GenRocket Synthetic Test Data Automation Fills Critical Need in Health Insurance Industry Software Testing

It is estimated that up to 80% of all health insurance claims submitted to an insurance company contain errors (or fraud). These errors slow claims processing time for providers and create revenue losses for insurers. With over 329 million Americans relying on the current healthcare system and the insurance companies that help pay for their medical care, it’s no wonder the system experiences problems.

The volume of electronic communications transmitting sensitive patient data is staggering. For example, CAQH reported in 2021 over 14,202,000 medical verification transactions of eligibility and benefits. In that same year, electronic claims submissions topped 7,219,000 million transactions.

Strict HIPAA privacy policies prevent the use of actual patient data to test systems transmitting healthcare data. Yet even if health insurance companies could use actual patient data for testing purposes, it is unlikely it would contain the variety needed for thorough test coverage.

Health insurance companies are also subject to heavy penalties should they fail to provide proper security for patient information. This creates the “perfect storm” of pressures that makes GenRocket synthetic test data an excellent solution for the health insurance industry.

GenRocket and X12 EDI Standards

For over 40 years, the American National Standard Institute (ANSI) has provided the guidance needed to create standardized systems. Such systems enable cross-communication among many platforms. One of the most important of these standards is ANSI ASC X12 EDI standard for the healthcare industry.

Through a partnership announced in October 2019 with X12, GenRocket developed an EDI accelerator that automates 90% of the setup of EDI test data projects, such as X12 EDI 837 Institutional claims, in less than 10 minutes. These EDI test data projects allow GenRocket to generate the exact volume, variety, and format of test data in accordance with X12 EDI Standards.

The GenRocket X12 EDI accelerator provides access to valid test data for all of the HIPAA mandated EDI transaction sets such as the 834 (enrollment), 835 (payment), and 837 (claims) data. GenRocket’s X12 EDI accelerator also allows synthetic data and enumerated (real) data values to be queried and blended together. For example, synthetic data claims can include real ICD-10 procedure codes and Member ID’s so that the test claims flow properly, without failure, through healthcare systems.

The result is secure test data that provides the volume, variety, and precise format required for testing health insurance systems with 100% HIPAA compliance since no sensitive patient data is used. Single claim, batch claims, primary payer and secondary payer, negative claims and edge-case claims can easily be generated allowing testing teams to test every single possible permutation and combination of data in claims transactions.

To learn more about the power of GenRocket synthetic test data and how it can be used to meet X12 EDI requirements, read our full document: X12 EDI Synthetic Test Data Scaled to Simulate Real-World Healthcare Transaction Volumes