Software Testing Procedures
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 Upcoming
Companion Guide Changes contains future system updates to the
guides. For information on future system enhancements view What's
New for EDI Vendors.
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 Trading Partner
Registration Procedure to get production submission
information.
Billing Services, Clearinghouses, VANs, and Managed Care
Entities
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
entities 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:
HP Enterprise Services
Trading Partner Agreement
950 North Meridian Street
10th Floor
Indianapolis, IN 46204