PA Form Testing Portal

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Total Tests

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Passed

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Test Status

Passed: 0

Failed: 0

Pending: 0

Performance

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Recent Tests

Time	Patient	Drug	Payer	Type	Mode	Status	Duration	Fields	Actions
No tests yet. Submit a form to get started.

Single PA Form Test

Test Configuration

Payer *

Benefit Type *

Patient Information

Subscriber ID *

First Name *

Last Name *

Date of Birth *

Gender

Phone

Drug & Insurance

Drug Name *

State

Plan Name

eBV Gateway

Subscriber is Patient?

Requester (Provider)

NPI

First Name

Last Name

Specialty

Phone

Fax

Office Contact

Facility Address

City

State

Zip Code

Subscriber Details

Email

Address

City

State

Zip Code

Drug Dosage Strength

Quantity

Days Supply

Rx Start Date

Rx End Date

PA Form Upload

Drag & drop your PA form PDF here

or click to browse · PDF files only · Max 20MB

Bulk PA Form Testing

Download Excel Template

Upload an Excel file with patient records and match each row to a PA form PDF. The system will process each pair automatically.

Payer *

Benefit Type *

Step 1: Upload Excel File

Drop your Excel file here (.xlsx or .csv)

Required columns: firstName, lastName, subscriberId, dateOfBirth, drugName, state, planName

Step 2: Upload & Map PDF Forms

Upload Excel and PDFs to continue

Bulk Jobs

Job ID	Payer	Type	Total	Passed	Failed	Progress	Status
No bulk jobs yet

Automated Test Suite

Run predefined test scenarios covering smoke tests, edge cases, demographic variations, and coverage types automatically.

Payer

Benefit Type

Test Scenarios (10 scenarios)

All Test Results

Time	Patient	Drug	Payer	Benefit	Mode	Filename	Status	Duration	Fields	Error	Actions
No results yet

Activity Log

[System] PA Testing Portal started. Ready to receive submissions.