Roles and Responsibilities

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Providing updates on daily testing activities

Performing smoke test when we get build patches
Performing regression testing during each new build implementation
Validation of defects fixes for every new build in all testing environments
Reporting and entering new defects
Identifying testing scenarios and writing test cases from requirement
documents
7. Attending walkthroughs by developers on new work items and change order
implementation.
8. Attending JAD sessions with business teams, Developers, provider teams and
other stakeholders on requirements analysis
9. Testing portal functionality for claims submission, eligibility verification, batch
upload of 837, 270, 276 files, batch download of 999, 834, 835
10.Testing claims processing of Edi and direct claims submission
11.Preparing EDI 837 files for testing, modifying loops, segments on 837 for
testing purpose
12.Validating different types of claims for pricing methods, edit posting,
member, provider validation, reimbursement rules.
13.Validating 834 files for INS, eligibility segments
14.Scheduling eligibility jobs and pulling 834 files on daily basis
15.Testing member and managed care modules for various scenarios like new
enrollments, disenrollment, transfers
16.Pulling testing summary reports, pending defects and provide them for
manager
Difference b/w 837I and P
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Type of bills in I but no types of bills in P

GS08 version control no I-005010X223A2, P-005010X222A1
Revenue codes are used only in I where as in P, HCPCS are used.
CLM05-02 is A for I, GS05-02 is B for P
Service line segment is SV2 in I and SV1 in P

834 Loops and segments

1000A-Sponsor name (N1)
1000B Payer (N1)
2000A-Member Level Detail
INS-Member Level Detail
REF-Subscriber Identifier
INS03-Maintainance Type Codes
001-Change-A change for an existing subscriber/dependent

021-Addition-To add a subscriber/dependent

024-Cancellation or Termination-For cancellation or termination or deletion of a
subscriber/dependent
025-Reinstatementfor reinstatement of cancelled subscriber
030-Audit-BGN-8 should be 4 or RX- to make sure Sponsor and payer data in sync
2100-Member Name
NM1-Member name
N4-City, state, Zip code
2300-Health coverage
HD-Health coverage
DTP-Health coverage dates
HD Maintenance type codes
001 Change
002 Delete-Deleting an incorrect coverage record
021-Addition
024-Cancellation/termination
025-Reinstatement
026-Correction-To correct an incorrect record

Test Plan during close dead line

Risk analysis
Identify risk factors
Identify critical functionality
Identify the functionality breakage of which might bring entire application down (I
will speak to developers for suggestions)
Identify the functionality covered by new code that is being implemented
Cover functionality most used by end users
Cover testing of critical defects or show stoppers (Will talk to business team for
approval on show stoppers)

999-Acknowledgement
It is generated at the gateway where compliance validation will be done. If the file
passed for compliance, 999A will be produced, if failed, 999R will be produced. 999
will not be generated if the envelopes are wrong.
999A
AK1 and AK2 are about submitted transaction. AK1 has GS/GE control no and
version cntl no, AK2 has ST/SE cntl no and version cntl no of submitted txn
IK501 and AK01 is A
999R
After AK1 and AK2, IK3 and IK4 are present
IK3-Segement, segment position, Loop and error type
IK4-Element position in the segment, data element error code (1-Requ data missing,
2-Conditional data missing, 3-Too many elements) and copy of bad data element