on or befo re the Cla im Service _Date_from have APP ROVED stat us,Claim i s in APPRO VED status , | ||
25 | |||
26 | Test Case# ,Test Ca se # T est Script s# 1545 24 Stor y CS010 Require ment, | ||
27 | |||
28 | |||
29 | |||
30 | TS4- CS010 - 593878 - Mature a nd Refacto ring busin ess Rules for Timely Filing - - Institu tional Cla ims , | ||
31 | Step numbe r,Descript ion,Expect ed results , | ||
32 | 1,Query fo r a claim with Start Date of m ore than 1 80 days ov er the Cla im Admissi on_date by using a q uery of a specific b atch,Claim line with Start Dat e of more than 180 d ays over t he Claim A dmission_d ate is ava ilable,Sta rt_date /a dmission_d ate, | ||
33 | 2,Select f ew of the claims and update th eir Receiv ed_date to be a NULL value,Cai ms with NU LL Admissi on_date ar e availabl e, | ||
34 | 3,Run batc h rule pro cessing jo b using th e same bat ch ID as p revious st ep,Batch p rocessing job is com pleted, | ||
35 | 4,Query th e RULE_OUT COME table ,Query re sults are displayed, | ||
36 | 5,Verify t hat claim with no A dmission_d ate have " Admission_ date is bl ank, unabl e to valid ate timely filing" m essage dis played,Mes sage is di splayed, | ||
37 | 6,Verify t hat the cl aims with NULL Admis sion_date are DENIED ,Claims ar e DENIED, | ||
38 | 7,Verify t hat for th e claims t hat have m ore than 1 80 days ra nge betwee n Claim Ad mission_da te and Sta rt Date ha ve "Claim Admission_ date %s is greater t han allowe d range fr om Date of Service % s",Message is displa yed, | ||
39 | 8,Verify t hat the cl aims of mo re than 18 0 days ran ge has a s tatus of D enied ,Cla ims have DENIED sta tus, | ||
40 | 9,Verify t hat the cl aims are a nnotated w ith the CA RC/RARC ap propriate reason num ber,Claims are annot ated with the CARC/R ARC approp riate reas on, | ||
41 | 10,Using a query loc ate claims with Star t Date is 180 days o n or befor e the Clai m Admissio n_date,Inv oices wit h First Da te of Serv ice of les s than 180 days from the Claim Admission _date are available, | ||
42 | 11,Verify that claim s that are 180 days on or befo re the Cla im Admissi on_date ha ve APPROV ED status, Claim is i n APPROVED status, | ||
43 | |||
44 | Test Case# ,Test Ca se # T est Script s# 154525 Sto ry CS010 Requir ement, | ||
45 | |||
46 | TS4- CS010 - 593878 - Mature a nd Refacto ring busin ess Rules for Timely Filing - Pharmacy Claims,Pas s 12/11/20 17, | ||
47 | Step numbe r,Descript ion,Expect ed results , | ||
48 | 1,Query fo r a claim with Start Date of m ore than 1 80 days ov er the Cla im Date_of _Service b y using a query of a specific batch,Clai m line wit h Start Da te of more than 180 days over the Claim Date_of_Se rvice is a vailable,S tart Date /date_of_s ervice, | ||
49 | 2,Select f ew of the claims and update th eir Servi ce date to be a NULL value,Cai ms with NU LL Date_of _Service a re availab le, | ||
50 | 3,Run batc h rule pro cessing jo b using th e same bat ch ID as p revious st ep,Batch p rocessing job is com pleted, | ||
51 | 4,Query th e RULE_OUT COME table ,Query re sults are displayed, | ||
52 | 5,Verify t hat claim with no D ate_of_Ser vice have "Date_of_S ervice is blank, una ble to val idate time ly filing" message d isplayed,M essage is displayed, | ||
53 | 6,Verify t hat the cl aims with NULL Date_ of_Service are DENIE D,Claims a re DENIED, | ||
54 | 7,Verify t hat for th e claims t hat have m ore than 1 80 days ra nge betwee n Claim Da te_of_Serv ice and St art Date h ave "Claim Date_of_S ervice %s is greater than allo wed range from Date of Service %s",Messa ge is disp layed, | ||
55 | 8,Verify t hat the cl aims of mo re than 18 0 days ran ge has a s tatus of D enied ,Cla ims have DENIED sta tus, | ||
56 | 9,Verify t hat the cl aims are a nnotated w ith the CA RC/RARC ap propriate reason num ber,Claims are annot ated with the CARC/R ARC approp riate reas on, | ||
57 | 10,Using a query loc ate claims with Star t Date is 180 days o n or befor e the Clai m Date_of_ Service,In voices wi th First D ate of Ser vice of le ss than 18 0 days fro m the Clai m Date_of_ Service ar e availabl e, | ||
58 | 11,Verify that claim s that are 180 days on or befo re the Cla im Date_of _Service h ave APPRO VED status ,Claim is in APPROVE D status, | ||
59 | TimelyFili ng:, | ||
60 | Test Case# ,Test Ca se # T est Script s# 1545 26 Stor y CS010 Require ment, | ||
61 | |||
62 | I’ll have to rework TimelyFili ng to chan ge Date of Service: , | ||
63 | TS4- CS010 - 593878 - Mature a nd Refacto ring busin ess Rules for Timely Filing - Dental Cla ims,Instit utional – From Claim level DI M_INSTITUT IONAL_CLAI M.admissio n_date, | ||
64 | Step numbe r,Descript ion,Expect ed results ,Professio nal – From Claim Lin e level F_ PROFESSION AL_MEDICAL _CLAIM_DET AILS.servi ce_date_fr om, | ||
65 | 1,Query fo r a claim with Start Date of m ore than 1 80 days ov er the Cla im service _date by u sing a que ry of a sp ecific bat ch,Claim l ine with S tart Date of more th an 180 day s over the Claim ser vice_date is availab le,Start_d ate / serv ice_Date,D ental – Fr om Claim L ine level F_DENTAL_C LAIM_DETAI LS.service _date, | ||
66 | 2,Select f ew of the claims and update th eir Servic e date to be a NULL value,Caim s with NUL L service_ date are a vailable,P harmacy – From Claim Line Leve l F_PHARMA CY_CLAIM_D ETAILS.dat e_of_servi ce, | ||
67 | 3,Run batc h rule pro cessing jo b using th e same bat ch ID as p revious st ep,Batch p rocessing job is com pleted,Pro vider Paid field wil l be added back in. Team 1 not ed this ma y not be p opulated b y 837, so a discussi on is need ed to iden tify where this date will come from (per haps inter faces), | ||
68 | 4,Query th e RULE_OUT COME table ,Query re sults are displayed, Claim Type can be de termined f rom DIM_VA _CLAIM.sou rce_entity , | ||
69 | 5,Verify t hat claim with no s ervice_dat e have "se rvice_date is blank, unable to validate timely fil ing" messa ge display ed,Message is displa yed, | ||
70 | 6,Verify t hat the cl aims with NULL servi ce_date ar e DENIED,C laims are DENIED,Add itional di scussion i s needed t o validate these fie ld changes with the VA (e.g.: is admissi on_date th e right fi eld for de termining timely fil ing for In situtition al?, | ||
71 | 7,Verify t hat for th e claims t hat have m ore than 1 80 days ra nge betwee n Claim se rvice_date and Start Date have "Claim se rvice_date %s is gre ater than allowed ra nge from D ate of Ser vice %s",M essage is displayed, | ||
72 | 8,Verify t hat the cl aims of mo re than 18 0 days ran ge has a s tatus of D enied ,Cla ims have DENIED sta tus, | ||
73 | 9,Verify t hat the cl aims are a nnotated w ith the CA RC/RARC ap propriate reason num ber,Claims are annot ated with the CARC/R ARC approp riate reas on, | ||
74 | 10,Using a query loc ate claims with Star t Date is 180 days o n or befor e the Clai m service_ date,Invoi ces with First Date of Servic e of less than 180 d ays from t he Claim s ervice_dat e are avai lable, | ||
75 | 11,Verify that claim s that are 180 days on or befo re the Cla im service _date have APPROVED status,Cl aim is in APPROVED s tatus, | ||
76 | |||
77 | Test Case# ,Test Ca se # T est Script s#154973 Stor y CS010 Require ment, | ||
78 | |||
79 | |||
80 | SHEET: Tim ely Filing 30 days | ||
81 | TC4- CS010 - 593878 Refactorin g business Rules for Timely Fi ling - 30 days / Cla im Line, | ||
82 | |||
83 | Test objec tive:,Veri fy The CCN s must sen d the clai m to CCRS within 30 days after they have paid the provider,T o be Updat ed , | ||
84 | Roles impa cted:,batc hIds,CCN1_ 837P_20121 107 , | ||
85 | Test setup /Precondit ions:,Time ly Filing business r ule is com pleted. 30 days rang e claims are identi fied in th e database and setup to used f or this te st,Provide Paid Date / Start_ Date,CCN2_ 837P_20121 107, | ||
86 | Requiremen t or Chang e,AA_20171 028_B, | ||
87 | Acceptance criteria, Rule is im plemented - All type s of claim s are impa cted,CCN1_ NCPDP_2012 0912, | ||
88 | CCN1_837D_ 20120914, | ||
89 | Assumption s:, | ||
90 | Test Case #,164814, | ||
91 | TC4- CS010 - Verifi cation of Code busin ess Rules for Timely Filing - 30 days P rofessiona l Claim li ne, | ||
92 | Step numbe r,Descript ion,Expect ed results ,select cl aim_id, d. claim_key, received_ date, d.da te_paid, d .etl_batch _id | ||
93 | from DIM_V A_CLAIM c JOIN F_DEN TAL_CLAIM_ DETAILS d | ||
94 | ON c. claim_key = d.claim_ key | ||
95 | where d. date_paid is not NUL L, | ||
96 | 1,Query fo r claims a nd claim l ines lines that are over the 3 0 days ran ge (Provid er has bee n paid mor e than 30 days befor e claim St art_Date). List cl aims & cla im lines., Claim line s with ran ge of more than 30 d ays are av ailable an d listed. Ran ge > 30 da ys,Out of range,F _p rofessiona l,query be fore run,s elect clai m_id, d.cl aim_key, e tl_batch_i d ,date_of _service,d ecision,ru le_name, o .message,o .rule_name ,o.rule_ou tcome_key, o.validati on_name | ||
97 | from dim_v a_claim c | ||
98 | join DECIS ION d on c .claim_key =d.claim_k ey | ||
99 | join RULE_ OUTCOME o on d.decis ion_key=o. decision_k ey | ||
100 | --where d. claim_key in (73,142 ,408,413,2 9,31,32,11 3), | ||
101 | 2,Query fo r claims a nd claim l ines lines that on t he range o f 30 days range (Pro vider has been paid 30 days be fore claim Start_Dat e). List claims & claim line s.,Claim l ines with range equa l to 30 da ys are ava ilable and listed. Range = 3 0 days,on range, | ||
102 | 3,Query fo r claims a nd claim l ines lines that have less than 30 days r ange (Prov ider has b een paid l ess than 3 0 days bef ore claim Start_Date ). List claims & c laim lines .,Claim li nes with r ange of le ss than 30 days are available and listed . Rang e < 30 day s,within r ange, | ||
103 | 4,Query fo r claims a nd claim l ines lines that have 0 days ra nge (Provi der has be en paid sa me day as claims Sta rt_Date). List cla ims & clai m lines.,C laim lines with rang e is 0 day are avail able and l isted. Range = 0 day, 0 range, | ||
104 | 5,Run batc h rule pro cessing jo b using th e same bat ch ID as p revious st ep,Batch p rocessing job is com pleted, | ||
105 | 6,Query th e DECISION table ,Qu ery result s are disp layed, | ||
106 | 7,Verify t hat claim lines with Range > 3 0 days hav e a messag e displaye d that cit es % of da ys are mor e than 30 days,Messa ge is disp layed, | ||
107 | 8,Verify t hat the cl aim lines that have a range > 30 days ar e REJECTED ,Claim lin es are REJ ECTED, | ||
108 | 9,Verify t hat the RE JECTED cla im lines a re annotat ed with th e CARC/RAR C appropri ate reason number (2 9),Claims are annota ted with t he CARC/RA RC appropr iate reaso n, | ||
109 | 10,Verify that claim lines wit h Range = 30 days ha ve a messa ge display ed that ci tes % of d ays are mo re than 30 days,Mess age is dis played, | ||
110 | 11,Verify that claim lines wit h Range = 30 days ar e ACCEPTED ,Claim lin es are ACC EPTED, | ||
111 | 12,Verify that claim lines wit h Range < 30 days ar e ACCEPTED ,Claim lin es are ACC EPTED, | ||
112 | 13,Verify that claim lines wit h Range 0 days are A CCEPTED,Cl aim lines are ACCEPT ED, | ||
113 | 14,Verify that the c laim lines with NULL Start_Dat e have a m essage tha t cites RE CEIVED Da te is NULL ,Claims ar e DENIED o r REJECTED , | ||
114 | 15,Verify that the c laim lines with NULL Paid Date have a me ssage that cites Pai d Date is NULL,Claim s are DENI ED or REJE CTED, | ||
115 | |||
116 | Test Case# ,Test Ca se # T est Script s# 15485 0 Story CS 010 R equirement , | ||
117 | |||
118 | TC4- CS010 -Verifi cation of Code busin ess Rules for Timely Filing - 30 days - Institutio nal Claim lines, | ||
119 | Step numbe r,Descript ion,Expect ed results , | ||
120 | 1,Query fo r claims a nd claim l ines lines that are over the 3 0 days ran ge (Provid er has bee n paid mor e than 30 days befor e claim St art_Date). List cl aims & cla im lines., Claim line s with ran ge of more than 30 d ays are av ailable an d listed. Ran ge > 30 da ys,Out of range,f_in titu, | ||
121 | 2,Query fo r claims a nd claim l ines lines that on t he range o f 30 days range (Pro vider has been paid 30 days be fore claim Start_Dat e). List claims & claim line s.,Claim l ines with range equa l to 30 da ys are ava ilable and listed. Range = 3 0 days,on range, | ||
122 | 3,Query fo r claims a nd claim l ines lines that have less than 30 days r ange (Prov ider has b een paid l ess than 3 0 days bef ore claim Start_Date ). List claims & c laim lines .,Claim li nes with r ange of le ss than 30 days are available and listed . Rang e < 30 day s,within r ange, | ||
123 | 4,Query fo r claims a nd claim l ines lines that have 0 days ra nge (Provi der has be en paid sa me day as claims Sta rt_Date). List cla ims & clai m lines.,C laim lines with rang e is 0 day are avail able and l isted. Range = 0 day, 0 range, | ||
124 | 5,Run batc h rule pro cessing jo b using th e same bat ch ID as p revious st ep,Batch p rocessing job is com pleted, | ||
125 | 6,Query th e DECISION table ,Qu ery result s are disp layed, | ||
126 | 7,Verify t hat claim lines with Range > 3 0 days hav e a messag e displaye d that cit es % of da ys are mor e than 30 days,Messa ge is disp layed, | ||
127 | 8,Verify t hat the cl aim lines that have a range > 30 days ar e REJECTED ,Claim lin es are REJ ECTED, | ||
128 | 9,Verify t hat the RE JECTED cla im lines a re annotat ed with th e CARC/RAR C appropri ate reason number (2 9),Claims are annota ted with t he CARC/RA RC appropr iate reaso n, | ||
129 | 10,Verify that claim lines wit h Range = 30 days ha ve a messa ge display ed that ci tes % of d ays are mo re than 30 days,Mess age is dis played, | ||
130 | 11,Verify that claim lines wit h Range = 30 days ar e ACCEPTED ,Claim lin es are ACC EPTED, | ||
131 | 12,Verify that claim lines wit h Range < 30 days ar e ACCEPTED ,Claim lin es are ACC EPTED, | ||
132 | 13,Verify that claim lines wit h Range 0 days are A CCEPTED,Cl aim lines are ACCEPT ED, | ||
133 | 14,Verify that the c laim lines with NULL Start_Dat e have a m essage tha t cites RE CEIVED Da te is NULL ,Claims ar e DENIED o r REJECTED , | ||
134 | 15,Verify that the c laim lines with NULL Paid Date have a me ssage that cites Pai d Date is NULL,Claim s are DENI ED or REJE CTED, | ||
135 | |||
136 | Test Case# ,Test Ca se # T est Script s# 15486 0 Sto ry CS010 Requir ement, | ||
137 | |||
138 | TC4- CS010 - Verific ation of C ode busine ss Rules f or Timely Filing - 3 0 days -Ph armacy Cla ims, | ||
139 | Step numbe r,Descript ion,Expect ed results , | ||
140 | 1,Query fo r claims a nd claim l ines lines that are over the 3 0 days ran ge (Provid er has bee n paid mor e than 30 days befor e claim St art_Date). List cl aims & cla im lines., Claim line s with ran ge of more than 30 d ays are av ailable an d listed. Ran ge > 30 da ys,Out of range,F_ph arma, | ||
141 | 2,Query fo r claims a nd claim l ines lines that on t he range o f 30 days range (Pro vider has been paid 30 days be fore claim Start_Dat e). List claims & claim line s.,Claim l ines with range equa l to 30 da ys are ava ilable and listed. Range = 3 0 days,on range, | ||
142 | 3,Query fo r claims a nd claim l ines lines that have less than 30 days r ange (Prov ider has b een paid l ess than 3 0 days bef ore claim Start_Date ). List claims & c laim lines .,Claim li nes with r ange of le ss than 30 days are available and listed . Rang e < 30 day s,within r ange, | ||
143 | 4,Query fo r claims a nd claim l ines lines that have 0 days ra nge (Provi der has be en paid sa me day as claims Sta rt_Date). List cla ims & clai m lines.,C laim lines with rang e is 0 day are avail able and l isted. Range = 0 day, 0 range, | ||
144 | 5,Run batc h rule pro cessing jo b using th e same bat ch ID as p revious st ep,Batch p rocessing job is com pleted, | ||
145 | 6,Query th e DECISION table ,Qu ery result s are disp layed, | ||
146 | 7,Verify t hat claim lines with Range > 3 0 days hav e a messag e displaye d that cit es % of da ys are mor e than 30 days,Messa ge is disp layed, | ||
147 | 8,Verify t hat the cl aim lines that have a range > 30 days ar e REJECTED ,Claim lin es are REJ ECTED, | ||
148 | 9,Verify t hat the RE JECTED cla im lines a re annotat ed with th e CARC/RAR C appropri ate reason number (2 9),Claims are annota ted with t he CARC/RA RC appropr iate reaso n, | ||
149 | 10,Verify that claim lines wit h Range = 30 days ha ve a messa ge display ed that ci tes % of d ays are mo re than 30 days,Mess age is dis played, | ||
150 | 11,Verify that claim lines wit h Range = 30 days ar e ACCEPTED ,Claim lin es are ACC EPTED, | ||
151 | 12,Verify that claim lines wit h Range < 30 days ar e ACCEPTED ,Claim lin es are ACC EPTED, | ||
152 | 13,Verify that claim lines wit h Range 0 days are A CCEPTED,Cl aim lines are ACCEPT ED, | ||
153 | 14,Verify that the c laim lines with NULL Start_Dat e have a m essage tha t cites RE CEIVED Da te is NULL ,Claims ar e DENIED o r REJECTED , | ||
154 | 15,Verify that the c laim lines with NULL Paid Date have a me ssage that cites Pai d Date is NULL,Claim s are DENI ED or REJE CTED, | ||
155 | |||
156 | |||
157 | Test Case# ,Test Ca se # T est Script s# 15487 7 Stor y CS010 Require ment, | ||
158 | |||
159 | TC4- CS010 - Verific ation of C ode busine ss Rules f or Timely Filing - 3 0 days -De ntal Claim s, | ||
160 | Step numbe r,Descript ion,Expect ed results , | ||
161 | 1,Query fo r claims a nd claim l ines lines that are over the 3 0 days ran ge (Provid er has bee n paid mor e than 30 days befor e claim St art_Date). List cl aims & cla im lines., Claim line s with ran ge of more than 30 d ays are av ailable an d listed. Ran ge > 30 da ys,Out of range,F_de ntal, | ||
162 | 2,Query fo r claims a nd claim l ines lines that on t he range o f 30 days range (Pro vider has been paid 30 days be fore claim Start_Dat e). List claims & claim line s.,Claim l ines with range equa l to 30 da ys are ava ilable and listed. Range = 3 0 days,on range, | ||
163 | 3,Query fo r claims a nd claim l ines lines that have less than 30 days r ange (Prov ider has b een paid l ess than 3 0 days bef ore claim Start_Date ). List claims & c laim lines .,Claim li nes with r ange of le ss than 30 days are available and listed . Rang e < 30 day s,within r ange, | ||
164 | 4,Query fo r claims a nd claim l ines lines that have 0 days ra nge (Provi der has be en paid sa me day as claims Sta rt_Date). List cla ims & clai m lines.,C laim lines with rang e is 0 day are avail able and l isted. Range = 0 day, 0 range, | ||
165 | 5,Run batc h rule pro cessing jo b using th e same bat ch ID as p revious st ep,Batch p rocessing job is com pleted, | ||
166 | 6,Query th e DECISION table ,Qu ery result s are disp layed, | ||
167 | 7,Verify t hat claim lines with Range > 3 0 days hav e a messag e displaye d that cit es % of da ys are mor e than 30 days,Messa ge is disp layed, | ||
168 | 8,Verify t hat the cl aim lines that have a range > 30 days ar e REJECTED ,Claim lin es are REJ ECTED, | ||
169 | 9,Verify t hat the RE JECTED cla im lines a re annotat ed with th e CARC/RAR C appropri ate reason number (2 9),Claims are annota ted with t he CARC/RA RC appropr iate reaso n, | ||
170 | 10,Verify that claim lines wit h Range = 30 days ha ve a messa ge display ed that ci tes % of d ays are mo re than 30 days,Mess age is dis played, | ||
171 | 11,Verify that claim lines wit h Range = 30 days ar e ACCEPTED ,Claim lin es are ACC EPTED, | ||
172 | 12,Verify that claim lines wit h Range < 30 days ar e ACCEPTED ,Claim lin es are ACC EPTED, | ||
173 | 13,Verify that claim lines wit h Range 0 days are A CCEPTED,Cl aim lines are ACCEPT ED, | ||
174 | 14,Verify that the c laim lines with NULL Start_Dat e have a m essage tha t cites RE CEIVED Da te is NULL ,Claims ar e DENIED o r REJECTED , | ||
175 | 15,Verify that the c laim lines with NULL Paid Date have a me ssage that cites Pai d Date is NULL,Claim s are DENI ED or REJE CTED, | ||
176 | |||
177 | Test Case# ,Test Ca se # T est Script s# 1548 78 Stor y CS010 Require ment, | ||
178 | |||
179 | |||
180 | SHEET: $$ Threshold | ||
181 | TC4 - CS01 0 - 628 449 - Ma ture dolla r threshol d business rule sets for all I nvoice typ es, | ||
182 | |||
183 | Test objec tive:,Vali date that Claim line s that exc eed $30,00 0 are flag ged for au dit (PENDI NG_REVIEW) , | ||
184 | Roles impa cted:, | ||
185 | Test setup /Precondit ions:,Data is availa ble for te sting. D atabase wi th all tab les and co lumns, | ||
186 | Requiremen t or Chang e,S4-CS010 , | ||
187 | Acceptance criteria, Claim line s that exc eed $30,00 0 are flag ged for au dit (PENDI NG_REVIEW) , | ||
188 | |||
189 | Assumption s:,This ru le will be ran with other rule s to check the valid ity of all incoming claims, | ||
190 | Test Case# ,166900, | ||
191 | |||
192 | TS4 - CS01 0 - 628 449 - Ma ture dolla r threshol d business rule sets for all I nvoice typ es - Profe ssional, | ||
193 | Action Ite ms:,Descri ption,Expe cted Resul ts,Notes, | ||
194 | 1,Using S QL query s elect clai ms that ar e more tha n $30.000 | ||
195 | List the c laims and their Batc h ID,$30,0 00 Claims areselecte d,select e tl_batch_i d, claim_k ey, etl_ba tch_id , s tart_date, end_date, Total_Cha rges | ||
196 | from DIM_ PROFESSION AL_CLAIM w here etl_b atch_id = 'CCN1_837P _20121107' | ||
197 | and Total _Charges > = '30,000' | ||
198 | , | ||
199 | 2,Query th e decision table and make sure that the selected c laims are not listed in the ta ble,Claims are not l isted,Add Claim line s, | ||
200 | 3,Run the rule engin e batch jo b using th e SQA link provided for the te st,Rule is ran and c ompleted, | ||
201 | 4,Verify t hat the cl aims above (> $30,00 0) are fla gged as "P ending For Review",C laims are flagged as "Pending For Review ", | ||
202 | 5,Verify t hat claims will be h eld for 48 hours,Cla ims are he ld for 48 hrs, | ||
203 | 6,Verify t hat after the 48 hrs the claim s are eith er back in to workflo w or Rejec ted,Claims are eithe r back int o workflow or Reject ed, | ||
204 | |||
205 | Test Case# ,Test Ca se # T est Script s# 1564 89 S tory CS010 Requi rement, | ||
206 | |||
207 | |||
208 | TS4 - CS01 0 - 628 449 - Ma ture dolla r threshol d business rule sets for all I nvoice typ es - Insti tutional, | ||
209 | Action Ite ms:,Descri ption,Expe cted Resul ts,Notes, | ||
210 | 1,Using S QL query s elect clai ms that ar e more tha n $30.000 | ||
211 | List the c laims and their Batc h ID,$30,0 00 Claims areselecte d, | ||
212 | 2,Query th e decision table and make sure that the selected c laims are not listed in the ta ble,Claims are not l isted, | ||
213 | 3,Run the rule engin e batch jo b using th e SQA link provided for the te st,Rule is ran and c ompleted, | ||
214 | 4,Verify t hat the cl aims above (> $30,00 0) are fla gged as "P ending For Review",C laims are flagged as "Pending For Review ", | ||
215 | 5,Verify t hat claims will be h eld for 48 hours,Cla ims are he ld for 48 hrs, | ||
216 | 6,Verify t hat after the 48 hrs the claim s are eith er back in to workflo w or Rejec ted,Claims are eithe r back int o workflow or Reject ed, | ||
217 | |||
218 | Test Case# ,Test Ca se # T est Script s# 15649 1 S tory CS010 Requi rement, | ||
219 | |||
220 | |||
221 | TS4 - CS01 0 - 628 449 - Ma ture dolla r threshol d business rule sets for all I nvoice typ es - Denta l, | ||
222 | Action Ite ms:,Descri ption,Expe cted Resul ts,Notes, | ||
223 | 1,Using S QL query s elect clai ms that ar e more tha n $30.000 | ||
224 | List the c laims and their Batc h ID,$30,0 00 Claims areselecte d, | ||
225 | 2,Query th e decision table and make sure that the selected c laims are not listed in the ta ble,Claims are not l isted, | ||
226 | 3,Run the rule engin e batch jo b using th e SQA link provided for the te st,Rule is ran and c ompleted, | ||
227 | 4,Verify t hat the cl aims above (> $30,00 0) are fla gged as "P ending For Review",C laims are flagged as "Pending For Review ", | ||
228 | 5,Verify t hat claims will be h eld for 48 hours,Cla ims are he ld for 48 hrs, | ||
229 | 6,Verify t hat after the 48 hrs the claim s are eith er back in to workflo w or Rejec ted,Claims are eithe r back int o workflow or Reject ed, | ||
230 | |||
231 | Test Case# ,Test Ca se # T est Script s# 156 492 S tory CS010 Requi rement, | ||
232 | |||
233 | |||
234 | TS4 - CS01 0 - 628 449 - Ma ture dolla r threshol d business rule sets for all I nvoice typ es - Pharm acy, | ||
235 | Action Ite ms:,Descri ption,Expe cted Resul ts,Notes, | ||
236 | 1,Using S QL query s elect clai ms that ar e more tha n $30.000 | ||
237 | List the c laims and their Batc h ID,$30,0 00 Claims areselecte d, | ||
238 | 2,Query th e decision table and make sure that the selected c laims are not listed in the ta ble,Claims are not l isted, | ||
239 | 3,Run the rule engin e batch jo b using th e SQA link provided for the te st,Rule is ran and c ompleted, | ||
240 | 4,Verify t hat the cl aims above (> $30,00 0) are fla gged as "P ending For Review",C laims are flagged as "Pending For Review ", | ||
241 | 5,Verify t hat claims will be h eld for 48 hours,Cla ims are he ld for 48 hrs, | ||
242 | 6,Verify t hat after the 48 hrs the claim s are eith er back in to workflo w or Rejec ted,Claims are eithe r back int o workflow or Reject ed, | ||
243 | |||
244 | Test Case# ,Test Ca se # T est Script s# 15 6493 S tory CS010 Requi rement, | ||
245 | |||
246 | |||
247 | SHEET: Ref erral # Ru le | ||
248 | TC4- CS014 - 623073 Update Re ferral rul es , | ||
249 | Test objec tive:,Veri fy that CC RS uutomat ically mat ch invoice s to exist ing active referrals within CC RS, so onl y matched invoices a re process ed. Deny invoices t hat have n o matching referral or if the referral i s no longe r active, so that de nials can be stored and commun icated. A pprove inv oices that do not in clude refe rral numbe rs if the service pr ovided was a flu sho t.,Retest and updat e in Ratio nal, | ||
250 | Roles impa cted:, | ||
251 | Test setup /Precondit ions:,1) C laim lines that do n ot match a referral should be annotated as denied. Validatio n name: VA LID_REFERR AL | ||
252 | 2) Claims that are n ot Flushot s , | ||
253 | Requiremen t or Chang e, | ||
254 | Acceptance criteria, When the s ystem matc hed the in voice with referral it is proc essed and the system shows the payment a pproved, | ||
255 | |||
256 | Assumption s:, | ||
257 | Test Case# ,165674, | ||
258 | TS4- CS014 - 623073 Code Busi ness rules for refer ral number s 837P,Not es,Claim l ines have a matching referral Pr ofessional , Institut ional, Ph armacy, De ntal (Cla imLine) | ||
259 | , | ||
260 | Step numbe r,Descript ion,Expect ed results , | ||
261 | 1,Run a qu ery to loc ate and se lect refer ral_number s and thei r valid da tes,Referr als are id entified w ith their valid date s,SELECT * | ||
262 | FROM [cc rsdb].[ccr a].[PreAut horization ] | ||
263 | order by PreAuthor izationNum ber | ||
264 | , | ||
265 | 2,Run a qu ery to loc ate and se lect Flush ots claims and their batchID | ||
266 | ex. 3 with CPT code, 3 with no CPT code, 3 do not match refe rral valid dates, 3 that match valid dat es, ,Flu shots Clai ms are sel ected,<met a http-equ iv="refres h" content ="0; URL=/ messages/D 7CSSQ1NH/s earch/30?n ojsmode=1" />, | ||
267 | 3,Run a qu ery and s elect clai ms with cl aim lines lines that are not F lushots. Locate the ir referra l number a nd their d ate of ser vice | ||
268 | ex. 3 wi th no CPT (Procedure Code), 3 with a NUL L date of service | ||
269 | ,Claims wi th claim l ines and r eferral nu mbers are selected. Referral numbers an d date of service ar e listed,I nvalid Dat e of Servi ce is a da te outside of the re ferreal pe riod,Rejec t/Resubmit testing:, | ||
270 | 4,Select c laims with with vali d referral numbers a nd an inva lid Date o f Service ,Claims ar e selected and liste d,SELECT * from DE CISION | ||
271 | |||
272 | ,Share mes sage …, | ||
273 | 5,Query de cision tab le by runn ing the fe tch job or using que ry. Make sure claim lines fro m steps ab ove are no t listed , Query resu lts do not include s elected cl aim lines, find ref,[ 9:579:57 P M]Yesterda y at 9:57: 31 PM Star this mess age , | ||
274 | 6,Run the referral r ule job,Ru le batch j ob is comp leted ,the ir dates,D avid Mulla ney [9:57 PM]Yesterd ay at 9:57 :31 PM Sta r this mes sage , | ||
275 | 7,Verify t hat all cl aim with n o referral _number ex cluding fl ushots are DENIED,C laim lines are DENIE D ,claim d ate of ser vice,Claim Must be P reviously Rejected, We can che ck by look ing at the decision table., | ||
276 | 8,Verify t hat all Fl ushots cla im with a valid Date of Servic e are all ACCEPTED,F lushots Cl aims are s elected,[9 :579:57 PM ]Yesterday at 9:57:4 3 PM Star this messa ge ,628441 T4-Mature referral editing ru le to assi gn CARC/RA RC for den ial, | ||
277 | 9,Verify t hat claims lines tha t have a v alid refer ral and in valid Date Of Servic e and a NU LL Date Of Service a re DENIED, Claims are DENIED,Da vid Mullan ey [9:57 P M]Yesterda y at 9:57: 43 PM Star this mess age ,62843 1 T4-Ident ify CARC / RARC for referral d enial deta il, | ||
278 | 10,Verify that invoi ces with n o CPT code (Procedur e code) ar e DENIED,I nvoices ar e DENIED,R esubmitted claim wil l have '-' suffix in the claim _id ( IE i f rejected claim_id is CLAIM00 69 then th e resubmit ted claim_ id will lo ok like CL AIM0069-1) .,628445 T 4-Refactor referral editing ru le to sear ch referra ls for ref erral that was activ e at the t ime of ser vice, | ||
279 | 11,Verify that Flush ots invoic es with a valid CPT and invali d Date of Service ar e DENIED,I nvoices ar e DENIED,S hare messa ge …,62844 3 T4-Matur e referral editing r ule to cor rectly ide ntify flu shot excep tions for approval, | ||
280 | 12,Verify that all t he claims with a val id referra l Number a nd a valid Date of S ervice are ACCEPTED, Claims wit h a valid referral N umber and a valid Da te of Serv ice are AC CEPTED,[9: 579:57 PM] Yesterday at 9:57:54 PM Star t his messag e , | ||
281 | 13,Verify that the D ENIED clai m lines ar e annotate d with the CARC/RARC appropria te reason number ,Cl aims are a nnotated w ith the CA RC/RARC ap propriate reason,Dav id Mullane y [9:57 PM ]Yesterday at 9:57:5 4 PM Star this messa ge ,and ru n Rule out come, | ||
282 | Test Case # Test Scripts# 155381 Story Requ irement,It is assume d that cla im_id and source_sys tem combin ation will ALWAYS be unique., | ||
283 | Show messa ge actions , | ||
284 | [9:589:58 PM]Yesterd ay at 9:58 :04 PM Sta r this mes sage , | ||
285 | David Mull aney [9:58 PM]Yester day at 9:5 8:04 PM St ar this me ssage , | ||
286 | TS4- CS014 - Code Business r ules for r eferral nu mbers 837I ,Claim mus t be resub mitted wit hin 30 day s: So the resubmitte d claim's "dim_va_cl aim.start date" minu s the Reje cted Claim 's "decisi on.last_up dated_date _time" mus t be < 30 days, | ||
287 | Step numbe r,Descript ion,Expect ed results ,[9:589:58 PM]Yester day at 9:5 8:46 PM St ar this me ssage , | ||
288 | 1,Run a qu ery to loc ate and se lect refer ral_number s and thei r valid da tes,Referr als are id entified w ith their valid date s,David Mu llaney [9: 58 PM]Yest erday at 9 :58:46 PM Star this message , | ||
289 | 2,Run a qu ery and s elect clai ms with cl aim lines lines that are not F lushots. Locate the ir referra l number a nd their d ate of ser vice | ||
290 | ex. 3 wi th no CPT (Procedure Code), 3 with a NUL L date of service | ||
291 | ,Claims wi th claim l ines and r eferral nu mbers are selected. Referral numbers an d date of service ar e listed,C urrently, the suppor ted invoic e types ar e 837I, 83 7, | ||
292 | 3,Select c laims with with vali d referral numbers a nd an inva lid Date o f Service ,Claims ar e selected and liste d,Add reac tion …, | ||
293 | 4,Query de cision tab le by runn ing the fe tch job or using que ry. Make sure claim lines fro m steps ab ove are no t listed , Query resu lts do not include s elected cl aim lines, [9:599:59 PM]Yesterd ay at 9:59 :05 PM Sta r this mes sage , | ||
294 | 5,Run the referral r ule job,Ru le batch j ob is comp leted ,Dav id Mullane y [9:59 PM ]Yesterday at 9:59:0 5 PM Star this messa ge , | ||
295 | 6,Verify t hat all cl aim with n o referral _number ex cluding fl ushots are DENIED,C laim lines are DENIE D ,837P, 8 37D, | ||
296 | 7,Verify t hat claims lines tha t have a v alid refer ral and in valid Date Of Servic e and a NU LL Date Of Service a re DENIED, Claims are DENIED,[9 :599:59 PM ]Yesterday at 9:59:1 7 PM Star this messa ge , | ||
297 | 8,Verify t hat invoic es with no CPT code (Procedure code) are DENIED,In voices are DENIED,Da vid Mullan ey [9:59 P M]Yesterda y at 9:59: 17 PM Star this mess age , | ||
298 | 9,Verify t hat Flusho ts invoice s with a v alid CPT a nd invalid Date of S ervice are DENIED,In voices are DENIED,Ph armacy is not suppor ted yet., | ||
299 | 10,Verify that all t he claims with a val id referra l Number a nd a valid Date of S ervice are ACCEPTED, Claims wit h a valid referral N umber and a valid Da te of Serv ice are AC CEPTED,Sta rt a threa d, | ||
300 | 11,Verify that the D ENIED clai m lines ar e annotate d with the CARC/RARC appropria te reason number ,Cl aims are a nnotated w ith the CA RC/RARC ap propriate reason,[10 :0110:01 P M]Yesterda y at 10:01 :42 PM Sta r this mes sage , | ||
301 | 13,David M ullaney [1 0:01 PM]Ye sterday at 10:01:42 PM Star th is message , | ||
302 | Looking at the CCRSD B. I see r ejected Cl aims but I do not se e any Clai ms that we can consi der "resub mitted", | ||
303 | Test Case # Test Scripts# 155388 Story Req uirement,A dd reactio n …, | ||
304 | [10:0210:0 2 PM]Yeste rday at 10 :02:48 PM Star this message , | ||
305 | David Mull aney [10:0 2 PM]Yeste rday at 10 :02:48 PM Star this message , | ||
306 | TS4- CS014 - Code B usiness ru les for re ferral num bers 837 P harmacy,So you let m e know wha t's going to work be st for you r testing, we can ei ther creat e the data in the CC RSDB or pe rhaps you can valida te your te st scripts via a uni t test, ju st let me know, we c an do eith er one., | ||
307 | Step numbe r,Descript ion,Expect ed results , | ||
308 | 1,Run a qu ery to loc ate and se lect refer ral_number s and thei r valid da tes,Referr als are id entified w ith their valid date s, | ||
309 | 2,Run a qu ery and s elect clai ms with cl aim lines lines that are not F lushots. Locate the ir referra l number a nd their d ate of ser vice | ||
310 | ex. 3 wi th no CPT (Procedure Code), 3 with a NUL L date of service | ||
311 | ,Claims wi th claim l ines and r eferral nu mbers are selected. Referral numbers an d date of service ar e listed, | ||
312 | 3,Select c laims with with vali d referral numbers a nd an inva lid Date o f Service ,Claims ar e selected and liste d, | ||
313 | 4,Query de cision tab le by runn ing the fe tch job or using que ry. Make sure claim lines fro m steps ab ove are no t listed , Query resu lts do not include s elected cl aim lines, | ||
314 | 5,Run the referral r ule job,Ru le batch j ob is comp leted , | ||
315 | 6,Verify t hat all cl aim with n o referral _number ex cluding fl ushots are DENIED,C laim lines are DENIE D , | ||
316 | 7,Verify t hat claims lines tha t have a v alid refer ral and in valid Date Of Servic e and a NU LL Date Of Service a re DENIED, Claims are DENIED, | ||
317 | 8,Verify t hat invoic es with no CPT code (Procedure code) are DENIED,In voices are DENIED, | ||
318 | 9,Verify t hat Flusho ts invoice s with a v alid CPT a nd invalid Date of S ervice are DENIED,In voices are DENIED, | ||
319 | 10,Verify that all t he claims with a val id referra l Number a nd a valid Date of S ervice are ACCEPTED, Claims wit h a valid referral N umber and a valid Da te of Serv ice are AC CEPTED, | ||
320 | 11,Verify that the D ENIED clai m lines ar e annotate d with the CARC/RARC appropria te reason number ,Cl aims are a nnotated w ith the CA RC/RARC ap propriate reason, | ||
321 | |||
322 | Test Case # Test Scripts# 155389 Story Req uirement, | ||
323 | TS4- CS014 - Code Business r ules for r eferral nu mbers Dent al, | ||
324 | Step numbe r,Descript ion,Expect ed results , | ||
325 | 1,Run a qu ery to loc ate and se lect refer ral_number s and thei r valid da tes,Referr als are id entified w ith their valid date s, | ||
326 | 2,Run a qu ery and s elect clai ms with cl aim lines lines that are not F lushots. Locate the ir referra l number a nd their d ate of ser vice | ||
327 | ex. 3 wi th no CPT (Procedure Code), 3 with a NUL L date of service | ||
328 | ,Claims wi th claim l ines and r eferral nu mbers are selected. Referral numbers an d date of service ar e listed, | ||
329 | 3,Select c laims with with vali d referral numbers a nd an inva lid Date o f Service ,Claims ar e selected and liste d, | ||
330 | 4,Query de cision tab le by runn ing the fe tch job or using que ry. Make sure claim lines fro m steps ab ove are no t listed , Query resu lts do not include s elected cl aim lines, | ||
331 | 5,Run the referral r ule job,Ru le batch j ob is comp leted , | ||
332 | 6,Verify t hat all cl aim with n o referral _number ex cluding fl ushots are DENIED,C laim lines are DENIE D , | ||
333 | 7,Verify t hat claims lines tha t have a v alid refer ral and in valid Date Of Servic e and a NU LL Date Of Service a re DENIED, Claims are DENIED, | ||
334 | 8,Verify t hat invoic es with no CPT code (Procedure code) are DENIED,In voices are DENIED, | ||
335 | 9,Verify t hat Flusho ts invoice s with a v alid CPT a nd invalid Date of S ervice are DENIED,In voices are DENIED, | ||
336 | 10,Verify that all t he claims with a val id referra l Number a nd a valid Date of S ervice are ACCEPTED, Claims wit h a valid referral N umber and a valid Da te of Serv ice are AC CEPTED, | ||
337 | 11,Verify that the D ENIED clai m lines ar e annotate d with the CARC/RARC appropria te reason number ,Cl aims are a nnotated w ith the CA RC/RARC ap propriate reason, | ||
338 | |||
339 | Test Case # Test Scripts# 155390 Story Req uirement, | ||
340 | |||
341 | |||
342 | SHEET: She et3 | ||
343 | Flushots t est querie s / data /setps, | ||
344 | Flushots t est querie s / data /setps, | ||
345 | , | ||
346 | User has a lready cre ated flush ots claim data , | ||
347 | 1,Find all the 837P claims wit h a valid referral n umber,sele ct c.clai m_id, c.cl aim_key, c .Start_dat e, c.is_cu rrent, c.e tl_batch_i d, c.refer ral_number ,c.last_up dated_user , rf.Refer ralDate, | ||
348 | rf.Referra lExpiratio nDate, rf. ReferralNu mber | ||
349 | from DIM_V A_CLAIM c | ||
350 | join ccra. Referral r f | ||
351 | on c.refer ral_number = rf.Refe rralNumber | ||
352 | where etl_ batch_id = 'DL_837P_ 20171126_6 ' | ||
353 | and referr al_number like 'ref% %',claim_i d claim_ke y Start_da te is_curr ent etl_ba tch_id ref erral_numb er last_up dated_user ReferralD ate Referr alExpirati onDate Ref erralNumbe r | ||
354 | CLAIM0022 1227 2017- 11-26 Y DL _837P_2017 1126_6 ref 12 referrt st 2017-01 -01 2017-1 2-31 ref12 | ||
355 | CLAIM0024 1229 2017- 11-26 Y DL _837P_2017 1126_6 ref 12 referrt st 2017-01 -01 2017-1 2-31 ref12 | ||
356 | CLAIM0013 1213 2017- 11-26 Y DL _837P_2017 1126_6 ref 13 Flushot tst 2017-0 1-01 2017- 12-31 ref1 3 | ||
357 | CLAIM0027 1224 2017- 11-26 Y DL _837P_2017 1126_6 ref 13 referrt st 2017-01 -01 2017-1 2-31 ref13 | ||
358 | CLAIM0019 1223 2017- 11-26 Y DL _837P_2017 1126_6 ref 14 referrt st 2017-01 -01 2017-1 2-31 ref14 | ||
359 | CLAIM0030 1228 2017- 11-26 Y DL _837P_2017 1126_6 ref 14 referrt st 2017-01 -01 2017-1 2-31 ref14 | ||
360 | CLAIM0014 1215 2016- 11-26 Y DL _837P_2017 1126_6 ref 15 Flushot tst 2010-0 1-01 2017- 12-31 ref1 5 | ||
361 | CLAIM0020 1225 2016- 11-26 Y DL _837P_2017 1126_6 ref 16 referrt st 2017-01 -01 2017-1 2-31 ref16 | ||
362 | CLAIM0025 1230 2017- 11-26 Y DL _837P_2017 1126_6 ref 17 referrt st 2017-01 -01 2017-1 2-31 ref17 , | ||
363 | 2,not like ref,Find 837P claim s with a n on valid r eferral nu mber | ||
364 | Also selec t some cla ims with n o Referral _number | ||
365 | and some w ith out of rand refe rrral date ,select cl aim_id, cl aim_key, S tart_date, is_curren t, etl_bat ch_id, ref erral_numb er,last_up dated_user | ||
366 | from DIM_V A_CLAIM | ||
367 | where etl_ batch_id = 'DL_837P_ 20171126_6 ' | ||
368 | and referr al_number like 'refb ad',claim_ id claim_k ey Start_d ate is_cur rent etl_b atch_id re ferral_num ber last_u pdated_use r | ||
369 | CLAIM0029 1226 2017- 11-26 Y DL _837P_2017 1126_6 REF bad referr tst | ||
370 | CLAIM0028 1231 2017- 11-26 Y DL _837P_2017 1126_6 ref bad Flusho ttst | ||
371 | claim_id c laim_key S tart_date is_current etl_batch _id referr al_number last_updat ed_user | ||
372 | CLAIM0001 1202 2017- 11-26 Y DL _837P_2017 1126_6 VAR EF0001 ds_ rw | ||
373 | CLAIM0003 1203 2017- 11-26 Y DL _837P_2017 1126_6 VAR EF0003 ds_ rw | ||
374 | CLAIM0002 1204 2017- 11-26 Y DL _837P_2017 1126_6 VAR EF0002 ds_ rw | ||
375 | CLAIM0005 1205 2017- 11-26 Y DL _837P_2017 1126_6 Fl ushottst | ||
376 | CLAIM0004 1206 2017- 11-26 Y DL _837P_2017 1126_6 ds _rw | ||
377 | , | ||
378 | 3,Check de cision tab le,Make su re they ar e no claim s in the t able from the select ed batch,s elect d.*, v.* from dbo.decisi on d | ||
379 | join dbo.v alidation_ failure v | ||
380 | on d.decis ion_key = v.decision _key | ||
381 | where d.et l_batch_id = 'DL_837 P_20171126 _6' | ||
382 | ,no result s, | ||
383 | 4,Run job 1, 2,3,htt p:// IP :8089/bren gine/proce ssBatch?ba tch_id=DL_ 837P_20171 126_6 | ||
384 | |||
385 | http:// IP :8089/logs /ccrs-bren gine.log | ||
386 | |||
387 | http:// IP :8089/bren gine/fetch Decisions? batch_id=D L_837P_201 71126_6, | ||
388 | 5,Verify t hat all Fl ushots cla ms are acc epted,"sel ect d.*, v .* from db o.decision d | ||
389 | join dbo.v alidation_ failure v | ||
390 | on d.decis ion_key = v.decision _key | ||
391 | where d.et l_batch_id = 'DL_837 P_20171126 _6' | ||
392 | " | ||
393 | , | ||
394 | |||
395 | |||
396 | |||
397 | SHEET: Dup licate Rul e | ||
398 | TC4 - S4-C S029- 6209 64 -Mature duplicate editing r ules for a ll invoice types, | ||
399 | Test objec tive:,Vali date Dupli cate Rule, | ||
400 | Roles impa cted:, | ||
401 | Test setup /Precondit ions:,Rule engine ha s been imp lemented- Test data has been s elected. Test data includes c laims and claim line s with dup licates - All types of claims are avail able - Use r has acce ss to the test envir onment, | ||
402 | Requiremen t or Chang e,Automati cally iden tify the d uplicate l ine item s ubmitted w ithin the contracted reimburse ment invoi ce using t he unique combinatio n of invoi ce line da ta so that improper payments c an be prev ented., | ||
403 | Acceptance criteria, | ||
404 | Assumption s:,decisio n is line based, | ||
405 | Test Case# ,166109, | ||
406 | TS4 - CS02 9- 620964 -Mature du plicate ed iting rule s for all invoice ty pes - Pro fessional ,Clai m line is not a dupl icate of a nother cla im line su bmitted wi thin the c laim or wi thin a pre vious clai m that was not set t o rejected or denied ,Professio nal, Insti tutional,, | ||
407 | Step numbe r,Descript ion,Expect ed results ,Pharmacy, , | ||
408 | 1,Select a new batch file and select cla ims with c laim lines lines ,Cl aims and c laim lines are liste d,Dental,C laimLine, Claim, | ||
409 | 2,Make sur e that the duplicate s records have a uni que combin ation of t he followi ng attribu tes: • Unique Id entifier | ||
410 | • Provider Id | ||
411 | • Patient Id | ||
412 | • Service Date From | ||
413 | • Service Date To (o ptional) | ||
414 | • Place Of Service | ||
415 | • Procedur e Code | ||
416 | • Procedur e Modifier (s) (optio nal) | ||
417 | • Billed A mount | ||
418 | ,the dupli cates reco rds have a unique co mbination of the fol lwing attr ibutes: • Unique I dentifier | ||
419 | • Provider Id | ||
420 | • Patient Id | ||
421 | • Service Date From | ||
422 | • Service Date To (o ptional) | ||
423 | • Place Of Service | ||
424 | • Procedur e Code | ||
425 | • Procedur e Modifier (s) (optio nal) | ||
426 | • Billed A mount | ||
427 | ,duplicate is always for line checking: when the rule is in itiated on the claim ---- - rule against ba tch ID. 1 st base on batch ret rieve al t he claims and claim lines, 2nd dup rule will find will find all claims lines. C laim is a global con cept is on e kind of claim,,the n retrieve #t lines… F_ D, F_I, F_P,… the re is cate gory claim table eac h claim ca n only bel ong to one category. Dim_Pr, DIm_I, th ese table are not us ed for dup rule casu e the are claim leve l. fro D , I, etc. .. only in sti are in voked in t he table.. . batch ID , all clai ms --> the n the clai m referenc e patient + provider then they retrive f act table and fact t able might retrieve other tabl e - Cla im is curr ent an dec ision is a pproved. it will retrieve a ll claim a nd claim l ines under neath and ===> and then it wi ll retriev e any matc hing lines if it exi sts. batc h ID with claims - n br of clai ms how can I find th e matching claim in the batch. 10 claim s 8 patien ts. Will use the 8 patient lo oking for the matchi ng claim l ines. the n it is sa ved. then we do the match. F unction sp ecs detail s, | ||
428 | 3,Select a duplicate claims wi th matchin g claim li nes that a re not rej ected nor declined a nd that ar e annotate d as PAID, Claims and matching claim line s are sele cted,notes , | ||
429 | 4,List all claims an d their ma tching cla im lines,C laims and claim line s are list ed, | ||
430 | 5,Run the duplicate rule job,J ob ran and completed , | ||
431 | 6,Query th e Validati on Decisio n table an d locate t he duplica tes claims and claim lines sel ected abov e,Claims a nd claim l ines selec ted above are locate d and sele cted, | ||
432 | 7,Verify t hat claim lines that are previ ously reim bursed by VA are DE NIED,Claim lines tha t are prev iously rei mbursed by VA are DE NIED,5 dup licated as existing data and m odified - ---> g ave a new batch id for the te st, | ||
433 | 8,Verify t hat duplic ates lines items are annotated as DENIED | ||
434 | ,Claim lin es are ann otated as DENIED ,as suming the new batch ID it wil l try to r un it new batch AA _20171024_ A, | ||
435 | 9,Verify t hat claim lines that are dupli cates incl ude a reas on for den ial from a standard list (CARC /RARC),Dup licates in clude a re ason for d enial from a standar d list (CA RC/RARC),t hen when u nit test c an run man ually --- > then run ning with all rules enabled ar e picking up, | ||
436 | 10,Verify that if ma tching rel ated claim line(s) h as been pa id and sho ws an allo wed amount > $0, the n the clai m will be flagged as a duplica te ,W hen matchi ng related claim lin e(s) has b een paid a nd shows a n allowed amount > $ 0, then th e claim wi ll be flag ged as a d uplicate,d uplicate t ry to find a matchin g line if it does no t catch a match, | ||
437 | 11,Verify that when there is m ore than o ne claim m odifier an d all modi fiers matc h, it wil l be flagg ed as a du plicate ,W hen there is more th an one cla im modifie r and all modifiers match, it will be f lagged as a duplicat e , | ||
438 | 12,Verify that when the matchi ng related claim lin e(s) has a Claim Sta tus which is NOT in {'Rejected ', 'Denied '} is /are flagged a s duplicat e,Claims l ine are fl agged as D uplicate(s ), | ||
439 | 13,Verify that if th e matching claim lin es are not part of t he same cl aim, it w ill be fla gged as a duplicate ,when clai m lines ar e not part of the sa me claim, it is flag ged as dup licate,to review, | ||
440 | 14,When bo th the mat ching rela ted claim line(s) an d the clai m line(s) show a pre vious Pay Flag set t o 'Yes' ,P ay Flag is set to 'Y es',to rev iew, | ||
441 | |||
442 | Test Case # Test Scripts# 155823 Story Requ irement, | ||
443 | |||
444 | |||
445 | |||
446 | TS4-CS029- 620964 -M ature dupl icate edit ing rules for all in voice type s - Instit utional, | ||
447 | Step numbe r,Descript ion,Expect ed results , | ||
448 | 1,Select a new batch file and select cla ims with c laim lines lines tha t have dup licates,Cl aims and c laim lines are liste d, | ||
449 | 2,Make sur e that the duplicate s records have a uni que combin ation of t he follwin g attribut es: • Un ique Ident ifier | ||
450 | • Provider Id | ||
451 | • Patient Id | ||
452 | • Service Date From | ||
453 | • Service Date To (o ptional) | ||
454 | • Place Of Service | ||
455 | • Procedur e Code | ||
456 | • Procedur e Modifier (s) (optio nal) | ||
457 | • Billed A mount | ||
458 | ,the dupli cates reco rds have a unique co mbination of the fol lwing attr ibutes: • Unique I dentifier | ||
459 | • Provider Id | ||
460 | • Patient Id | ||
461 | • Service Date From | ||
462 | • Service Date To (o ptional) | ||
463 | • Place Of Service | ||
464 | • Procedur e Code | ||
465 | • Procedur e Modifier (s) (optio nal) | ||
466 | • Billed A mount | ||
467 | , | ||
468 | 3,Select a duplicate claims wi th matchin g claim li nes that a re not rej ected nor declined a nd that ar e annotate d as PAID, Claims and matching claim line s are sele cted, | ||
469 | 4,List all claims an d their ma tching cla im lines,C laims and claim line s are list ed, | ||
470 | 5,Run the duplicate rule job,J ob ran and completed , | ||
471 | 6,Query th e Validati on Decisio n table an d locate t he duplica tes claims and claim lines sel ected abov e,Claims a nd claim l ines selec ted above are locate d and sele cted, | ||
472 | 7,Verify t hat claim lines that are previ ously reim bursed by VA are DE NIED,Claim lines tha t are prev iously rei mbursed by VA are DE NIED, | ||
473 | 8,Verify t hat duplic ates lines items are annotated as DENIED | ||
474 | ,Claim lin es are ann otated as DENIED , | ||
475 | 9,Verify t hat claim lines that are dupli cates incl ude a reas on for den ial from a standard list (CARC /RARC),Dup licates in clude a re ason for d enial from a standar d list (CA RC/RARC), | ||
476 | 10,Verify that if ma tching rel ated claim line(s) h as been pa id and sho ws an allo wed amount > $0, the n the clai m will be flagged as a duplica te ,W hen matchi ng related claim lin e(s) has b een paid a nd shows a n allowed amount > $ 0, then th e claim wi ll be flag ged as a d uplicate, | ||
477 | 11,Verify that when there is m ore than o ne claim m odifier an d all modi fiers matc h, it wil l be flagg ed as a du plicate ,W hen there is more th an one cla im modifie r and all modifiers match, it will be f lagged as a duplicat e , | ||
478 | 12,Verify that when the matchi ng related claim lin e(s) has a Claim Sta tus which is NOT in {'Rejected ', 'Denied '} is /are flagged a s duplicat e,Claims l ine are fl agged as D uplicate(s ), | ||
479 | 13,Verify that if th e matching claim lin es are not part of t he same cl aim, it w ill be fla gged as a duplicate ,when clai m lines ar e not part of the sa me claim, it is flag ged as dup licate, | ||
480 | 14,When bo th the mat ching rela ted claim line(s) an d the clai m line(s) show a pre vious Pay Flag set t o 'Yes' ,P ay Flag is set to 'Y es', | ||
481 | |||
482 | |||
483 | Test Case # Test Scripts# 15582 4 Story Requ irement, | ||
484 | |||
485 | TS4-CS029- 620964 -M ature dupl icate edit ing rules for all in voice type s - Dental , | ||
486 | Step numbe r,Descript ion,Expect ed results , | ||
487 | 1,Select a new batch file and select cla ims with c laim lines lines tha t have dup licates,Cl aims and c laim lines are liste d, | ||
488 | 2,Make sur e that the duplicate s records have a uni que combin ation of t he follwin g attribut es: • Un ique Ident ifier | ||
489 | • Provider Id | ||
490 | • Patient Id | ||
491 | • Service Date From | ||
492 | • Service Date To (o ptional) | ||
493 | • Place Of Service | ||
494 | • Procedur e Code | ||
495 | • Procedur e Modifier (s) (optio nal) | ||
496 | • Billed A mount | ||
497 | ,the dupli cates reco rds have a unique co mbination of the fol lwing attr ibutes: • Unique I dentifier | ||
498 | • Provider Id | ||
499 | • Patient Id | ||
500 | • Service Date From | ||
501 | • Service Date To (o ptional) | ||
502 | • Place Of Service | ||
503 | • Procedur e Code | ||
504 | • Procedur e Modifier (s) (optio nal) | ||
505 | • Billed A mount | ||
506 | , | ||
507 | 3,Select a duplicate claims wi th matchin g claim li nes that a re not rej ected nor declined a nd that ar e annotate d as PAID, Claims and matching claim line s are sele cted, | ||
508 | 4,List all claims an d their ma tching cla im lines,C laims and claim line s are list ed, | ||
509 | 5,Run the duplicate rule job,J ob ran and completed , | ||
510 | 6,Query th e Validati on Decisio n table an d locate t he duplica tes claims and claim lines sel ected abov e,Claims a nd claim l ines selec ted above are locate d and sele cted, | ||
511 | 7,Verify t hat claim lines that are previ ously reim bursed by VA are DE NIED,Claim lines tha t are prev iously rei mbursed by VA are DE NIED, | ||
512 | 8,Verify t hat duplic ates lines items are annotated as DENIED | ||
513 | ,Claim lin es are ann otated as DENIED , | ||
514 | 9,Verify t hat claim lines that are dupli cates incl ude a reas on for den ial from a standard list (CARC /RARC),Dup licates in clude a re ason for d enial from a standar d list (CA RC/RARC), | ||
515 | 10,Verify that if ma tching rel ated claim line(s) h as been pa id and sho ws an allo wed amount > $0, the n the clai m will be flagged as a duplica te ,W hen matchi ng related claim lin e(s) has b een paid a nd shows a n allowed amount > $ 0, then th e claim wi ll be flag ged as a d uplicate, | ||
516 | 11,Verify that when there is m ore than o ne claim m odifier an d all modi fiers matc h, it wil l be flagg ed as a du plicate ,W hen there is more th an one cla im modifie r and all modifiers match, it will be f lagged as a duplicat e , | ||
517 | 12,Verify that when the matchi ng related claim lin e(s) has a Claim Sta tus which is NOT in {'Rejected ', 'Denied '} is /are flagged a s duplicat e,Claims l ine are fl agged as D uplicate(s ), | ||
518 | 13,Verify that if th e matching claim lin es are not part of t he same cl aim, it w ill be fla gged as a duplicate ,when clai m lines ar e not part of the sa me claim, it is flag ged as dup licate, | ||
519 | 14,When bo th the mat ching rela ted claim line(s) an d the clai m line(s) show a pre vious Pay Flag set t o 'Yes' ,P ay Flag is set to 'Y es', | ||
520 | |||
521 | |||
522 | Test Case # Test Scripts# 155826 Story Requ irement, | ||
523 | |||
524 | |||
525 | TS4-CS029- 620964 -M ature dupl icate edit ing rules for all in voice type s - Pharma cy, | ||
526 | Step numbe r,Descript ion,Expect ed results , | ||
527 | 1,Select a new batch file and select cla ims with c laim lines lines tha t have dup licates,Cl aims and c laim lines are liste d, | ||
528 | 2,Make sur e that the duplicate s records have a uni que combin ation of t he follwin g attribut es: • Un ique Ident ifier | ||
529 | • Provider Id | ||
530 | • Patient Id | ||
531 | • Service Date From | ||
532 | • Service Date To (o ptional) | ||
533 | • Place Of Service | ||
534 | • Procedur e Code | ||
535 | • Procedur e Modifier (s) (optio nal) | ||
536 | • Billed A mount | ||
537 | ,the dupli cates reco rds have a unique co mbination of the fol lwing attr ibutes: • Unique I dentifier | ||
538 | • Provider Id | ||
539 | • Patient Id | ||
540 | • Service Date From | ||
541 | • Service Date To (o ptional) | ||
542 | • Place Of Service | ||
543 | • Procedur e Code | ||
544 | • Procedur e Modifier (s) (optio nal) | ||
545 | • Billed A mount | ||
546 | , | ||
547 | 3,Select a duplicate claims wi th matchin g claim li nes that a re not rej ected nor declined a nd that ar e annotate d as PAID, Claims and matching claim line s are sele cted, | ||
548 | 4,List all claims an d their ma tching cla im lines,C laims and claim line s are list ed, | ||
549 | 5,Run the duplicate rule job,J ob ran and completed , | ||
550 | 6,Query th e Validati on Decisio n table an d locate t he duplica tes claims and claim lines sel ected abov e,Claims a nd claim l ines selec ted above are locate d and sele cted, | ||
551 | 7,Verify t hat claim lines that are previ ously reim bursed by VA are DE NIED,Claim lines tha t are prev iously rei mbursed by VA are DE NIED, | ||
552 | 8,Verify t hat duplic ates lines items are annotated as DENIED | ||
553 | ,Claim lin es are ann otated as DENIED , | ||
554 | 9,Verify t hat claim lines that are dupli cates incl ude a reas on for den ial from a standard list (CARC /RARC),Dup licates in clude a re ason for d enial from a standar d list (CA RC/RARC), | ||
555 | 10,Verify that if ma tching rel ated claim line(s) h as been pa id and sho ws an allo wed amount > $0, the n the clai m will be flagged as a duplica te ,W hen matchi ng related claim lin e(s) has b een paid a nd shows a n allowed amount > $ 0, then th e claim wi ll be flag ged as a d uplicate, | ||
556 | 11,Verify that when there is m ore than o ne claim m odifier an d all modi fiers matc h, it wil l be flagg ed as a du plicate ,W hen there is more th an one cla im modifie r and all modifiers match, it will be f lagged as a duplicat e , | ||
557 | 12,Verify that when the matchi ng related claim lin e(s) has a Claim Sta tus which is NOT in {'Rejected ', 'Denied '} is /are flagged a s duplicat e,Claims l ine are fl agged as D uplicate(s ), | ||
558 | 13,Verify that if th e matching claim lin es are not part of t he same cl aim, it w ill be fla gged as a duplicate ,when clai m lines ar e not part of the sa me claim, it is flag ged as dup licate, | ||
559 | 14,When bo th the mat ching rela ted claim line(s) an d the clai m line(s) show a pre vious Pay Flag set t o 'Yes' ,P ay Flag is set to 'Y es', | ||
560 | |||
561 | |||
562 | Test Case # Test Scripts# 155827 Story Requ irement, | ||
563 | |||
564 | |||
565 | SHEET: Dup Rule Step s | ||
566 | DUPLICATES RULE TEST ING STEPS, Rule is ch ecking to see if any duplicate s exist fo r ,Test ca ses to be updated , | ||
567 | Professio nal claim lines,Clai m lines th at are PAI D, not den ied and no t rejected ===> APPR OVED, | ||
568 | Test prepa ration and condition s, | ||
569 | Tester has access to the SQA environmen t - Tester has Dupli cate rule engine job / logs li nks | ||
570 | All other rules are turned off - Only Du plicate ru le is runn ing For th is demo | ||
571 | Tester has access to Database to update and alter Data to cr eate dupli cates if n eeded,Uniq ue Identif ier attrib utes | ||
572 | • Provider Id | ||
573 | • Patient Id | ||
574 | • Service Date From | ||
575 | • Service Date To (o ptional) | ||
576 | • Place Of Service | ||
577 | • Procedur e Code | ||
578 | • Procedur e Modifier (s) (optio nal) | ||
579 | • Billed A mount | ||
580 | , | ||
581 | 1,Query DB for a bat chID,Selec t a batchI D,c.etl_ba tch_id = ' AA_2017102 4_A', | ||
582 | Query DB f or test cl aim lines data ,Sel ect claim lines with in batchID that will be dups t est data , select dis tinct c.cl aim_key, c .etl_batch _id, f.cla im_detail_ key, f.etl _batch_id, f.pos_key , pr.npi a s provider , p.member _id as pat ient, f.se rvice_date _from, f.s ervice_dat e_to, f.ch arge_amoun t | ||
583 | from dbo.d im_va_clai m c join d bo.F_PROFE SSIONAL_ME DICAL_CLAI M_DETAILS f on c.cla im_key = f .claim_key | ||
584 | join dbo.DIM_PR OVIDER pr on pr.prov ider_key = c.billing _provider_ key | ||
585 | join dbo.DIM_PA TIENT p on p.patient _key = c.p atient_key | ||
586 | where c.et l_batch_id = 'AA_201 71024_A' | ||
587 | order by p os_key, pr ovider, pa tient, ser vice_date_ from, serv ice_date_t o, charge_ amount | ||
588 | , | ||
589 | Query DB f or matchi ng data (E xisting ma tching cla ims that a re already Approved) ,Select ma tching Dat a,select d istinct c. claim_key, c.etl_bat ch_id, f.c laim_detai l_key, f.e tl_batch_i d, f.pos_k ey, pr.npi as provid er, p.memb er_id as p atient, f. service_da te_from, f .service_d ate_to, f. charge_amo unt | ||
590 | from dbo.d im_va_clai m c join d bo.F_PROFE SSIONAL_ME DICAL_CLAI M_DETAILS f on c.cla im_key = f .claim_key | ||
591 | jo in dbo.DIM _PROVIDER pr on pr.p rovider_ke y = c.bill ing_provid er_key | ||
592 | join dbo .DIM_PATIE NT p on p. patient_ke y = c.pati ent_key | ||
593 | join dbo .decision d on d.cla im_detail_ key = f.cl aim_detail _key | ||
594 | where d.de cision = ' APPROVED' | ||
595 | order by p os_key, pr ovider, pa tient, ser vice_date_ from, serv ice_date_t o, charge_ amount | ||
596 | |||
597 | , | ||
598 | Query to c lean test data,Check if decisi on has pre vious resu lts in tes ting claim s ,select d.*, v.* f rom dbo.de cision d | ||
599 | join dbo.v alidation_ failure v | ||
600 | on d.decis ion_key = v.decision _key | ||
601 | where d.et l_batch_id = 'AA_201 71024_A' | ||
602 | if records are found run this query: De lete from dbo.decisi on where e tl_batch_i d = 'AA_20 171024_A' | ||
603 | , | ||
604 | Run job li nks 1, 2 a nd 3,http: // IP : PORT /brengine/ processBat ch?batch_i d=AA_20171 024_A | ||
605 | |||
606 | http:// IP : PORT /logs/ccrs -brengine. log | ||
607 | |||
608 | http:// IP : PORT /brengine/ fetchDecis ions?batch _id=AA_201 71024_A | ||
609 | |||
610 | ,DL_837P_2 0171126_6, | ||
611 | Query for decision,C heck decis ion table, select d.* , v.* from dbo.decis ion d join dbo.valid ation_fail ure v on d .decision_ key = v.de cision_key | ||
612 | where d.et l_batch_id = 'AA_201 71024_A',h ttp:// IP : port /brengine/ processBat ch?batch_i d=DL_837P_ 20171126_6 , | ||
613 | Verificati on,Verify that the d up record is DENIED, | ||
614 | http:// IP : port /brengine/ processBat ch?batch_i d=DL_837P_ 20171126_6 , | ||
615 | |||
616 | |||
617 | |||
618 | DUPS tes r esults sav ed screen shots , | ||
619 | |||
620 | |||
621 | |||
622 | |||
623 | |||
624 | |||
625 | |||
626 | |||
627 | |||
628 | 2, | ||
629 | 3, | ||
630 | 4, | ||
631 | 5, | ||
632 | |||
633 | 6, | ||
634 | |||
635 | |||
636 | 7, | ||
637 | 8, | ||
638 | 9, | ||
639 | 10, | ||
640 | |||
641 | 11, | ||
642 | 12, | ||
643 | 13, | ||
644 | |||
645 | |||
646 | SHEET: Dup rule note s | ||
647 | IF claim l ine matche s any othe r claim li ne within the invoic e or withi n another invoice ba sed on uni que combin ation of , | ||
648 | · Unique Ide ntifier,qu estions no t answered ???? Fake ?, | ||
649 | · Provider I d ,provide r ID ,ICN, PCN, Key, | ||
650 | · Patient Id ,Patient ID, | ||
651 | · Service Da te From , | ||
652 | · Service Da te To (opt ional) ,ma ybe for in stitutiona l,not nece ssary the same batch ?, | ||
653 | · Place Of S ervice ,th e dup clai m might sh ow up in a nother bat ch few day s later, | ||
654 | · Procedure Code , | ||
655 | · Procedure Modifier(s ) (optiona l) , | ||
656 | · Billed Amo unt, | ||
657 | AND the ma tching cla im line is not annot ated as pr eviously r ejected or declined, Decision i s approved , | ||
658 | AND the ma tching cla im line is annotated as PAID,N ext sprint will have our paid column, | ||
659 | THEN annot ate the cl aim line r ecord as d enied with the appro priate CAR C/RARC rea son,Next s print will have our paid colum n, | ||
660 | collect da ta for typ es, claim claim line s, 1 to 3 patients with dup l ines, , | ||
661 | select * f rom claim , | ||
662 | patient ID ,no modifi cation, | ||
663 | patient ID = claim t hen plug j oins, | ||
664 | Run rule w ith this d ata ==== > no dups, | ||
665 | then 2nd t est modify some tabl e to creat e dups add 3 line wi th all the same,with mods, | ||
666 | run again ===> dups, | ||
667 | use provid er ID ,, | ||
668 | use other. .., | ||
669 | run first script wit h meaningf ul etl_bat ch_id,see data 1 and data 2 sh eets, | ||
670 | then run s econd scri pt with th e same etl _batch_id, | ||
671 | The first script sho uld give y ou list of claims to be tested ; the seco nd script should giv e you list of claims to be mat ched., | ||
672 | |||
673 | 5 duplicat ed as exis ting data and modifi ed - - --> gave a new batch id for t he test, | ||
674 | assuming t he new bat ch ID it w ill try to run it n ew batch AA_2017102 4_A, | ||
675 | then when unit test can run ma nually -- -> then ru nning with all rules enabled a re picking up, | ||
676 | duplicate try to fin d a matchi ng line if it does n ot catch a match, | ||
677 | |||
678 | |||
679 | |||
680 | SHEET: Res ubmission of claims | ||
681 | |||
682 | |||
683 | Test Case# ,166109, | ||
684 | TS4 - Resu bmit Claim - Dental , | ||
685 | Step numbe r,Descript ion,Expect ed results , | ||
686 | 1,Select a new batch file and select cla ims with c laim lines lines ,Cl aims and c laim lines are liste d, | ||
687 | 2,Identify claims th at are REJ ECTED by r unning DEC ISION tabl e query, | ||
688 | ,select * from DECIS ION | ||
689 | where deci sion = 'RE JECTED', | ||
690 | 3,Select a duplicate claims wi th matchin g claim li nes that a re not rej ected nor declined a nd that ar e annotate d as PAID, Claims and matching claim line s are sele cted, | ||
691 | 4,List all claims an d their ma tching cla im lines,C laims and claim line s are list ed, | ||
692 | 5,Run the duplicate rule job,J ob ran and completed , | ||
693 | 6,Query th e Validati on Decisio n table an d locate t he duplica tes claims and claim lines sel ected abov e,Claims a nd claim l ines selec ted above are locate d and sele cted, | ||
694 | 7,Verify t hat claim lines that are previ ously reim bursed by VA are DE NIED,Claim lines tha t are prev iously rei mbursed by VA are DE NIED, | ||
695 | 8,Verify t hat duplic ates lines items are annotated as DENIED | ||
696 | ,Claim lin es are ann otated as DENIED , | ||
697 | 9,Verify t hat claim lines that are dupli cates incl ude a reas on for den ial from a standard list (CARC /RARC),Dup licates in clude a re ason for d enial from a standar d list (CA RC/RARC), | ||
698 | 10,Verify that if ma tching rel ated claim line(s) h as been pa id and sho ws an allo wed amount > $0, the n the clai m will be flagged as a duplica te ,W hen matchi ng related claim lin e(s) has b een paid a nd shows a n allowed amount > $ 0, then th e claim wi ll be flag ged as a d uplicate, | ||
699 | 11,Verify that when there is m ore than o ne claim m odifier an d all modi fiers matc h, it wil l be flagg ed as a du plicate ,W hen there is more th an one cla im modifie r and all modifiers match, it will be f lagged as a duplicat e , | ||
700 | 12,Verify that when the matchi ng related claim lin e(s) has a Claim Sta tus which is NOT in {'Rejected ', 'Denied '} is /are flagged a s duplicat e,Claims l ine are fl agged as D uplicate(s ), | ||
701 | 13,Verify that if th e matching claim lin es are not part of t he same cl aim, it w ill be fla gged as a duplicate ,when clai m lines ar e not part of the sa me claim, it is flag ged as dup licate, | ||
702 | 14,When bo th the mat ching rela ted claim line(s) an d the clai m line(s) show a pre vious Pay Flag set t o 'Yes' ,P ay Flag is set to 'Y es', | ||
703 | |||
704 | Test Case # Test Scripts# 155823 Story Requ irement, | ||
705 | |||
706 | |||
707 | |||
708 | |||
709 | |||
710 | |||
711 | |||
712 | |||
713 | |||
714 | |||
715 | |||
716 | |||
717 | |||
718 | |||
719 | |||
720 | |||
721 | |||
722 | |||
723 | |||
724 | |||
725 | |||
726 | |||
727 | |||
728 | |||
729 | |||
730 | |||
731 | |||
732 | |||
733 | |||
734 | |||
735 | |||
736 | |||
737 | |||
738 | |||
739 | |||
740 | |||
741 | |||
742 | |||
743 | |||
744 | |||
745 | |||
746 | |||
747 | |||
748 | |||
749 | |||
750 | |||
751 | |||
752 | |||
753 | |||
754 | |||
755 | |||
756 | |||
757 | |||
758 | |||
759 | |||
760 | |||
761 | |||
762 | |||
763 | |||
764 | |||
765 | |||
766 | |||
767 | |||
768 | |||
769 | |||
770 | |||
771 | |||
772 | |||
773 | |||
774 | |||
775 | |||
776 | |||
777 | |||
778 | |||
779 | |||
780 | |||
781 | |||
782 | |||
783 | |||
784 | |||
785 | |||
786 | |||
787 | |||
788 | |||
789 | |||
790 | |||
791 | |||
792 | |||
793 | |||
794 | |||
795 | |||
796 | |||
797 | |||
798 | |||
799 | |||
800 | |||
801 | |||
802 | |||
803 | |||
804 | |||
805 | |||
806 | |||
807 | |||
808 | |||
809 | |||
810 | |||
811 | |||
812 | |||
813 | |||
814 | |||
815 | |||
816 | |||
817 | SHEET: DU P data 1 | ||
818 | |||
819 | |||
820 | |||
821 | |||
822 | |||
823 | |||
824 | |||
825 | |||
826 | |||
827 | |||
828 | |||
829 | |||
830 | |||
831 | |||
832 | |||
833 | |||
834 | |||
835 | |||
836 | |||
837 | |||
838 | |||
839 | |||
840 | |||
841 | |||
842 | |||
843 | |||
844 | |||
845 | |||
846 | |||
847 | |||
848 | |||
849 | |||
850 | |||
851 | |||
852 | |||
853 | |||
854 | |||
855 | |||
856 | |||
857 | |||
858 | |||
859 | |||
860 | |||
861 | |||
862 | |||
863 | |||
864 | |||
865 | |||
866 | |||
867 | |||
868 | |||
869 | SHEET: DUP data 2 | ||
870 | |||
871 | |||
872 | SHEET: Tes t Data | ||
873 | |||
874 | Profession al Claims no claim l ine,Profes sional wit h claim li nes,Profes sional wit h bad clai m lines,In stitutiona l Inpatien t,Institut ional Outp atient,Ins titutional Claim lin es,Pharmac y,Dental, | ||
875 | Claim # | Claim key ,Claim # | Claim ke y,Claim # | Cla im key,Cla im # | Claim key, Claim # | Claim key, Claim # | Claim key, Claim # | Claim key ,Claim # | Claim key, | ||
876 | |||
877 | |||
878 | |||
879 | |||
880 | |||
881 | |||
882 | |||
883 | |||
884 | |||
885 | |||
886 | |||
887 | |||
888 | |||
889 | |||
890 | |||
891 | |||
892 | |||
893 | |||
894 | |||
895 | |||
Araxis Merge (but not the data content of this report) is Copyright © 1993-2016 Araxis Ltd (www.araxis.com). All rights reserved.