In response to CMS audit failures, we were approached to set up and lead the user acceptance testing (UAT) for our client’s Explanation of Benefits (EOB) form. The compliance issues were a result of a complete rewrite that was rolled out across multiple geographic markets using different claims processing applications, development teams, and print vendors.
We developed a UAT process, including the use of a new bug and defect tracking system, to test new updates to the EOB. Our team also created a database mapping template for the client, and a data dictionary, a roadmap of data sources and their uses, and documentation of all significant business rules.
With the support of InfoWorks, our client was able to close all internal audit findings and pass the next CMS audit with no findings on the Explanation of Benefits.