Test cases & QA

Twelve traceable tests plus severity, triage, retest, regression and evidence requirements for defect closure.

Product decision
Release evidence must cover successful completion and controlled failure.

Document type

Test cases & QA

Status

Portfolio sample · written from my healthcare claims experience

Product decision

Release evidence must cover successful completion and controlled failure.

Portfolio sample from my healthcare product experience. Requirements, thresholds and review records are illustrative; they are not employer documents or historical sign-offs.

In this document 8 sections

Execution status and fixtures

Execution status: NOT RUN against the historical systems for this reconstructed sample. Use sample professional/institutional claims, controlled provider records, a receiver simulator and role-specific accounts. Freeze build, fixture and contract versions before execution. Record each actual outcome and evidence reference independently of the expected result. Cover valid completion, controlled failure and recovery; no historical pass rate is inferred.

1. Use sample professional/institutional claims, controlled provider records a receiver simulator and role-specific accounts
2. Freeze build, fixture and contract versions before execution
3. Record each actual outcome and evidence reference independently of the expected result
4. Cover valid completion, controlled failure and recovery no historical pass rate is inferred

Execution status: NOT RUN against the historical systems for this reconstructed sample

Traceable test set

Expected outcomes below are acceptance criteria, not reported pass results.

Case / requirements	Given / When	Expected result
Q1 · Valid professional claim · FR1/5/6	Given a complete sample CMS-1500 and uniquely supported provider, when processed	Select 837P; pass the agreed receiver contract; retain submission identity and receiver status.
Q2 · Valid institutional claim · FR1/5/6	Given a complete sample UB-04 and required provider evidence, when processed	Select 837I; validate institutional mapping; retain source lineage and receiver status.
Q3 · Extraction correction · FR1/2	Given an unreadable required field, when an authorized operator corrects it	Hold initially; record source and correction; advance only after revalidation.
Q4 · Invalid EDI · FR5	Given a wrong variant or required-field violation, when validated	Block handoff and display a specific error; no invalid live submission.
Q5 · Normalization · FR3	Given equivalent address representations, when normalized	Preserve original values; match only with sufficient identity evidence.
Q6 · Missing / ambiguous provider · FR4	Given missing required identity evidence or two plausible candidates, when resolved	Return a distinct unresolved reason and review path; no arbitrary choice.
Q7 · Stale / unavailable source · FR4	Given an expired sample freshness limit or unavailable provider source, when queried	Expose source status; hold or controlled retry; no silent current-match assertion.
Q8 · Acknowledgement vs outcome · FR6	Given an accepted acknowledgement but no final result, when state is reported	Show accepted/awaiting disposition; only a later adjudication response updates the final state.
Q9 · Timeout / repeated request · FR7	Given a lost response and the same request identity, when retried	Check known state and emit no unintended duplicate live claim.
Q10 · Migration comparison · FR8	Given a bounded replay inventory, when legacy/new results differ	Isolate replay from live submission, identify every discrepancy and block promotion.
Q11 · Access denial · FR9	Given an unauthorized actor, when read/correct/export is attempted	Deny the action without claim-data exposure and record the access event.
Q12 · Queue / reporting · FR10 / MR1–MR5	Given mixed current states and known operator actions, when reports are built	Reconcile unique inventory; show held items, manual work and correct denominators.

Performance and specialist evidence

Run provider resolution at the declared 50 requests/second sample load with p95 ≤500 ms. Separate cache-hit and source-query latency, timeouts and errors so a fast cache does not conceal a failing source path. Record duration, warm-up, concurrency, data distribution and environment in the actual run. Claims specialists assess receiver interpretation; operators assess recovery usability; security/compliance assess relevant controls. Load, functional and UAT evidence remain distinct.

1. Run provider resolution at the declared 50 requests/second sample load with p95 ≤500 ms
2. Separate cache-hit and source-query latency, timeouts and errors so a fast cache does not conceal a failing source path
3. Record duration, warm-up, concurrency, data distribution and environment in the actual run
4. Claims specialists assess receiver interpretation operators assess recovery usability; security/compliance assess relevant controls

Load, functional and UAT evidence remain distinct

Severity versus priority

Severity is the consequence of the defect; priority is the repair order considering exposure and dependencies. A narrow occurrence can still have high severity. Product and QA assign priority with domain/control input, without relabeling consequence to meet a release date.

Severity	Example consequence	Sample release treatment
S1 critical	Unauthorized protected-data exposure, unsupported identity applied, unintended live duplicate or lost inventory	Stop affected release/traffic; immediate triage
S2 major	Valid cohort cannot complete or exceptions cannot be recovered	Block affected scope until fix or safe exclusion
S3 moderate	Incorrect noncritical queue presentation with verified workaround	Document risk and retest before agreed expansion
S4 minor	Cosmetic issue without loss of meaning or action	Schedule correction; retain reproduction

Defect lifecycle and triage

New → triaged → assigned → in progress → ready for retest → verified → closed; failed retest returns to assigned. Each record includes requirement/test ID, build, fixture, reproduction steps, expected/actual result, consequence, evidence and owner. Sample triage service levels: S1 immediately during an active run; S2 by the next working day; S3/S4 at the next scheduled triage. These are proposed response commitments, not historical incident metrics. Remediation time depends on diagnosis and must be explicitly agreed.

1. S1 immediately during an active run
2. S2 by the next working day
3. S3/S4 at the next scheduled triage proposed response commitments, not historical incident metrics

Retest, regression and waivers

Retest the original fixture and a neighboring boundary: ambiguity after normalization, repeated timeout after acknowledgement, replay with a discrepancy, and permission denial after a role change. A corrected screenshot alone cannot close a transaction defect. For a nonblocking waiver, document scope, residual risk, workaround, accountable approver, expiry and required follow-up. Unexplained identity, duplicate, inventory or access defects cannot be waived into the sample release merely to hit a milestone.

1. Retest the original fixture and a neighboring boundary ambiguity after normalization, repeated timeout after acknowledgement, replay with a discrepancy, and permission denial after a role change
2. A corrected screenshot alone cannot close a transaction defect
3. For a nonblocking waiver document scope, residual risk, workaround, accountable approver, expiry and required follow-up

Unexplained identity, duplicate, inventory or access defects cannot be waived into the sample release merely to hit a milestone

Closure evidence and exit gate

The closure record is reviewable and tied to the candidate build.

Evidence	Closure requirement
Original case	Reproduction and initial actual result preserved
Fix verification	Same case passes with trace/log or state evidence
Regression	Related requirements pass; no uncontrolled duplicate or lost record
Domain review	Relevant claims/provider/control specialist accepts interpretation
Release scope	Residual issues, exclusions and any waiver are explicit

Release recommendation

Recommend release only with executed Q1–Q12, complete inventory reconciliation, performance evidence, resolved blocking defects and operator acceptance. QA does not approve benefit policy or infer clinical safety from automation. Customer care, operations and relevant patient-safety/legal/compliance partners review the consequences they own. A test count without coverage and closure evidence is insufficient.

1. executed Q1–Q12
2. complete inventory reconciliation
3. performance evidence
4. resolved blocking defects
5. operator acceptance

A test count without coverage and closure evidence is insufficient