Implementation Testing Sample Clauses

Implementation Testing. Implementation reviews are critical to ensuring the system was programmed to reflect the plan provisions and to ensure proper plan design administration and benefit adjudication.  Comparison of plan documents (e.g., SPDs, SBCs, etc.) to system mapping documents – independently validates the interpretation of Plan benefits referenced by system programmers, customer service representatives, and claims processors, benefit and implementation teams. Variances will be discussed with the carrier and/or the Plan to confirm the plan intent has been properly documented.  Adjudication Procedures Review - evaluates day-to-day procedures associated with claims adjudication. This review ensures proper controls and appropriate monitoring of processing activities are in place for accurate and timely benefit administration.  Scenario-Based Plan Design Testing – ▇▇▇▇▇ will review up to 75 claim scenarios. A scenario-based audit a comprehensive way to validate that the adjudication system is coded for proper administration of the plan design and benefit programs.