About the Company
Our client is a leading healthcare service provider, part of the Fortune 500. They operate across a wide range of healthcare services, handling complex processes related to Medicare Claims, Membership, Enrollment, and Electronic Data Interchange (EDI). The client required a robust testing strategy to support their high-volume claims processing systems, which serve millions of members and providers.
Business Challenges
The client faced several challenges that necessitated the implementation of a comprehensive testing strategy. These included:
Complexity in Claims Processing
- The need to support multiple lines of business, each with varying claims processing requirements.
High-Volume Transactions
- Processing up to 250,000 claims per hour and managing over 20,000 member transactions per hour.
Regulatory Compliance
- Ensuring adherence to healthcare regulations such as Medicare and Medicaid standards.
EDI Integration
- Seamless integration with EDIFECS for managing claims submissions across trading partners and healthcare providers.
Scalability
- Creating a scalable testing strategy to handle increasing transaction volumes and ensure system performance during peak loads.
Reporting and Notifications
- Generating over 500 reports and 400 letters to providers and members regarding membership, payment status, and enrollment.
Solutions Provided
To address these challenges, Infinite implemented a comprehensive End-to-End Testing Strategy that covered all aspects of the claims processing system. The key components of the solution included:
Requirements Decomposition
- Decomposed 3,454 master requirements into smaller, manageable components, ensuring clarity in the testing objectives.
Agile Approach for Story Creation
- Conducted concept and requirements sessions before development sprints, resulting in the creation of approximately 9,000 detailed user stories.
Story Acceptance Testing
- Performed development and story acceptance testing at the development level, achieving a 90% pass rate.
Automation for Efficiency
- Automated 2,500 test scripts for enhanced speed and accuracy during testing cycles.
Component Acceptance Testing
- Implemented testing at multiple stages, including System Integration Testing (SIT), Operation Readiness Testing (ORT), Performance Testing, and Parallel Testing to ensure system stability and compliance with business needs.
Performance and Scalability Testing
- Created a scalable testing strategy that could process 250,000 claims per hour and handle over 20,000 member transactions per hour.
Key Benefits
The solutions provided resulted in
substantial improvements to the
client’s operations. These benefits
included:
Cost Reduction
- Achieved a 35% reduction in total ownership cost, resulting from optimized processes and improved system performance.
Enhanced UI Performance
- Reduced UI screen response time to under 2 seconds, improving user experience and operational efficiency.
100% Availability with Alerts
- Implemented alert mechanisms to ensure 100% system availability, minimizing downtime and improving service reliability.
Parallel Requirement Sessions
- Conducted 10 parallel sessions per week, completing around 150 stories, ensuring continuous progress and timely delivery.
Defect-Free Story Development
- Developed stories with a 100% defect-free rate, enhancing the reliability and robustness of the application.
Go-Live Readiness
- Ensured rapid operation readiness for Go-Live, preparing the system to handle live transactions without delays or failures.
Conclusion
Through a highly structured and comprehensive testing approach, Infinite helped the client achieve significant operational improvements. The solutions provided ensured that the claims processing system could handle high volumes, meet regulatory requirements, and deliver optimal performance with minimal downtime. The automation and agile practices also contributed to enhanced testing efficiency, reduced costs, and improved customer satisfaction.