Generate Test Patient

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Overview

The Generate Test Patient form creates synthetic patients pre-loaded with the clinical data shapes a guideline needs to evaluate. Use it to test PA initiation, rejection, approval, and continuation scenarios without manually building patient records.

Opening the Form

From the left navigation, select Patients, then click Generate Test Patient in the top-right area. The form opens as a panel on the right side of the screen.

Configuring the Patient

Selecting a Guideline

Use the guideline search box to find the guideline you want to test against. Select it; a configuration row appears for that guideline.

Generation Type

Choose how the patient’s claims history should be shaped:

• Standard — creates a patient with standard pharmacy claim records.
• EDI Continuation (A) — generates an EDI file simulating a patient already receiving the therapy (continuation scenario).
• EDI Initiation (B) — generates an EDI file simulating a patient starting therapy for the first time.

Drug Selection

For standard generation, select the target drug and package NDC from the dropdowns that appear in the guideline row. The generated patient’s claims will reflect that exact NDC.

When the guideline names a specific brand, the first dropdown offers brand-qualified choices such as Semaglutide (Ozempic). Whichever choice you pick is what the patient chart records: pick a brand and the medication card on the Medications tab shows that brand name with a Brand chip; pick Generic and it shows a Generic chip. This matters when you are testing a guideline or therapeutic interchange that only applies to one brand — a patient generated as generic semaglutide will not match an interchange whose source drug is Ozempic.

Scenario Options

Each guideline row offers checkboxes to shape what claim records are created:

• PA rejection — adds a claim with a PA rejection status.
• PA approval — adds a claim with a PA approval.
• Current therapy — adds a paid claim filled today, so the medication shows as Current on the patient’s Medications tab and counts as active therapy when a guideline or interchange is run.
• Prior therapy — adds a paid claim filled far enough in the past that the therapy has lapsed, so the medication shows as a completed course rather than current.

Pinning Pharmacy and Prescriber NPIs

By default the form picks random real pharmacy and prescriber NPIs from the NPI reference database. You can pin specific NPIs to control which provider appears on every claim for the generated patient — useful when testing whether outbound letters reach a particular fax number.

Dispensing Pharmacy NPI

Type at least two characters in the Dispensing pharmacy NPI field to search pharmacies by name. Select one from the list; that pharmacy’s NPI will appear on all claim records. Clear the field to revert to a random pharmacy.

Prescriber NPI

Type at least two characters in the Prescriber NPI field to search any NPI provider by name. Select one; that prescriber’s NPI will appear on all claim records, including PA rejection and approval records. Clear the field to revert to a random prescriber.

Only Show NPIs with Fax Numbers

Check Only show NPIs with fax numbers to filter both the pharmacy and prescriber search results to entries that have a fax number on record. This is helpful when testing the outbound fax letter path — you can confirm the NPI you pick will receive a fax when interchange letters are generated.

When this checkbox is on, the NPI item subtitles display the fax number so you can confirm it at a glance before selecting.

Additional Options

Faker Seed

Enter an integer in the Faker seed field to produce a reproducible patient. Two runs with the same seed and settings generate the same demographic data. Leave it blank for a random patient each time.

Age

Enter a specific age in years to control the generated patient’s date of birth. Leave blank for a random age.

Business Units

Use the business-unit selector to assign the generated patient to specific business units. This controls which evaluators and letter templates apply.

Generating the Patient

Click Generate. The form shows progress while the patient is created (and, for EDI types, while the EDI file processes). When complete, a link to the new patient record appears. Click it to open the patient chart and verify the data.

Reproducing a Test Patient

Each generated patient stores a generation string in its record. From the patient chart, copy the generation string and paste it into the Generate from string tab of the form. This recreates the same clinical shape — optionally with a different seed for varied demographics.