Testing for Payers

Payers can drive administrative efficiency, optimize the cost and quality of care and meet regulatory needs by utilizing end-to-end testing, automated test frameworks and robust commercial / open-source solution accelerators that are readily customizable.

Payers today are looking for partners with the right testing methods to help them improve service quality, drive down costs and meet stringent regulatory demands, whether it is testing for ICD-10 conversion, HIX/HIE connectors, products and package testing, group renewals or software releases.

In testing, the right tool and methodology can make all the difference. Dell’s flexible and open testing solution can help Payers meet their challenging and complex needs. We can also provide commercial/open-source tool-based automation frameworks, embedded business analysts within testing teams, robust solution accelerators, and flexible delivery models. Partnering with us, Payers can benefit from an array of testing capabilities including business testing, end-to-end testing, non-functional testing, test automation and frameworks/accelerators.

What we offer

• Members and Groups

• Provider Management

• Benefits — Products/Plan

• Capitation

• Accounts payable

• Referrals / Authorizations

• Pricing

• Claims Adjudication

• Premium Billing

• Customer Management

Payer Landscape

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100+ Health Plans

45+ Million members

Solution that leads to

substantial cost saving in

strategic initiatives

ICD-10 transition

Healthcare reform

compliance

Legacy modernization

Implementation of

industry standard

healthcare products and

applications

Business process services

Federal and State

mandates

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Payer Functions

Payer Functions

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Members and Groups

Provider Management

Benefits - Products / Plan

Capitation

Accounts payable

Referrals / Authorizations

Pricing

Claims Adjudication

Premium Billing

Customer Management

� Functional Testing

Regression

Automation

Regulatory

compliance

Integration

UAT

Production readiness

BI/DW, etc.

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� Non- Functional Testing

Performance (load/

stress/volume/

endurance)

Security

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Payer Services

Content

Management

Business

Intelligence

Risk

Management

Transaction

Management

Member

ServicesEnrollment

Provider

Credential-

ingEligibility

Repricing

TransactionsAdjudicationSettlementEOB/EOP

Presentment

Hosting and Workflow

Cla

ims

Ad

min

istra

tion

Benefits to PayersSome Payers have gained up to 30% cost savings on their test programs and gained 10% year-on-year productivity by using Dell’s testing services Dell’s testing services brings the following benefits to Payers:

• Fastergo-to-market with solution accelerators and flexible solutions

• Higherefficiencyandproductivity with automated regression testing, open-source tool architecture (reduced cost of licenses) and flexibility to address changing customer needs

• Betterproductivity with tool-automation and robust frameworks that give 100% accuracy

• Highervalue with several innovative practices and domain expertise with proven track record in Payer segment engagements. Maturedelivery with P3M methodology for consistent portfolio, program and project management and benchmarked against industry standards like TPI, TMM and TMap

• Highlyskilledresources: Testing professionals that are skilled in processes, methodologies, and automated testing tools, along with functional expertise in Payer segment

• Flexibledeliverymodels with complete visibility of the engagement to the customer

• Globaldeliveryfootprint to bring optimized cost and utilization as per customer budget

Testing services for HPHC

• Complete SOA test automation framework and test management

• Regression, functional, system integration and non-functional testing of SOA–based claim processing system

• Product testing of Oracle Health Insurance (OHI) including functional aspects of claims testing, benefits configuration, product configuration, accumulator management system and third-party interfaces

BenefitstoHPHC

• Savings due to usage of an open source tool (soapUI) to create a robust SOA test automation framework

• Robust test reporting by integrating QC & QTP tools, with the soapUI framework

• Bulk data load scripts for loading base and seed data for claims processing

• Automated test case generator for requirement and test cases to be uploaded in QC

Testing services for HPHC

Core testing expertise Benefits

ICD-10 / HIPAA 5010 testing

• iSimpli5 is a comprehensive testing program for ICD-10

• Gives overallefficiency, productivity at lower cost

• Ensures failsafecode-mapping between ICD-9 and ICD-10

• FunctionalTestScriptframeworkForwardandbackwardmapping, using soapUI web service tool for crosswalk application to extract converted codes

• Ensure 100%coverage of test scenarios

Xcelys / iKA product testing

• Completelifecyclesupport — test plans, test design, test execution, defect reporting and validation for Xcelys

• HomegrownUTAFautomationframework being implemented to reducecostoflicenses

• Testingacrossfunctionalities — membership & billing, benefits, claims, provider and vendor contracting, authorization, finance, EDI, customer management and HIPAA transactions (e.g. 837, 834, 820, 835, etc.)

• Alliance with ikaSystems lends high level of operationalefficiency at lowercostfor product testing

• HIPAAcompliant, validates inter-connectivity between health plans and all constituents

• Ensures total security of medical information

Facets-Trizetto testing • Comprehensivetestlibrary containing an array of designed test suites for Trizetto and similar systems

• Reducestime,effort and cost for test creation

Oracle Health Insurance (OHI) testing

• Fastergo-to-market with tool-based test automation

• Robusttestautomationframeworks with SOA architecture

• Complete functional and non-functional testing of OHI

Package Testing • Functionalandnon-functional integrated testing for industry standard packages - Oracle, Lawson, SAP, etc.

• Robustandadvancedframework including processes, methodologies and accelerators

• Optimizes testing service delivery for package applications

Solution accelerators and benefits

UniversalTestAutomationFramework(UTAF)• Uses simple English keywords for test

automation scripting

• Allows manual testers and business analysts to create automation test scripts

• Cost reduced by 40-50% because licenses are required only during test execution

• Tool independent automation framework; supports QTP, RFT, Selenium and VSTS

VSTSKeywordDrivenFramework• Reduces set-up time to automate by 60%

• Reduces gap between domain experts and technology

• Decreases TCO (licenses and resources)

• Codeless automation framework

IntegratenonHPTestingToolwithHPQualityCenter

• Integrates Quality Center with external tools

• Uses Quality Center as the single source of test repository

• Execute the soapUI web services automated scripts from Quality Center, thus obtaining Pass/Fail results there in

OpenSourcePerformanceTestingFramework• Aligns with performance testing life cycle

• End-to-end test performance test solution

• No cost for performance testing of web-based applications

• Reduced license-fees

• Higher Productivity

• Better Efficiency

• Superior quality

• Faster go-t-market

• Broad array of reusable test cases

• Tool-independent automation framework

For more information about any of our service offerings, please contact your Dell representative or visit dell.com/services.

Availability varies by country. © 2011 Dell Inc. All rights reserved.

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