Trading partner testing during 4010-5010 upgradeCase Study

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Hexaware Approach• Used Hexaware 5010 Impact analysis to identify test cases and scenarios.• Charted out detailed strategy to test and certify both in-house and vendor upgraded

claim systems for 5010 compliance.• Used up-coded 4010 files and program generated test scenarios to simulate and test

out real-world 4010 and 5010 claims, enrolment and payout scenarios.• Setup an onsite trading partner co-ordination cell for efficient and smooth transition of

client’s customers to the HIPAA 5010 standard.• Used near-shore (Mexico) resources to optimize cost of trading partner co-ordination in

US business hours.

The Challenge• Core claim systems handling > 70 % of business were to be upgraded and tested for

HIPAA 5010 compliance.• 6 other claim systems upgraded by vendors had to be tested for 5010 compliance.• 500 EDI files were to be verified in co-ordination with trading partners. • File types in scope were 837P-I-D Claims, 834 Enrollment and Maintenance, 271/272

Eligibility inquiry, 276/277 Claim status inquiry response. • 300 Trading partner interfaces had to be tested & certified for 5010 compliance.

Technology EnvironmentTools used • Hexaware proprietary tools for EDI HIPAA 5010 impact analysis. • Data generation tools to up-code 4010 files to 5010 standard.

Testing approach: Manual Testing using auto-generated test files for • EDI validation • XML validation • Data comparison • Application data validation

Client Benefits• 30 % savings on cost of QA validation

for 5010 compliance because of usage of automated test data generation tools

• 25 % saving on cost of trading partner interaction and compliance certification because of usage of near-shore and offshore resources

• Long term savings on QA effort because of development of reusable testing components.

Hexaware Trading partner QA co-ordination cell streamlines testing and transition to HIPAA 5010standard for a large independent provider of services for self-funded health plans in North America.Client OverviewLarge independent provider of services for self-funded health plans in North America.

Case Study Trading partner testing during 4010-5010 upgrade

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About HexawareHexaware is a leading global provider of IT and BPO services. The company has achieved leadership position in domains such as Banking, Financial Services, Insurance, Transportation, Logistics and HR-IT solutions. Hexaware focuses on delivering business results leveraging technology solutions and specializes in Business Intelligence & Analytics, Enterprise Applications, Independent Testing and Legacy Modernization. Hexaware has been providing business technology solutions for over 21 years and offers world class service delivery, technology leadership and skilled human capital.