Resources

Testing

In the Sandbox environment, use a combination of States and Member ID’s, for testing. All Payers that do not require a Member ID, will respond as active. Any Payer that requires a Member ID, will respond active for anything other than the test Member ID’s below. The sandbox Member ID’s are case-insensitive. One policy may have multiple errors, send a comma-separated list (no whitespace) of testing Member ID’s to simulate.

Blue Shield of California and Medicaid are are configured to require a Member ID.

Sandbox Member ID’s

Policy Lookup

Member IDBehavior
INCONCLUSIVEPolicy requires asynchronous follow-up
NOT_FOUNDPolicy is not found, with no additional reason
PATIENT_NAMEPolicy found, patient name issue
SUBSCRIBER_NAMEPolicy found, subscriber name issue
DOBPolicy found, date of birth doesn’t match
DOB_INVALIDPolicy found, date of birth is invalid
MEMBER_IDPolicy found, submitting Member ID is required

Policy Errors

Member IDBehavior
GENERIC_ERRORGeneric system error
PAYER_ERRORPayer responds as unavailable
DUPLICATEDuplicate Member ID is found by Payer
TIMEOUTPayer did not respond, request timed out

Service Eligibility

To test service eligibilities in the sandbox, you need to:
  • Add providers in the Providers section of the dashboard.
  • Set Licenses and Enrollments.
Managing Providers, Licenses, and Enrollments

All provider settings, including licenses and payer enrollments, can be managed on the Sandbox Manage page. Providers must have at least one state license and payer enrollment to appear during testing.

Estimates

To test estimates, select a Payer that requires Member ID, and use these values. All non-test Payers will resolve with a $25 copayment.

Member IDEstimate
COPAYMENT$25 copayment
DEDUCTIBLE$150 of remaining individual deductible
DEDUCTIBLE-FAMILY$150 of remaining family deductible
COINSURANCE$30/20% co-insurance
FREE$0 copayment, $0 co-insurance
OOP-MAX$25 copayment, waived due to already-hit OOP limits
OOP-LIMIT$25 copayment, $10 waived due to reaching OOP limits
DEDUCTIBLE-LIMIT$75 of remaining individual deductible, and a $15/20% co-insurance
DEDUCTIBLE-LIMIT-FAMILY$75 of remaining family deductible, and a $15/20% co-insurance
FALLBACK$150 estimate, unresolvable “maximum” cost

Conditional Patient Responsibility

If sending clinicalInfo with a ServiceEligibility request, use the following Member ID’s to test conditional preventative care coverage. These Member IDs are case insensitive. See the Conditional Patient Responsibility guide for detail on how to interpret the results.

All payers support this behavior. These will only be evaluated if the clinicalInfo is included in the request. Patient responsibility will respond as $0 (covered as preventative care), with varying limits.

Member IDLimit
CPR_UNKNOWN{ type: "UNKNOWN" }
CPR_UNLIMITED{ type: "UNLIMITED" }
CPR_LIMITED{ type: "LIMITED" }
CPR_LIMITED_VALUE{ type: "LIMITED", value: 12 }

Limit Modifiers

Additionally, dash separated modifiers can be appended to CPR_LIMITED_VALUE to apply limit periods and metrics. These modifiers should be equal to a valid period or metric value. Modifiers are case and order insensitive.

Member IDLimit
CPR_LIMITED_VALUE-ANNUAL{ type: "LIMITED", value: 12, period: "ANNUAL" }
CPR_LIMITED_VALUE-Units-Lifetime{ type: "LIMITED", value: 12, period: "LIFETIME", metric: "UNITS }
CPR_LIMITED_VALUE-benefit_year-visit{ type: "LIMITED", value: 12, period: "BENEFIT_YEAR", metric: "VISIT"}