Page Comparison

#

Name

Details

External ID

Name

Summary

PreConditions

1

98

Scenario: 16.1 insuree having already used all her antenatal

<div>
<div>When the service @SC6 is added to the claim @CM6 </div>

<div>And the claim @CM6 is submitted </div>

<div>Then the service @SC6 must be rejected with the 'reason code 19'</div>
</div>

<div>
<div>Given the service @SC6 is a 'A'type service</div>

<div>And the deliveries limits is already reached for the beneficiary @BE3 for his active policy @PL1 </div>

<div></div>

<div>With the test data script I84 has A type of service</div>

<div></div>
</div>

2

52

Scenario: 1.1 beneficiary not found

<div>
<div>When the claim @CM1 is submitted by @CA </div>

<div>
<div>
<div>Then the claim @CM1 is rejected with the 'errorcode7'</div>
</div>
</div>
</div>

<div>
<div>
<div>
<div>Background:</div>

<div>Given@HF1isavalidhealthfacility</div>

<div>And@CAisavalidclaimadministrator</div>
</div>

Given a claim @CM1 is created for a valid health facility @HF

<div>
<div>And the beneficiary @BE1 provided doesn't exist</div>

<div>And the dates are correctes</div>
</div>
</div>
</div>

3

53

Scenario: 1.2 Familly/Group not found

<div>
<div>When the claim @CM2 is submitted by @CA </div>

<div>Then the claim @CM2 is rejected with the 'errorcode7'</div>
</div>

<div>
<div>Given a claim @CM2 is created for a valid health facility @HF</div>

<div>And the beneficiary @BE2 provided exist but doesn't belong to a valid group / familly (ie.nohead?)</div>

<div>And the dates are correctes</div>
</div>

4

54

Scenario: 1.3 no active policy on the familly/group

<div>
<div>When the claim @CM3 is su mitted by @CA </div>

<div>Then the claim @CM3 is rejected with the 'errorcode7' </div>
</div>

<div>
<div>Given a claim @CM3 is created for a valid health facility @HF</div>

<div>And the beneficiary @BE3 provided belong group/familly @FM1 not covered by a policy </div>

<div>And the dates are correctes </div>
</div>

5

55

Scenario: 2.1 Care 'From' date empty

<div>
<div>When the claim @CM4 is submitted by @CA </div>

<div>Then the claim @CM4 is rejected with the 'error code9'</div>
</div>

<div>
<div>Given a claim @CM4 is created for a valid health facility @HF</div>

<div>And the claim @CM4 is for the beneficiary @BE3 </div>

<div>And the 'visit date from 'is empty or unvalid </div>
</div>

6

56

Scenario: 2.2 Care 'To' date before 'From' date

<div>
<div>When the claim @CM5 is submitted by @CA </div>

<div>Then the claim @CM5 is rejected with the' errorcode9' </div>
</div>

<div>
<div>Given a claim @CM5 is created for valid health facility @HF </div>

<div>And the claim @CM5 is for the beneficiary @BE3 </div>

<div>And the 'visit date from' is empty </div>

<div>And the 'visitdateTo' is empty or unvalid </div>
</div>

7

57

Scenario: 3.1 The Item doesn't have a mask compatible with the beneficiary mask

<div>
<div>When the claim @CM6 is submitted by @CA </div>

<div>Then the Service @IT1 of the claim @CM6 is rejected with the 'errorcode4'</div>
</div>

<div>
<div>Given the Beneficiary has a mask @MS1 </div>

<div>When the Item @IT1 is added to the claim @CM6 </div>

<div>And the service @IT1 mask @MS2 is not compatible with @MS1 </div>
</div>

8

58

Scenario: 3.2 The Service doesn't have a mask compatible with the beneficiary mask

<div>
<div>When the claim @CM6 is submitted by @CA  </div>

<div>Then the Service @SC1 of the claim @CM6 is rejected with the 'errorcode4' </div>
</div>

<div>
<div>Given the Beneficiary has a mask @MS1 </div>

<div>When the service @SC1 is added to the claim @CM6 </div>

<div>And the service @SC1 mask @MS2 is not compatible with @MS1 </div>
</div>

9

59

Rule: 4. the beneficiary CANNOT benefit from the service/item within the waiting period

<div>
<div>When this service @SC2 is added to a new claim @CM6 </div>

<div>And the claim @CM6 is submitted by @CA </div>

<div>Then the service @SC2 must be rejected (and the claim if no other valid service /Item)with the'reason code17'</div>
</div>

<div>
<div>Given that the service @SC2 has a waiting period set</div>

<div>And the waiting period is not reached (policy age smaller than waiting period & amp; not a renewal ) </div>
</div>

10

60

Scenario: 4.2 The Item cannot be provided within the item waiting period

<div>
<div>When this Item @IT2 is added to a new claim @CM6 </div>

<div>And the claim @CM6 is submitted by @CA</div>

<div>Then the Item @IT2 must be rejected (and the claim if no other valid service /Item)with the 'reasoncode17'</div>
</div>

<div>
<div>Given that the Item @IT2 has a waiting period set</div>

<div>And the waiting period is not reached (policy age smaller than waiting period & amp ;not a renewal)</div>
</div>

11

61

Scenario: 5.1 The service was already provided the maximum number of time for an adult

<div>
<div>When this service is added to a new claim @CM6 </div>

<div>And the claim is submitted by @CA </div>

<div>Then the service @SC3 must be rejected (and the claim if no other valid service/Item)with the 'reasoncode16' </div>
</div>

<div>
<div>Given that the service @SC3 has a ceiling set for adults</div>

<div>And its service @SC3 cieling is already reached for the beneficiary @BE3 for his active policy @PL1 </div>

<div></div>
</div>

12

62

Scenario: 5.2 The Item was already provided within the maximum number of time time for an children

<div>
<div>When this item @IT3i is added to a new claim @CM7 </div>

<div>And the claim is submitted by @CA </div>

<div>Then the item @IT3 must be rejected (and the claim if no other valid service/Item)with the 'reasoncode16'</div>
</div>

<div>
<div>Given that the item @IT3 has a ceiling set for childrens</div>

<div>And the item @IT3 cieling is already reached for the beneficiary @BE3 for his active policy @PL1 </div>

<div></div>
</div>

13

63

Scenario: 6.1 insuree having already used all her consultations

<div>
<div>When the service @SC4 is added to the claim @CM6 </div>

<div>And the claim @CM6 is submitted </div>

<div>Then the service @SC4 must be rejected with the 'reasoncode13' </div>
</div>

<div>
<div>Given the service @SC4 is a 'C' type service</div>

<div>And the consultation limit is already reached for the beneficiary @BE3 for his active policy @PL1 </div>

<div></div>
</div>

14

64

Scenario: 7.1 insuree having already used all her surgeries

<div>
<div>Whentheservice@SC5isaddedtotheclaim@CM6</div>

<div>Andtheclaim@CM6issubmitted</div>

<div>Thentheservice@SC5mustberejectedwiththe'reasoncode14'</div>
</div>

<div>
<div>Given the service @SC5 is a 'S ' type service </div>

<div>And the surgeries limits is already reached for the beneficiary @BE3 for his active policy @PL1 </div>

<div></div>
</div>

15

65

Scenario: 8.1 insuree having already used all her delivery

<div>
<div>When the service @SC6 is added to the claim @CM6 </div>

<div>And the claim @CM6 is submitted</div>

<div>Then the service @SC6 must be rejected with the 'reasoncode15'< /div>
</div>

<div>
<div>Giventheservice@SC6isa'D'typeservice</div>

<div>And the deliveries limits is already reached for the beneficiary @BE3 for his active policy @PL1 </div>

<div></div>
</div>

16

66

Scenario: 9.1 insuree having already used all her hospital visit

<div>
<div>
<div>
<div></div>
</div>

<div>
<div>When the service @SC7 is added to the claim @CM6 </div>

<div>And the claim @CM6 is submitted </div>

<div>Then the service @SC7 must be rejected with the 'reasoncode11'</div>
</div>
</div>
</div>

<div>Given the service @SC7 is a 'H' type service </div>

<div>And the Hospital visit limit is already reached for the beneficiary @BE3 for his active policy @PL1 </div>

17

67

Scenario: 10.1 insuree having already used all her hospital visit

<div>
<div>
<div>
<div>When the service @SC8 is added to the claim @CM6 </div>

<div>And the claim @CM6 is submitted </div>

<div>Then the service @SC8 must be rejected with the 'reasoncode12'</div>
</div>
</div>
</div>

<div>
<div>Given the service @SC8 is a 'V 'type service</div>

<div>And the Hospital visit limit is already reached for the beneficiary @BE3 for his active policy @PL1 </div>
</div>

18

68

Scenario: 11.1 Service not found

<div>
<div>
<div>
<div>When this service @SC9 is added to a newclaim @CM6 </div>

<div>And the claim @CM6 is submitted by  @CA < /div>

<div>Then the service @SC2 must be rejected (and the claim if no other valid service/Item)with the 'reasoncode3'</div>
</div>
</div>
</div>

<div>
<div>Given that the service @SC9 has doesn t exist</div>

<div></div>
</div>

19

69

Scenario: 11.2 Item not found

<div>
<div></div>

<div>When this Item @IT4 is added to a newclaim @CM6 </div>

<div>And the claim @CM6 is submitted by @CA </div>

<div>ThentheItem@IT4mustberejected(andtheclaimifnoothervalidservice/Item)withthe'reasoncode3'</div>
</div>

<div>
<div>Given that the Item @IT4 has doesn't exist</div>

<div></div>
</div>

20

70

Scenario: 12.1 Invalid Item (not covered by policy I guess)

<div>
<div>When the Item @IT5 is added to a new claim @CM6 </div>

<div>And the claim @CM6 is submitted by @CA </div>

<div>Then the Item @IT5 must be rejected (and the claim if no other valid service/Item)with the'reasoncode1'</div>
</div>

<div>
<div>
<div>
<div>given that the  item @IT5 doesn't exist for the claim date</div>
</div>
</div>
</div>

21

71

Scenario: 12.2 Invalid service 

<div>
<div>When the service @SC1 is added to a newclaim @CM6 </div>

<div>And the claim @CM6 is submitted by @CA</div>

<div>Then the service @SC10 must be rejected (and the claim if no other valid service/Item)with the 'reasoncode1'</div>
<br />
</div>

<div>
<div>
<div>
<div>Given that the service @SC1 doesn't exist for the claim date</div>
</div>
</div>
</div>

22

72

Scenario: 13.1 Item not part of a valid price list

<div>
<div>
<div>When the Item @IT6 is added to a new claim @CM6 </div>

<div>And the claim @CM6 is submitted by @CA </div>

<div>Then the Item@IT6 must be rejected (and the claim if no other valid service/Item)with the'reasoncode2'</div>
</div>
</div>

<div>
<div>Given that the  Item@IT6exist</div>

<div>And the Item @IT6 is not in a price list valid for @HF and @PL1</div>

<div></div>
</div>

23

73

Scenario: 13.2 Service not part of a valid price list

<div>
<div>
<div>
<div>Whentheservice@SC11isaddedtoanewclaim@CM6</div>

<div>Andtheclaim@CM6issubmittedby@CA</div>

<div>Then the service @SC11 must be rejected (and the claim if no other valid service/Item)with the 'reason code2'</div>
</div>
</div>
</div>

<div>
<div>Given that the service @SC11 exist</div>

<div>And the service @SC11 is not in a price list valid for @Hfand @PL1 </div>

<div></div>
</div>

24

74

Scenario: 14.1 Item not for the right care type (in/out patient)

<div>
<div>When the Item @IT7 is added to a new claim @CM7 </div>

<div>And the claim @CM7 is submitted by  @CA </div>

<div>Then the Item @IT7 must be rejected (and the claim if no other valid service/Item)with the 'reason code10'</div>
</div>

<div>
<div>Given that Item@IT7 is for an'in-patient'</div>

<div></div>
</div>

25

75

Scenario: 14.2 Service not for the right care type (in/out patient)

<div>
<div>When the service @SC12 is added to a newc laim @CM6 </div>

<div>And the claim @CM6 is submitted by @CA </div>

<div>Then the service @SC12 must be rejected (and the claim if no other valid service/Item)with the'reasoncode10'</div>
</div>

<div>
<div>Given that the service @SC12 is for an 'out-patient'</div>

<div></div>
</div>

26

76

Scenario: 15.1 The Service already be provided within the item frequency period

<div>
<div>When this Service @SC15 is added to a new claim @CM6 </div>

<div>And the claim @CM6 is submitted by @CA </div>

<div>ThentheService@SC15mustberejected(andtheclaimifnoothervalidservice/Item)withthe'reasoncode5'</div>
<br />
</div>

<div>
<div>Given that the Service @SC15 has a waiting period set</div>

<div>
<div>
<div>And the beneficiary @BE3 had the Service @SC15 already covered by his active policy @PL1 within the frequency period</div>

<div></div>
</div>
</div>
</div>

27

77

Scenario: 15.2 The Item already be provided within the item frequency period

<div>
<div>When this Item @IT15 is added to a new claim @CM6 </div>

<div>And the claim @CM6 is submitted by @C A </div>

<div>Then the Item @IT15 must be rejected (and the claim if no other valid service / Item)with the 'reason code5' </div>
<br />
</div>

<div>
<div>Given that the Item @IT15 has a waiting period set</div>

<div>And the beneficiary @BE3 had the Item @IT15 already covered by his active policy @PL1 within the frequency period </div>

<div></div>
</div>