Software Testing Procedures
The Health Insurance Portability and Accountability Act (HIPAA)
requires that all healthcare organizations that exchange HIPAA
transaction data electronically with the Indiana Health Coverage
Programs (IHCP) establish an electronic data interchange (EDI)
relationship. All entities requesting to exchange data with
the IHCP must be tested and approved by the IHCP before production
Vendors must review the X12N transaction HIPAA implementation
guides and the IHCP Companion Guides to carefully assess
the changes needed to their businesses 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 wpc-edi.com.
The IHCP Companion Guides link
takes you to the current production versions of the guides, and the
Upcoming Companion Guide Changes contains future
system updates to the guides. For information on future system
enhancements, view What's New for EDI
The following steps describe the testing process for EDI vendors
that 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 to 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 they will use. When the IHCP receives 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 its business application systems to
comply with the IHCP Companion Guides.
The accuracy of the vendor's system must be tested to ensure that
all transactions process correctly. The vendor must determine
what modifications and additions its technical infrastructure
needs 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.
Two levels of data testing are required:
- Compliance testing
- IHCP specification validation testing
All transactions must pass data integrity, requirements,
balancing, and situational compliance testing. Although
third-party HIPAA certification is not required, the preceding
levels of compliance are required and must be
tested. Compliance is accomplished when the transaction is
processed without errors and the response transaction or a 999
Acknowledgement is produced.
The software used by the IHCP for compliance checking and the
translation of the HIPAA transaction is Edifecs.
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 field
lengths, output, security, load/capacity/volume, and external code
4. Become an IHCP-approved software vendor
The testing and approval process differs slightly for software
developers, billing services, and clearinghouses. The
processes are described in the following subsections.
Entities whose clients will be submitting directly to the IHCP
are not required to become IHCP trading partners. When testing and
approval are complete, the IHCP sends written notification of
approval to the software developer. On receipt of this approval,
the software developer should submit a list of its IHCP clients and
inform its clients that its software has been
approved. However, providers are required to complete the
procedures outlined in Trading Partner
Registration Procedure to get production submission
Billing Services, Clearinghouses, and Managed Care
At 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
setup of any outbound transactions.
Billing services, clearinghouses, and managed care entities
(MCEs) must submit a signed IHCP Trading
Partner Agreement. The trading partner agreement is a
contract between parties that 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 emailed to INXIXTradingPartner@hpe.com
or faxed to (317) 488-5185.