Claims Testing

Claims Testing With UHA Trading Partners

Claims testing is a necessary period after an agreement has been reached between the provider and UHA with regard to the submission of claims via EDI. The purpose of the testing is to ensure that the data being generated by the provider’s data processing system meets the technical requirements as specified in the National Implementation Guides and the Supplemental Implementation Guides, and also to work out the procedural aspects of data transfer.

UHA recommends that the provider go to a national certification organization and get certified in levels 1 – 6 before requesting a test with UHA.

In order to accomplish the testing, the provider will be asked to supply a minimum of three (3) tests which will be reviewed for format and content by UHA. A test is comprised of claims which are submitted on both EMC and hard copy media. All test materials (hard copy claims) must be packaged separately from any other materials being mailed/delivered to UHA and each must be clearly marked “TEST.” Test data sets must not reside on the same physical file as production data sets.

Depending on the quality of the test data and/or any problems which may arise, additional tests may be requested. Frequent coordination between the provider and UHA will be necessary during this period to ensure rapid resolution of problems. A provider’s data set will be considered successfully tested when three (3) consecutive data sets are processed without problems or complications. At the successful conclusion of the testing period, the regularly scheduled submission of claims via EDI will begin.

To learn more about HIPAA EDI clims testing and become a certified  EDI Professional please visit our course schedule page.

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