Test Cases

Use these test cases for PMJAY HMIS sandbox exit preparation. Keep the test evidence, request payload, callback payload, and correlation ID for each case.

Core test cases

Test case ID	Scenario	Precondition	API or resource	Inputs	Validation rules	Expected output	Remarks
TC-ABHA-01	Validate PMJAY policy with ABHA	Valid ABHA and consent exist.	CoverageEligibilityRequest with purpose validation	ABHA 91-XXXX-XXXX-XXXX, purpose validation	Check ABHA linkage and active policy.	CoverageEligibilityResponse with active coverage.	Happy path.
TC-HBP-01	Fetch admissible HBP package	Policy validation passed.	InsurancePlan	Plan ID PMJAY-TS-001, provider ID HOSP123, payer ID SHA-HARYANA	Validate provider against state network hospitals.	InsurancePlan with HBP packages, inclusions, exclusions, claim conditions, and documents.	State-specific HBP applies.
TC-CE-01	Check coverage eligibility for auth requirements	Wallet balance exists.	CoverageEligibilityRequest with purpose auth-requirements	Amount 25000, package HBP-123	Check wallet balance and speciality rules.	Eligible response with sufficient balance.	Preauth can proceed.
TC-PA-01	Submit preauthorisation request	Eligibility check passed.	/preauth/submit with Claim	Diagnosis I10, treatment plan, support documents, doctor details	Validate clinical and financial rules.	Preauth ID with status PENDING.	Sent to workflow.
TC-PA-02	Submit preauth query update	Preauthorisation exists.	/preauth/submit with Claim	Additional documents	Match preauth and treatment details.	Preauth query details accepted for adjudication.	Sent to workflow.
TC-CL-01	Submit claim after discharge	Preauthorisation approved.	/claim/submit with Claim	Approved amount 23000, attached documents	Match preauth and treatment details.	Claim accepted for adjudication.	Sent to workflow.
TC-CL-02	Submit claim query update	Claim exists.	/claim/submit with Claim	Documents	Match claim and treatment details.	Claim query details accepted for adjudication.	Sent to workflow.
TC-CL-03	Submit CRC claim	Claim is rejected or partially paid.	/task/submit with Task	Claim number and reprocess reason	Match claim and treatment details.	Source does not state the expected output.	Confirm before exit demo.

Additional scenario checklist

Area	Scenario
Registration	Registration
Wallet	Wallet update
Registration	Registration cancel
Preauthorisation	Preauth submission
Preauthorisation	Preauth query
Preauthorisation	Preauth query response
Preauthorisation	Preauth enhancement
Preauthorisation	Preauth with implant
Preauthorisation	Preauth resubmission
Preauthorisation	Preauth rejection
Preauthorisation	Preauth approval
Preauthorisation	Preauth cancel or delete
Discharge	Discharge in multiple modes with amount calculation
Claim	Claim submission
Claim	Claim query
Claim	Claim rejection
Claim	Claim approval
Payment	Claim final payment and payer bank transaction update
CRC	CRC after claim rejection or partial payment

Evidence to capture

• Store the request payload before encryption.
• Store the callback payload after decryption.
• Store the JWE header metadata.
• Store the correlation ID and workflow ID.
• Store screenshots from the HMIS screen.
• Store validation errors and retry proof.