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Jun 2 2011   8:00AM GMT

HIPAA 5010 testing: Benefits of a rules based testing approach

Posted by: Jenny Laurello
5010 conversion, HIPAA, HIPAA 5010

Guest post by: Baskar Mohan, Director, Healthcare Practice, Virtusa Corporation

A crucial requirement for the successful implementation of HIPAA 5010 is the testing of systems, applications and processes. As mentioned in my previous blog post, testing also encompasses systems and other transactional artifacts of the payer company’s partners.

To be successful, payers and providers need to select the right testing approach and methodology since much of the complexity lies in this area. One of the testing approaches that can be adopted is rules based testing, as it offers many benefits.

Payers and providers are moving toward rules based testing as it provides more robust test case repository and quality coverage on the business scenarios.

Below is a list of key benefits achieved using rules based testing for 5010 conversion projects:

1. Test Case Creation – Enables business users who understand the existing process to design test cases with confidence so that the entire processes and sub processes are taken care of. Each of the transactions has its own set of business processes that might change due to additional data collected from 5010.

2. Test Data Creation – Creation of 5010 test data from existing 4010 test data can be achieved through rules based mapping, which is easier to build and maintain. It gives the power to business users to complete the circle by having them create data matching the test scenarios they built in the first place.

3. Test Validation Automation – Regression testing is a key element in 5010 testing and much of the manual effort spent in data validation can be automated using a rules based engine.

4. Re-use of Business Flow Diagrams – Mapping of “as-is” and “to-be” flows completed during the requirements and design phase can be used during the testing phase to prioritize test cases and help identify data flow of 4010 vs. 5010. These rules can be further re-used during ICD-10 testing as well.

Above are some of the key benefits that we have achieved with our clients. Have you begun to use any BPM tools for testing? If so, what has been your experience?

Please visit or email Mr. Mohan directly for more information.

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