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Software Testing Procedures |
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The Health Insurance Portability and Accountability Act (HIPAA) requires
that all healthcare organizations exchanging HIPAA transaction data electronically with the
IHCP establish an Electronic Data Interchange (EDI) relationship. All entities requesting
to exchange data with the IHCP must be tested approved by the IHCP before production transmission begins.
Vendors must review the X12N transaction HIPAA implementation guides and the IHCP Companion Guides to
carefully assess the changes needed to both their business and technical operations to meet
the requirements of HIPAA. The national X12N transaction HIPAA implementation guides are
available on the Washington Publishing Company site at
www.wpc-edi.com.
The IHCP Companion Guides link takes
you to the current production versions of the guides, and the
IHCP Pre-Release Companion Guides
contains future system updates to the guides. For information on future system enhancements view
What's New for EDI Vendors.
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The following steps describe the testing process for EDI vendors who have not yet been
approved by the IHCP.
1. Complete the Trading Partner Profile
The IHCP requires each testing entity exchanging data directly with the IHCP complete and submit
the
IHCP Trading Partner Profile to initiate the testing process. The IHCP Trading Partner
Profile is the tool the vendor must use to notify the IHCP about the types of transactions they
will test and the method of communication that they will use. Upon IHCP receipt of the
profile form, testing information is sent to the vendor. Follow the instructions received
in the testing information to ensure accuracy and completeness of testing.
2. Conduct application development
The vendor must modify their business application systems to comply with the IHCP
Companion Guides. The accuracy of the vendor's system must be tested to ensure all
transactions process correctly. The vendor must determine the modifications and
additions that are needed to their technical infrastructure to perform the communication
functions.
3. Test each transaction
Connectivity testing performed with the transmissions ensures a successful connection between
the sender and receiver of data.
Three levels of data testing are required:
a. Compliance Testing
b. IHCP Specification Validation Testing
c. End-to-End Testing
Compliance Testing:
All transactions must pass data integrity, requirements, balancing, and situational compliance
testing. Although third-party HIPAA certification is not required, the above levels of
compliance are required and must be tested. Compliance is accomplished when the transaction
is processed without errors and either the response transaction or a 997 Acknowledgement is
produced.
The software used by the IHCP for compliance checking and the translation of the HIPAA
transaction is Sybase with the HIPAA Accelerator, also known as HIPAA Toolkit.
Sybase Translator Information identifies the Sybase product version, as well as
information related to known issues, corrections and common compliance errors detected by
this product.
IHCP Specification Validation Testing:
Specification validation testing ensures conformity to the IHCP Companion Guides.
This testing ensures that the segments or records that differ based on certain healthcare
services, are properly created and produced in the transaction data formats. Validation
testing is unique to specific relationships between entities and includes testing of field
lengths, output, security, load/capacity/volume, and external code sets.
End-to-End Testing:
End-to-end testing ensures a successful round-trip completion of the transmission.
It originates from the sender as an inbound transaction, proceeds through system processing
and ends with a successful outbound transaction back to the sender. For example, for vendors
set up to test both the 837 and 835 transactions, this level tests processing the inbound
837-Claims and Encounters transactions and follows through to create an outbound
835-Remittance Advice transaction.
4. Become an IHCP-approved software vendor
The testing and approval process differs slightly for software developers, billing services,
clearinghouses, and VANs. The processes are described in the following subsections.
Software Developers:
Entities whose clients will be submitting directly to the IHCP are not required to become
IHCP trading partners. Upon completion of testing and approval, the IHCP sends written
notification of approval to the software developer. Upon receipt of this approval,
the software developer should submit a list of their IHCP clients and inform their clients that
their software has been approved. However, providers are required to complete the
procedures outlined in
Provider EDI Implementation Procedures to get production submission information.
Billing Services, Clearinghouses, VANs, and Managed Care Organizations:
Upon completion of testing and approval, a written production approval notification is sent
to the vendor. These entities are required to submit a list of IHCP providers for
internal system set up of any outbound transactions.
Billing services, clearinghouses, VANs, and managed care organizations must submit a signed
IHCP Trading Partner Agreement. The trading partner agreement is a contract
between parties who have chosen to become electronic business partners. This document
stipulates the general terms and conditions under which the partners agree to exchange
information electronically. The signed trading partner agreement must be mailed to the
following address:
EDS
Trading Partner Agreement
950 North Meridian Street
10th Floor
Indianapolis, IN 46204
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