How Tricentis and Capgemini ensured a health insurance company’s data integrity with automated testing

Company overview

For over 60 years, a leading managed healthcare company has administered health insurance coverage and related services in the United States for employer groups, individuals, and government-sponsored programs.

The company’s Medicare (federal health coverage for people 65 or older) and Medicaid (federal and state health coverage for people with limited income and resources) group is part of the clinical operations division. Clinical operations apply business rules to the Medicare and Medicaid programs on the back end. Based on the rules, the data is populated for different clinical operations and user roles, such as approvals. Until now, all the testing was being done manually, with the team having to make updates by going to each data table to look for quality or regression issues.

The health insurance company needed to streamline the complex manual process for a production instance for medical records and was under time constraints for project completion. The company turned to Capgemini, its longtime partner since 2009, for help with the project. Capgemini is a global leader in consulting, technology services, and digital transformation and has a managed testing service responsible for business assurance (User Acceptance Testing) of clinical application releases, including critical Medicare and Medicaid rollouts across states.

Manual testing takes too much time and effort

As a part of the Medicare and Medicaid programs, the health insurance company’s business rules team would create CSV files in Excel and update/modify the decision tables with each release. The associated testing involved a lot of manual effort, and testers did not have enough time to cover all the testing scenarios within the release scope.

Once all the converted records were passed through the business rules, the output tables were validated with the associated input records. This comparison was time-consuming and error-prone – a significant issue since the data elements are related to claims and benefits coverage, and there could not be any margin of error.

The post data refresh required a great deal of manual test data validation setup before the UAT test cycle began. Due to the time crunch, the test data issues were identified on the fly, often resulting in downstream delays in the UAT cycle.

Automating end-to-end testing with Tosca Data Integrity

The health insurance company has been a Tricentis customer since 2018. Tricentis Tosca is heavily utilized by 8 of 11 business teams for managing automated testing.

Tricentis’ partner Capgemini implemented Tricentis Data Integrity, which allows the health insurance company to end-to-end test its data with automated test cases and catch data errors before they cause costly consequences. Tricentis Data Integrity’s automated testing capabilities provide:

  • Pre-screening tests to verify whether the files contain the expected data
  • Vital checks and field tests to ensure the data’s integrity and the completeness and correctness of tables and fields
  • Reconciliation tests to compare two data sets from two different systems
  • Report testing to check the presentation and content of reports
  • Profiling to validate data from a business perspective for logical consistency and correctness

According to Arun Pakkan, National Automation Solution Architect at Capgemini, the Tricentis Data Integrity reporting has been a major win for his client. “An interesting Tricentis Data Integrity feature is the data comparison and reconciliation check parts where it can compare source and data and provide a report. That was exciting for our client because any other tool would not give such comprehensive and detailed reporting,” said Pakkan. “Whereas in the past, the client would only get a simple pass/fail and no details or visual representation of how the comparison happened.”

Transforming testing with more speed and less errors

Tricentis Data Integrity has been beneficial for transformation and standardizations for Medicare and Medicaid in the DevOps toolchain. The health insurance company can isolate the cloud license server for dedicated Tosca users in Medicare and enable DevOps speed for the production instance of medical billing for its special purpose project.

With Tricentis Data Integrity, the health insurance company can execute millions of data scenarios in minutes. A team of eight to nine people used to do manual, row-by-row comparisons of 8 to 30 tables for each release, which took 2 to 4 hours per table. With Tricentis Data Integrity, it takes only two to three people to perform the same task and two minutes for the table validation script execution time.

Post data refresh tests are being run for each cycle and selected test cases on a weekly basis to ensure some cron jobs populate data correctly. This approach has helped for a smoother UAT and saved numerous hours of tester and developer debugging time due to quality data.

Capgemini has helped the health insurance company save 40 to 60 testing hours per release. The data integrity issues have improved by eliminating human error. Because of the project’s success, the company has been able to reallocate its team members and resources to more value-added activities. In the future, the health insurance company plans to move towards using Snowflake and real-time data with support from Tricentis Data Integrity.