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Claim submission scenarios

1. Submission of a claim (Apple)

Given I am a clinician and I am submitting a claim for a client
When I supply the following details for an accident for a client who is retired
Then I receive a successful response

Apple scenario details

Apple scenario payload example 

2. Submission of a claim (Banana)

a) Given I am a clinician and I am submitting a claim for a client
When I supply the following details for an accident for a client who is retired
Then I receive a failed response

Banana scenario details

Banana scenario payload example

b) Given I am a clinician and I received a  failed response of a claim I submitted from my system,
I adjust the details in my claim and resend it with updated claim details
Then I receive a successful response

3. Submission of a claim for a self-employed client with a referral to a provider (Chocolate)

Given I am a clinician and I am submitting a claim
When I supply the following details for an injury for a client who is self-employed and has been referred to a physiotherapist
Then I receive a successful response

Chocolate scenario details

Chocolate scenario payload example

4. Submission of a claim for an employed client who is injured and will go to work on restricted duties. The client will need to provide a medical certificate to their employer showing these details. ACC to contact the provider to discuss more details about the claim. (Strawberry)

Given I am a clinician and I am submitting a claim
When I supply the following details for a client who is employed and the client’s injury requires support at work and so I am advising that the client will need 4 days at work doing restricted duties. The client needs further support and so ACC should contact me to discuss this further
Then I receive a successful response

Strawberry scenario details

Strawberry scenario payload example

5. Submission of a claim for an employed client who is unable to work for a period and then will be able to return to work for a period on restricted duties. The client will need to provide a medical certificate to their employer showing these details. (Orange)

Given I am a clinician and I am submitting a claim
When I supply the following details for a client who is employed and the client’s injury requires time off work
Then I am advising that the client will need 7 days of leave starting from the date of the accident following with 3 days at work doing restricted duties

Orange scenario details

Orange scenario payload example

6. Submission of a claim that fails and returns an error message (and remains on system records for queries) (Lemon)

Given I am a clinician and I am submitting a claim
When I supply the following details for an accident for a client
I receive a failed response with the claim being stored in my system for queries at a later date

Lemon scenario details

Lemon scenario payload example

 

Claim printing scenarios

1. Print a copy of claim submission scenario 5 (Orange) for a client

Given I am a clinician and I have submitted a claim successfully
When my client requires a copy of the claim for their records
Then I am able to print a copy of this

 

2. Print a copy of claim submission scenario 5 (Orange) for a clinician for their records (and as a potential manual submission)

Given I am a clinician and I have submitted a claim successfully
When I need a copy of the claim for my clinics records
Then I am able to print a copy of this

 

3. Print a copy of claim submission scenario 5 (Orange) for a client's employer which shows all the relevant fit for work information and none of the medical/clinical information

Given I am a clinician and I have submitted a claim successfully
When my client requires a copy of the relevant fit for work information to provide to their employer,
Then I am able to print a copy of this

 

4. Print a copy of Claim submission scenario 3 (Chocolate) for a referral for to be given to a physiotherapist

Given I am a clinician and I have submitted a Claim successfully
When my client requires a copy of the referral form to provide to their physiotherapist,
Then I am able to print a copy of this