Certification Test Program and Annual Recertification Activities For CMS Trading Partners
Certification Test Program and Annual Recertification is initiated by CMS and is comprised of the following: use cases, test cases, and associated test data files to verify that each A/B MACs, DME MACs, or other contractors if designated by CMS is ready to receive and process current transactions as well as other CMS required EDI enhancements. A/B MACs, CEDI or other contractors if designated by CMS will perform certification testing using the CTP and produce reports based on the test results. For each use/test case the actual result must be the same as the expected results and must match the associated transactions. Certification results, reports, and files will be retained by the A/B MACs, CEDI or other contractors if designated by CMS for audit ability in the future. As changes are made in to the ASC X12 Version 5010 and D.0 transactions, the CTP will be updated and utilized during recertification. The CMS will provide detailed instructions to the A/B MACs, CEDI or other contractors if designated by CMS to be used to perform the certification testing. These instructions will be revised as needed and communicated to the A/B MACs, CEDI, or other contractors if designated by CMS.
In developing the CTP the use case represents the type of response expected by each of the test cases within the use case. Following the ASC X12 Version 5010 and D.0 Edit Spreadsheets as a guide, a use case for each loop transaction was developed. There are multiple test cases for each use case. In most cases, each loop has at least one “accept” (in process/flat file mapping) use case and at least one “reject” use case. The “reject loop” use case contains only one test case for the rejection or first negative test of the entire loop.
Depending on the edit type, additional use cases were necessary. For example, each loop will have one ASC X12 999 implementation acknowledgement use case with multiple test cases, one accepted (“A”) use case for “good clean” claims in process, flat file mapping, and may have one ASC X12 277CA claim acknowledgement use case with multiple test cases. It may be necessary to have more than one data file per use case if there are elements which will result in a structural error by the translator. In those cases, there are multiple data files per use case. For NCPDP, each segment has one “accept (in process/flat file mapping)” use case, one “reject” use case, and one flat file mapping use case.