Pega Smart Claims Engine for Healthcare is packaged with a series of testing tools to support the testing and validation of features. There are three parts to the testing suite:
- Test claims - The test claims tools provide the capability to create a professional, institutional, or dental test claim for submission and processing within the system.
- Test scenarios - The test scenarios tools provide the capability to create and validate that a specific business scenario has been met by the test claim. The scenario could be to validate an event code, an allowed amount, a benefit matched or one of the other key attributes that are used. The test scenario will be tagged as a successful run or a failure depending upon the status of the attribute(s) being validated. Multiple claims can be added to a scenario to test for more complex or multi-claim situations.
- Test sets - The test sets tools provide the ability to link multiple scenarios together to run them sequentially to support regression testing or bulk testing of scenarios. The number of successful scenarios is reported after the test set has completed executing.