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Healthcare Testing as a Service
In the rapidly evolving healthcare industry, ensuring the accuracy and compliance of systems related to benefits, enrollment, and claims processing is critical. At RelQ Technologies, our Healthcare Testing as a Service is specifically designed to support health plans, providers, and administrators with robust testing solutions that ensure operational efficiency and regulatory compliance. We focus on three critical areas:
Our Benefit Testing ensures that healthcare plans and benefit packages are implemented accurately and align with the designated plan year. We test the full lifecycle of benefits, including:
- Benefit Configuration Validation: Ensuring that new and updated benefits are configured correctly in the system and correspond to plan documents and regulatory requirements.
- Member Eligibility and Coverage Testing: Verifying that members are enrolled in the correct benefit plans and that coverage levels and limitations are applied as expected.
- End-to-End Benefit Processing: Testing the impact of benefits on claims processing, out-of-pocket costs, and coordination with other healthcare services.
- Compliance Assurance: Ensuring all benefits comply with healthcare regulations and standards, such as HIPAA and ACA guidelines.
Enrollment accuracy is essential for proper member management. Our Enrollment Testing services validate the integrity and accuracy of 834 transactions, focusing on:
- 834 File Validation: Ensuring that enrollment data, including member details and coverage information, is transferred correctly between systems.
- Enrollment Modifications: Testing the system’s ability to process enrollment changes, including member updates, terminations, and reinstatements.
- Plan Year Transitions: Validating that enrollment data is accurately carried over during plan year transitions, ensuring that members are enrolled in the appropriate plans and benefits for the new period.
- Error Handling: Identifying and mitigating errors during the enrollment process, such as missing data or misrouted files, to prevent issues in downstream processes.
Our Claims 837 Testing ensures the accuracy and integrity of healthcare claims, verifying that claims are correctly formatted and processed. We provide:
- 837 File Validation: Testing the accuracy and structure of 837 claims files, ensuring compliance with EDI standards.
- Claim Adjudication Testing: Verifying the accurate processing of claims, ensuring that payment amounts, deductibles, co-pays, and reimbursements are calculated correctly.
- Integration Testing: Ensuring seamless integration between claims processing systems, including coordination with third-party administrators, billing systems, and clearinghouses.
- Compliance with Payer Requirements: Validating that claims meet the specific requirements of healthcare payers, reducing the likelihood of claim rejections and delays in payment.
RELQ Test Hub – Data Creation Tool
The RELQ Test Hub – Data Creation Tool is an advanced solution designed to streamline healthcare data creation and testing processes. This tool focuses on generating membership and claims data by modifying existing 834 files and applying new benefits for the upcoming plan year. It ensures the accuracy of enrollment and claims data across healthcare systems.
Key features of the RELQ Test Hub – Data Creation Tool include:
- 834 File Modification: The tool allows for easy modification of existing 834 enrollment files from production, applying new benefits, updating member information, and reflecting changes planned for the new plan year. This ensures that all membership data is accurate and aligned with the latest benefit configurations.
- Benefits Application: As part of the plan year transition, the tool automatically applies benefits that are scheduled for the upcoming year, ensuring that all member records are updated with the correct coverage information and benefit packages.
- Service Testing: The tool provides robust testing for a wide range of services related to member benefits, enrollment, and claims. It validates that each service accurately reflects the updated membership and benefits, ensuring a smooth transition during plan changes.
- 837 Claims Generation: The tool automatically creates 837 claims files for the corresponding members, enabling comprehensive testing of the claims portion. This ensures that all claims are accurately processed according to the new benefits, helping identify potential issues before going live.
- Efficient Testing and Automation: By automating the creation and testing of membership and claims data, RELQ Test Hub – Data Creation Tool significantly reduces manual effort and accelerates testing timelines, ensuring data accuracy and compliance with healthcare standards.