Description

When an EDI 834 Project is created in GenRocket, the entire Transaction Set is enabled. Of course, when you are testing a Transaction Set, not every Segment or Loop will be needed to complete each test or to achieve a specific Business Scenario.

Test Data Cases can be used to not only perform specific types of testing, but also to create certain Business Case Scenarios, such as Enrolling an Employee in Multiple Health Care Insurance Products (shown in this example). This can be accomplished by:

Creating a Test Data Case
Disabling EDI Segments and Loops within the Test Data Case
Adding any Additionally Needed EDI 834 Segments to the Test Data Case
Altering Loop Counts for Test Data Case Segments
Adding Attributes to Test Data Case Domains for Enabled Segments
Altering Each Added Attribute's Generator Configuration

Prerequisites

Create an X12 EDI 834 Project
Customize Transaction Set Based on Specific Needs (Review Attributes and Replace Generators as needed)
Validate Output File Prior to Configuring Test Data Cases
Created Test Data Case Suite and Test Data Category (Integration for this example)

Business Case Scenario 1

This EDI 834 Business Case Scenario will show how to set up Test Data Cases for enrolling an employee in multiple health care insurance products.

Important: Please note that this is a sample for tutorial purposes and has been designed to show how Test Data Cases can be used to accomplish your EDI 834 Business Case objectives. The provided EDI Test Data Case samples can be copied and modified to meet your specific testing needs.

The instructions in this tutorial will show how to configure a Test Data Case to achieve the X12 Syntax displayed below:

X12 Syntax for Example

Loop for each health care product:

Recommended Action

The example below shows how the provided Business Case Scenario was created and modified to achieve a specified testing goal.

It is recommended to copy one of the provided Test Data Case Business Case Scenarios and modify it using the same methods below to meet your specific testing needs.

Story

This Story shows how to enroll an employee in multiple health care insurance products by configuring an EDI Test Data Case based on the Business Case Scenario Syntax above.

Step 1: Create a Test Data Case (or Copy an Existing Case to Modify)
Step 2: Disable Segments and Loops for the Segment
Step 3: Add Additional Required Segments to the Test Data Case
Step 4: Update the Loop Count for Loop_2300
Step 5: Add and Configure Attributes for BGN_BeginningSegment
Step 6: Add and Configure Attributes for N1_SponsorName_1000ASegment
Step 7: Add and Configure Attributes for N1_Payer_100B Segment
Step 8: Add and Configure Attributes for INS_MemberLevelDetail_2000 Segment
Step 9: Add and Configure Attributes for DTP_MemberLevelDates_2000 Segment
Step 10: Add and Configure Attributes for NM1_MemberName_2100A Segment
Step 11: Add and Configure Attributes for HD_HealthCoverage_2300 Segment
Completed Test Data for REF_SubscriberIdentifier_2000 Segment
Completed Test Data for REF_MemberPolicyNumber_2000 Segment
Completed Test Data for PER_MemberCommunicationsNumbers_2100A Segment
Completed Test Data for N4_MemberCityZIPCode_2100A Segment
Completed Test Data for DMG_MemberDemographics_2100A Segment
Completed Test Data for COB_CoordinationOfBenefits_2320 Segment

Note: Please note that this tutorial is designed to show how to implement a specific EDI 834 Business Case Scenario sample.

Step 1: Create a Test Data Case (or Copy an Existing Case to Modify)

Access the Test Data Cases (G-Case) Dashboard and select the Test Data Case Suite.
Select the Test Data Category within the Dashboard.
Click the Create New G-Case button.
Enter a Name and Description.
Click the Save button.

Note: To copy a Business Scenario Test Data Case, click the Copy icon within the Actions column for the appropriate Test Data Case.

Step 2: Disable Segments and Loops for the Segment

The EDI Project will be created with all Headers, Segments, and Trailers that make up an EDI 834 Transaction. By default, every Segment and Loop will be enabled for the EDI 834 Project.

Segments and Loops can be disabled or turned "off" directly within the Test Data Cases (G-Case) Dashboard. To do so, complete the following steps:

Click the drop-down menu in the top left corner of the Dashboard and choose EDI View.
Click on the EDI Tree icon on the G-Case Editor tab.
Use each checkbox to enable or disable a Segment or Loop. A checkmark means the Segment or Loop is currently enabled.
Expand Segments and Loops within to make additional changes.
Click OK once finished.
When Segments, Loops, and Elements are disabled within the Tree View, specific Segments will be added automatically and enabled or disabled depending on your selections. For this example, these Segments and Loops have been disabled:
- TransactionSetPolicyNumber
- FileEffectiveDate
- TransactionSetControlTotals
- Loop1000c

These additional items have been disabled within the EDI Tree View:

BGN_BeginningSegment

BGN05_TimeZoneCode
BGN06_OriginalTransactionSetReferenceNumber

Loop_1000A > N1_SponsorName_1000A1

N102_PlanSponsorName

For Loop_1000b > Payer_1000B1

N102_InsurerName

Loop_2000

REF_MemberLevelDates_2000
Loop_2100B
Loop_2100C
Loop_2100D
Loop_2100E
Loop_2100F
Loop_2100G
Loop_2100H
Loop_2200
LS_AdditionalReportingCategories_2000
Loop_2700
LE_AdditionalReportingCategoriesLoopTermination_2000

Loop2000 > MemberLevelDetail2000

INS06_MedicareStatusCode_2000
INS07_ConsolidatedOmnibusBudgetReconciliationActCOBRAQualifyingEventCode
INS09_StudentStatusCode
INS10_HandicapIndicator
INS11_DateTimePeriodFormatQualifier
INS12_MamberIndividualDeathDate
INS13_ConfidentialityCode
INS17_BirthSequenceNumber

Loop2000 > Loop2100A

EC_EmployementClass_2100A
ICM_MemberIncome_2100A
AMT_MemberPolicyAmounts_2100A
HLH_MemberHealthInformation_2100A
LUI_MemberLanguage_2100A

Loop_2100 > NM1_MemberName_2100A

NM106_MemberNamePrefix
NM107_MemberNameSuffix

Loop_2100A > PER_MemberCommunicationsNumbers_2100A

PER07_CpmmunicationNumberQualifier
PER08_CommunicationNumber

Loop_2100A > N4_MemberCityStateZIPCode_2100A

N404_CountryCode
N407_CountrySubdivisionCode

Loop_2100A > DMG_MemberDemographics_2100A

DMG04_MaritalStatusCode
DMG05_CompositeRadeOrEthnicityInformation_2100A
DMG06_CitizenshipStatusCode
DMG10_CodeListQualifierCode
DMG11_RaceOrEthnicityCollectionCode

Loop_2000 > Loop_2300

AMT_HealthCoveragePolicy_2300
REF_HealthCoveragePolicyNumber_2300
REF_PriorCoverageMonths_2300
IDC_IdenificationCard_2300
Loop_2310

Loop_2000 > Loop_2300 > HD_HealthCoverage_2300

HD04_PlanCoverageDescription
HD05_CoverageLevelCode
HD09_LateEnrollmentIndicator

Loop_2000 > Loop_2300 > Loop_2320

REF_AdditionalCoordinationOfBenefitsIdentifiers_2320
DTP_CoordinationOfBenefitsEligibilityDates_2320
Loop_2330

LoopLoop_2300 > Loop_2320 > COB_CoordinationOfBenefits_2300

COB04_ServiceTypeCode

Step 3: Add Additional Required Segments to the Test Data Case

Depending on what has been disabled within the Tree View, you may need to add additional Segments to the Test Data Case. The Tree View is designed to make this process easier; however, sometimes you will need to add another Segment or Segments to test a specific Business Case Scenario.

The following additional Segments will need to be added for this example:

DTP_MemberLevelDates_2000
Loop_2300
REF_SubscriberIdentifier
REF_MemberPolicyNumber_2000

The basic steps are shown below:

Use the Filter to locate each needed Segment. For this example "DTP_Member" has been entered to find this Segment: DTP_MemberLevelDates_2000.
Next, click the Plus (+) icon located to the right of the Segment within the G-Case Editor tab.
Once finished, the added Segments will appear in the table located on the right of the G-Case Editor tab. Segments added this way are automatically enabled and will appear at the bottom of the list.

Note: You can click, drag, and drop a Segment into another location within the list to better organize enabled Segments.

Step 4: Update the Loop Count for Loop_2300

The Loop Count for each Test Data Case Segment will default to the loopCount Global Variable value. For this example all enabled Segments and Loops have a Loop Count of 1 except Loop_2300.

Loop_2300 will need to have a Loop Count of 3 because the individual is being enrolled in three separate plans (Health, Dental, and Vision).

Complete these steps to update the Loop Count for Loop_2300:

Click on the Update Loop Count for Domain icon in the Actions column.
Enter 3 for the Loop Count and then click the Save button.
Loop_2300 will now have a 3, as shown below:

Step 5: Add and Configure Attributes for BGN_BeginningSegment

In some instances, you may need to make changes to the generated data for a specific Test Data Case to match the Business Case Scenario. This can be done by adding a Attribute to the Test Data Case Domain for the Segment.

For this example, the BGN_BeginningSegment test data configuration will need to match the following X12 Syntax:

Based on the syntax above, the following Attributes will need to be added and modified to generate this test data:

purposeCode01 - Value = 00
actionCode08 - Value = 2

Step 5a: Add Attributes to the BGN_BeginningSegment Test Data Case Domain

Complete the following steps to view the Test Data Case Domain for the Segment and add Attributes with the required test data:

Click the Edit Test Data Case Domain icon in the Actions column.
Click the Plus (+) button to add one or more Attributes to the Test Data Case Domain.
In the dialog window, tick the checkbox for each Attribute that needs to be added.
Click the Save button once finished.
Each Attribute will be added to the Test Data Case Domain, as shown below:

Step 5b: Modify the purposecode01 Attribute Generator Configuration

The purposeCode by default has 3 codes: 00, 15, and 22. For this sample, only 00 is needed. You will need to modify the Generator configuration so that only 00 is generated. Complete the steps below:

Click on the purposecode01 Attribute.
Click on a value within the list to select it and then click the Remove button. This will need to be done twice to remove each value from the Attribute.
The configuration will appear as shown below. Click the Save Generator button.

Step 5c: Modify the actionCode08 Attribute Generator Configuration

The actionCode08 Attribute, by default, has 3 codes: 2, 4, and RX. For this sample, only 2 is needed since it is a Change (Update). You will need to modify the Generator configuration so that only 2 is generated. Complete the steps below:

Click on the actionCode08 Attribute to select it.
Select the 4 list value and click on the Remove button.
Select the RX list value and click the Remove button.
Click the Save Generator button once finished.

Completed Test Data for BGN_BeginningSegment

Step 6: Add and Configure Attributes for N1_SponsorName_1000ASegment

For this example, N1_SponsorName_1000A Segment test data configuration will need to match the following X12 Syntax:

Based on the syntax above, the following Attributes will need to be added and modified to generate this test data:

codeQualifier103 - FI

Step 6a: Add Attributes to the N1_SponsorName_1000A Test Data Case Domain

Click the Edit Test Data Case Domain icon in the Actions column.
Click the Plus (+) button to add one or more Attributes to the Test Data Case Domain.
In the dialog window, tick the checkbox for each Attribute that needs to be added.
Click the Save button once finished.
Each Attribute will be added to the Test Data Case Domain, as shown below:

Step 6b: Modify the codeQualifier103 Attribute Generator Configuration

The codeQualifier103 Attribute Generator by default has 3 codes: 24, 94, and FI. For this sample, only FI is needed. You will need to modify the Generator configuration so that only FI is generated. Complete the steps below:

Click on the codeQualifier103 Attribute.
Click on a value within the list to select it and then click the Remove button. This will need to be done twice to remove each value from the Attribute.
The configuration will appear as shown below. Click the Save Generator button.

Completed Test Data for N1_SponsorName_1000A Segment

Step 7: Add and Configure Attributes for N1_Payer_100B Segment

For this example, N1_Payer_100B1 Segment test data configuration will need to match the following X12 Syntax:

Based on the syntax above, the following Attribute will need to be added and modified to generate this test data:

codeQualifier103 - FI

Step 7a: Add Attributes to the N1_Payer_100B Segment Test Data Case Domain

Click the Edit Test Data Case Domain icon in the Actions column.
Click the Plus (+) button to add one or more Attributes to the Test Data Case Domain.
In the dialog window, tick the checkbox for each Attribute that needs to be added.
Click the Save button once finished.
Each Attribute will be added to the Test Data Case Domain, as shown below:

Step 7b: Modify codeQualifier103 Attribrute Generator Configuration

The codeQualifier103 by default has 3 codes: 94, FI, and XV. For this sample, only FI is needed. You will need to modify the Generator configuration so that only FI is generated. Complete the steps below:

Click on the codeQualifier103 Attribute.
Click on a value within the list to select it and then click the Remove button. This will need to be done twice to remove each value from the Attribute.
The configuration will appear as shown below. Click the Save Generator button.

Completed Test Data for N1_Payer_100B Segment

Step 8: Add and Configure Attributes for INS_MemberLevelDetail_2000 Segment

For this example, the INS_MemberLevelDetail_2000 Segment test data configuration will need to match the following X12 Syntax:

Based on the syntax above, the following Attributes will need to be added and modified to generate this test data:

memberindicator01- Y
typeCode03 - 021
reasonCode04 - 20
statusCode05 - A
statusCode08 - FT

Step 8a: Add Attributes to the INS_MemberLevelDetail_2000 Segment Test Data Case Domain

Complete the following steps to view the Test Data Case Domain for the Segment and add Attributes with the required test data:

Click the Edit Test Data Case Domain icon in the Actions column.
Click the Plus (+) button to add one or more Attributes to the Test Data Case Domain.
In the dialog window, tick the checkbox for each Attribute that needs to be added.
Click the Save button once finished.
Each Attribute will be added to the Test Data Case Domain, as shown below:

Step 8b: Modify memberIndicator01 Attribute Generator Configuration

The memberIndicator01 Attribute Generator by default has 2 codes: N and Y. For this sample, only Y is needed. You will need to modify the Generator configuration so that only Y is generated. Complete the steps below:

Click on the memberIndicator01 Attribute.
Click on the N list value to select it and then click the Remove button.
The configuration will appear as shown below. Click the Save Generator button.

Step 8c: Modify typeCode03 Attribute Generator Configuration

The typeCode03 Attribute Generator by default has 5 codes: 001, 021, 024, 025, and 030. For this sample, only 021 is needed. You will need to modify the Generator configuration so that only 021 is generated. Complete the steps below:

Click on the typeCode03 Attribute.
The 001, 024, 025, and 030 list values will need to be removed. Click on each list value to select it and then click the Remove button.
The configuration will appear as shown below. Click the Save Generator button.

Step 8d: Modify reasonCode04 Attribute Generator Configuration

The reasonCode04 Attribute Generator contains several codes. For this sample, only 20 is needed. You will need to modify the Generator configuration so that only 20 is generated. Complete the steps below:

Click on the reasonCode04 Attribute.
Click on the each list value to select it and then click the Remove button. Remove all values except 20.
The configuration will appear as shown below. Click the Save Generator button.

Step 8e: Modify statusCode05 Attribute

The statusCode05 Attribute Generator by default has 4 codes: A. C, S, and T. For this sample, only A is needed. You will need to modify the Generator configuration so that only A is generated. Complete the steps below:

Click on the statusCode05 Attribute.
The C, S, and T list values will need to be removed. Click on each list value to select it and then click the Remove button.
The configuration will appear as shown below. Click the Save Generator button.

Step 8f: Modify statusCode08 Attribute

The statusCode08 Attribute Generator by default has several codes. For this sample, only FT is needed. You will need to modify the Generator configuration so that only FT is generated. Complete the steps below:

Click on the statusCode08 Attribute.
All list values will need to be removed except FT. Click on each list value to select it and then click the Remove button.
The configuration will appear as shown below. Click the Save Generator button.

Completed Test Data for INS_MemberLevelDetail__2000 Segment

Step 9: Add and Configure Attributes for DTP_MemberLevelDates_2000 Segment

For this example, DTP_MemberLevelDates_2000 Segment test data configuration will need to match the following X12 Syntax:

Based on the syntax above, the following Attributes will need to be added and modified to generate this test data:

timeQualifier01- 356

Step 9a: Add timeQualifier01 Attribute to the DTP_MemberLevelDates_2000 Segment Test Data Case Domain

Complete the following steps to view the Test Data Case Domain for the Segment and add the timeQualifier01 Attribute:

Click the Edit Test Data Case Domain icon in the Actions column.
Click the Plus (+) button to add one or more Attributes to the Test Data Case Domain.
In the dialog window, tick the checkbox for each Attribute that needs to be added.
Click the Save button once finished.
Each Attribute will be added to the Test Data Case Domain, as shown below:

Step 9b: Modify timeQualifier01 Attribute Generator Configuration

The timeQualifier01 Attribute by default has several possible values. For this sample, only 356 is needed. You will need to modify the Generator configuration so that only 356 is generated. Complete the steps below:

Click on the timeQualifier01 Attribute.
Click on a value within the list to select it and then click the Remove button. This will need to be done for every value except 356.
The configuration will appear as shown below. Click the Save Generator button.

Completed Test Data for DTP_MemberLevelDates_2000 Segment

Step 10: Add and Configure Attributes for NM1_MemberName_2100A Segment

For this example, NM1_MemberName_2100A Segment test data configuration will need to match the following X12 Syntax:

Based on the syntax above, the following Attributes will need to be added and modified to generate this test data:

identifierCode101- IL
codeQualifier108 - 34

Step 10a: Add Attributes to the NM1_MemberName_2100A Segment Test Data Case Domain

Complete the following steps to view the Test Data Case Domain for the Segment and add Attributes with the required test data:

Click the Edit Test Data Case Domain icon in the Actions column.
Click the Plus (+) button to add one or more Attributes to the Test Data Case Domain.
In the dialog window, tick the checkbox for each Attribute that needs to be added.
Click the Save button once finished.
Each Attribute will be added to the Test Data Case Domain, as shown below:

Step 10b: Modify identifierCode101 Attribute Generator Configuration

The identifierCode101 Attribute Generator by default has 2 codes: IL and 74. For this sample, only IL is needed. You will need to modify the Generator configuration so that only IL is generated. Complete the steps below:

Click on the identifierCode101 Attribute.
Click on the 74 list value to select it and then click the Remove button.
The configuration will appear as shown below. Click the Save Generator button.

Step 10c: Modify codeQualifier108 Attribute Generator Configuration

The codeQualifier108 Attribute Generator by default has 2 codes: 34 and ZZ. For this sample, only 34 is needed. You will need to modify the Generator configuration so that only 34 is generated. Complete the steps below:

Click on the codeQualifier108 Attribute.
Click on the ZZ list value to select it and then click the Remove button.
The configuration will appear as shown below. Click the Save Generator button.

Completed Test Data for NM1_MemberName_2100A Segment

Step 11: Add and Configure Attributes for HD_HealthCoverage_2300 Segment

For this example, HD_HealthCoverage_2300 Segment test data configuration will need to match the following X12 Syntax:

Based on the syntax above, the following Attribute will need to be added and modified to generate this test data:

typeCode01- 021

Step 11a: Add Attributes to the HD_HealthCoverage_2300 Segment Test Data Case Domain

Complete the following steps to view the Test Data Case Domain for the Segment and add Attributes with the required test data:

Click the Edit Test Data Case Domain icon in the Actions column.
Click the Plus (+) button to add one or more Attributes to the Test Data Case Domain.
In the dialog window, tick the checkbox for each Attribute that needs to be added.
Click the Save button once finished.
Each Attribute will be added to the Test Data Case Domain, as shown below:

Step 11b: Modify typeCode01 Attribute Generator Configuration

The typeCode01 Attribute by default has 8 code values: 001, 002, 021, 024, 025, 026, 030, and 032. For this sample, only 021 is needed. You will need to modify the Generator configuration so that only 021 is generated. Complete the steps below:

Click on the typeCode01 Attribute.
Click on a value within the list to select it and then click the Remove button. This will need to be done multiple times to remove each value (001, 002, 024, 025, 026, 030, and 032) from the Attribute.
The configuration will appear as shown below. Click the Save Generator button.