Software Solution Validation Test Form – PCSS-eCCSA

(Revision 1)
Name of Health Care Institution
In-house ☐ Outsourced ☑ Name of Service Provider DEPARTMENT OF HEALTH
Software Name / Title Integrated Hospital Operation and Management Information System (iHOMIS) Version # 4.0

Date of Test Time of Test

CYCLE # _____ CYCLE # _____ CYCLE # _____

CRITERIA
P F Remarks P F Remarks P F Remarks
 Check if the document is located in the cloud
Note: Mouse hover on the document type. If the URL starts with
“http://ocid” then the document has successfully been
transmitted/stored in the PhilHealth Cloud Storage
 Required documents (CF4, CSF, SOA) should be viewable in NClaims
application for the 3 cycles or for at least 3 claims.
 Screenshot indicating successful upload (showing the URL of the
document)
 Data same as in RAW PDF (as provided by the HCI provider)
 Check clarity of the image

R E S U L T: PASSED / FAILED: _____________________________________ EVALUATORS:

Cycle # _____ Cycle # _____ Cycle # _____

______________________________________________________ ______________________________________________________ ______________________________________________________

Signature above Name Signature above Name Signature above Name
__________________________________ __________________________________ __________________________________
Position Position Position

______________________________________________________ ______________________________________________________ ______________________________________________________

Signature above Name Signature above Name Signature above Name
__________________________________ __________________________________ __________________________________
Position Position Position

______________________________________________________ ______________________________________________________ ______________________________________________________

Signature above Name Signature above Name Signature above Name
__________________________________ __________________________________ __________________________________
Position Position Position