YOUR SUCCESS IS OUR FOCUS. Whitepaper. Claim Processing Test Suite. Hexaware Technologies. All rights reserved.

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1 YOUR SUCCESS IS OUR FOCUS Whitepaper Hexaware Technologies. All rights reserved.

2 Table of Contents 1. Introduction 2. Scope Definition 3. Hexaware Approach 4. Solution Proposition 5. Solution Benefits 04 Hexaware Technologies. All rights reserved. 2

3 1. Introduction Medical claims processing is important for healthcare service providers in getting paid for the services that they have provided. However, it is one of the most challenging business processes in the healthcare industry. Poor claims processing, be it due to the long processing time or claims denial, leads to customer dissatisfaction and loss of business. Major challenges for testing of claim processing system: Complex functionality of Insurance Claim System Large volume of claim forms received by the insurance company Dependencies on the SMEs (Subject Matter Experts) Traceability on Functional Coverage Managing the overall testing cost by meeting deadlines and identifying key functional failures at earlier stages 2. Scope Definition Hexaware s Claim processing Test Suite aims at supporting claim system across the globe. Scope of this suite includes Extensive functional test suite with reusable business components Easy customization of existing scenarios using reusable business components from the repository Maximum test coverage and traceability on requirements Reduced test planning and design effort resulting in cost savings End to end business scenarios which would be the core of any claim processing systems 3. Hexaware Approach Hexaware s reduces the overhead of dependencies on SMEs and brings in the concept of reusability. The Claim processing test suite has been created by leveraging Hexaware s vast exposure to insurance company projects, using the power of End to End testing through ready to use test cases. While this solution enables effective manual testing of any Claim system application, it also adds value by providing a jump start to automation process. 4. Solution Proposition The Claim processing Test suite has been specifically developed for Insurance companies. The prime focus of Claim processing Test suite lies in the quality of the system through well defined test scenarios and work flows. The Claim processing test suite introduces the concept of reusable components for test design phase. All the major functionalities in the Claim processing lifecycle are captured as business components and these components are effectively used for creation / modification of end to end scenarios as and when the system changes. Major Functionalities covered in the Claim processing Test Suite Mail Room Claim Identification Claim Sorting Claim Scanning Data Capturing Uploading Scanned Image Claims Capturing Converting Claims Merging Claims Claims Encryption Pre-Adjudication Member Queue validation Provider Queue validation Claim detail Queue validation Sub- doc Queue validation Adjudication Medically Necessary Services and Supplies Deductible Coinsurance Coordination of Benefits Hexaware Technologies. All rights reserved. 3

4 Hexaware s Claims Processing Testing Suite includes: Extensive functional test suite with reusable business components Easy customization of existing scenarios Maximum test coverage and traceability of requirements Reduced test planning and design effort resulting in cost savings Improves test creation efficiency End to end business scenarios which would be the core of any claim processing system Hexaware s claim processing Suite adopts the following methodology for creation of test scenarios for complete coverage. Example: Testing Scenarios Coordination of Benefits Business Areas Mail Room Data Capturing Pre-Adjudication Adjudication Sub-Business Areas Medically Necessary Services and supplies Deductible Coinsurance Coordination of Benefits Test Scenarios Member and his/her spouse are employed Member Age over 65 years Member Age under 65 years with disability Dependent Child 5. Solution Benefits Extensive coverage of functionalities of claim processing reviewed by Industry experts Ready to use generic scenarios which leads to saving time & effort up to 80% Jump start requirement gathering process Achieve higher degree of requirement stability Standardization of core business process Quick identification of Test Scenarios Reusable Business components from the existing Claim processing Test suite repository used for easy customization Hexaware Technologies. All rights reserved. 4

5 Address 1095 Cranbury South River Road, Suite 10, Jamesburg, NJ Main: Fax: Safe Harbor Certain statements on this whitepaper concerning our future growth prospects are forward-looking statements, which involve a number of risks, and uncertainties that could cause actual results to differ materially from those in such forward-looking statements. The risks and uncertainties relating to these statements include, but are not limited to, risks and uncertainties regarding fluctuations in earnings, our ability to manage growth, intense competition in IT services including those factors which may affect our cost advantage, wage increases in India, our ability to attract and retain highly skilled professionals, time and cost overruns on fixed-price, fixed-time frame contracts, client concentration, restrictions on immigration, our ability to manage our international operations, reduced demand for technology in our key focus areas, disruptions in telecommunication networks, our ability to successfully complete and integrate potential acquisitions, liability for damages on our service contracts, the success of the companies in which Hexaware has made strategic investments, withdrawal of governmental fiscal incentives, political instability, legal restrictions on raising capital or acquiring companies outside India, and unauthorized use of our intellectual property and general economic conditions affecting our industry. Hexaware Technologies. All rights reserved.