Data Validation & Scenario Testing
The purpose of this article is to provide an explanation of the 834 Carrier Feed testing process as well as to provide a guide for first time users who may be unfamiliar with the different types of testing and general carrier expectations. Please remember, every carrier has different expectations so this is simply meant to provide an overview of those expectations.
The data validation phase consists of 2 parts of testing and will generally be completed at one time. The first part is to validate that required values on the file are populated and that it meets the ANSI specifications. The second part is to confirm that required employee values are present on the file.
Part 1: Generally, a carrier is reviewing the file to confirm that the required values in the Header & Footer have been properly formatted and included on the file as indicated. Any company level values that need to be added to the file will be indicated in the Account Structure document from the carrier OR noted in the associated EN Carrier Configuration article. Please note that most values in the header & footer are pre-configured which means you should only need to configure a few fields, such as Sender ID(ISA06) or Master Policy Number(REF02).
Part 2: After the file has passed part 1, the carrier will then review the file to confirm that all employees and dependents on the file have the minimum required values associated with their record. Before you complete any testing, Employee Navigator highly recommends any EDI administrator to complete an employee and dependent audit. By completing this audit, you will greatly decrease the amount of time spent during the employee data validation phase. Please note that some carriers have an additional data validation layer at this step to insure that the data entered is correct. For example, Cigna has a zip code validation test and they require that the City/State and Zip match USPS records.
*only if rules are mapped by class, division, department etc.
**only when sending a Guardian file with salary-based plans included.
Some carriers require an extra layer of testing, often referred to as scenario testing.
If a carrier requests Scenario Testing, you must create enrollments in Employee Navigator that mimic real life activities such as New Hire elections, Changes in Coverage Levels, and Terminations, etc. You can either create them yourself or you may utilize the sample scenario spreadsheet that we have created that accompanies the use cases outlined below. Please remember this is only a sample and you may need to customize it based on your carrier requirements!
- First, you will need to create test employees in Employee Navigator, enroll them and send test file #1. This first file is referred to as a baseline file and it establishes a baseline from which to create the required scenarios. Some carriers will apply all data validation tests noted above on this file.
- Once the baseline file is approved, you will then need to follow the carriers scenario testing instructions and complete the changes for each use case in Employee Navigator then send the next test file for approval. Don't forget to provide a list of the test employee's name & applicable use case so they know which employee/dependent applies to each scenario - we recommend that you create a use case matrix similar to the attached document.
- After the Carrier processes the next file, they may return errors that need to be updated in order to proceed. You will make the changes in either Employee Navigator at the employee level or you will make the changes to the file configuration, depending upon the type of error returned. This process will continue until the Carrier has no more errors to report and states you may move to Production.
- Once your file has been approved for production, do not forget to remove the test employees by using the "Delete Employee" tool. If the carrier asks to use the final test file as a production file and your use cases are included, either they will need to remove the test employees manually or you will need to send a new file without those test employees.
Sample Scenario Testing Use Cases:
We created 8 Scenarios (aka Use Cases) based upon situations Carriers typically want to see. This list may not be all inclusive and may require additional “employees” to accommodate for additional scenarios. The attached excel document is available to assist in importing these test employees/enrollments but don't forget you have to delete these after testing is completed!
- Terminate a dependent with no change in coverage
- Example: Family Coverage EE/SP/CH/CH/CH. Terminating one child will not change the coverage level from FAM coverage.
- Terminate a dependent with a change in coverage
- Example: Family Coverage EE/SP/CH. Terminating a dependent will cause FAM to change to either ESP if child was terminated or ECH if spouse was terminated.
- Existing Subscriber with a Name Change
- Example: Employee gets married and changes last name.
- Add a dependent with a change in coverage
- Example: Employee gets married and coverage changes from EE to ESP
- Subscriber Address Change
- Example: Employee resides in one state but then moves to another
- Terminate a subscriber
- Example: Employee had coverage and has now terminated resulting in End Date on plan level and/or termination date
- Change of Plans
- Example: Employee was in High Option Medical and is changing to Low Option Medical
- Change of Class
- Example: Employee was in class 123 and has moved to class 321. This class change may result in different eligibility or plan options.
Additional items to Note:
- Test Employees Recommendations:
- By design, "Demo Employees" do NOT populate on an 834 file. If you need to include test employees on the file, you will need to use the "Add Employee" function and add an actual test employee. Just don't forget to go back & delete them when you are done.
- Enter multiple employees to account for the various scenarios you will need to test. Do not simply enter 1 test employee and apply all scenarios to that test employee.
- Consider other "active" feeds and/or integration before entering test employees.
- If you are attempting to test while holding an active OE, Employee Navigator's recommendation is to wait until after close-out and send enrollments another method, for example by spreadsheet. If, however, you need to complete testing while in OE, you have 2 options:
- To generate a test file with the current year enrollments - this requires that current year enrollments be loaded in Employee Navigator.
- If you are using this option, because your group is also in OE, you have to remember that when approved you will need to map the future plans so that enrollments are captured once close-out is completed.
- To generate a test file with open enrollments - open enrollments must be in the system and before transmitting the file, select "Include Open Enrollments" option on the Setup tab in the EDI Engine.