Qualitest Conducts ICD-10 Testing for National Healthcare Payer

Client Overview

The client is a large, well-known national healthcare insurance company. This healthcare payer serves millions of members with both, Healthcare Maintenance Organization (HMO) and Point of Service (POS) offerings. Faced with the challenge of thoroughly testing its core in-house claims management systems which it uses for claims processing, member enrolment, and billing to assure proper support for the impending ICD-10 cutover, the client realized it needed to seek software testing expertise from outside the company.

Business Needs and Objectives

There is general agreement that the upcoming CMS dictated conversion from ICD-9 to ICD-10 could have a dramatic, if not existential, effect on healthcare payers and Providers. With approximately five times as many CM and PCS codes in ICD-10 versus ICD-9, the amount of testing required to substantiate support of the new standard is daunting. Since a failure to handle the new ICD-10 codes across all systems in the billing process could cause an immediate freeze on the ability to collect payments, the stakes couldn’t be much higher.

To be sure the testing is done correctly, specialized knowledge of Healthcare IT systems and government regulations such as HIPAA are required along with advanced software testing skills. Very few healthcare payers have this type of software QA expertise in-house. In addition, the number of independent software testing organizations that can effectively perform ICD-10 testing is limited. Even large health insurers such as the client, who have extensive internal software QA capabilities, have been looking outside for specialized ICD-10 testing capabilities. Thus, the selection of a proper test partner became a top priority for the client.

The Qualitest Solution

Fortunately, the client had prior experience utilizing an external partner for a related software testing projects. When the client was seeking a testing partner to verify the functionality of its HIPAA 4010 to 5010 EDI upgrade in 2010, it selected Qualitest. At that time the client had received a recommendation from one of its provider partners. It then did a thorough analysis of the Healthcare IT projects completed by Qualitest before awarding the company the testing contract. A Qualitest team worked on the effort completing both internal and external testing in less than a year. That effort included manual testing, performance testing, test automation and security testing.

Less than a year later, the client decided to engage Qualitest to conduct its ICD-10 testing as well. By then Qualitest had already begun ICD-10 testing projects for other Payers and Providers. The test lead who had worked on the client’s 4010/5010 tests was made available to serve as the lead on the client’s ICD-10 project. After the development of an ICD-10 Master Test Plan, the Lead established a team which included varying experience levels to work on site at the client’s offices. The Test Lead met with the client’s QA management weekly for status meetings. A QualiTest Senior Test Specialist, working from a Qualitest Test Center, provided free ongoing technical support to the onsite team.

The Qualitest ICD-10 team completed testing in the 2^nd Quarter of 2013. The team focused on testing the client’s various systems individually before shifting to Interoperability and Integration Testing. Next, Production Testing and Live Claims Testing were performed to demonstrate that the client’s systems were ready to go live. With Qualitest’s QA professionals at work, the client is confident its core claims systems will be ready to support the new ICD-10 codes when it is time to cutover.