Successful Digital Transformation at Major Health Insurer Enabled by Synthetic Data.
by admin on Nov 09, 2022GenRocket Generates X12 EDI 837 Data for Extensive Claims Processing Testing.
Health insurance systems testing poses unique challenges. Yet without accurate systems, insurers run the risk of overcharges and revenue leakage for health payers and delayed payments to providers. In fact, the health insurance industry estimated that up to 80% of submitted claims having errors resulting from human error or deliberate fraud.
When one of the United States’ largest private health insurance companies began their digital transformation, the company began migrating from a monolithic in-house claims processing system to a modern, distributed system. The goal was to improve speed, accuracy, efficiency, and security.
The company decided to undertake a major in-house software development effort to achieve all these goals with advanced development tools, a fully automated software test environment and GenRocket’s Synthetic Test Data Automation platform.
Protected Health Information
It was mandated that no Protected Health Information (PHI) would be used in any phase of the software development and testing process. As a result, a comprehensive synthetic test data solution became a critical component of this software migration initiative.
Requirements
To accurately simulate the many types of data exchanged during a claims processing workflow, the GenRocket platform was deployed to generate synthetic transaction data in the X12 EDI format to deliver 100% HIPAA compliant test data.
The GenRocket platform supports both the current X12 EDI 837 standard (5010) and the next generation (8020) that covers expanded transaction sets for wearable medical devices and IoMT technologies.
A typical claims data feed contains a complex assortment of data for many subscribers having many types of treatments rendered by multiple providers.
Such feeds needed to be tested under various conditions to ensure they function properly.
The GenRocket Solution
In our latest case study learn how a major health insurance carrier deployed a Synthetic Test Data Automation framework to ensure the quality of new claims processing systems and accelerate the entire testing lifecycle.