end-to-end testing for icd-10 june 18, 2013. proprietary and confidential...

End-to-End Testing for ICD-10June 18, 2013

Proprietary and Confidential

ngs.compliancetesting@wellpoint.com

Welcome

Presenters: Kari Gaare, Centers for Medicare & Medicaid ServicesDean Cook, National Government Services, Inc.

Topics Why this project is needed

What we set out to do

What we have completed to date

What we continue to do

– Checklists (High Level and Detailed)

– Collaboration (ICPs, Listening Sessions)

– Other collaboration (CMS, HIMSS, NGS, WEDI)

More information

Questions

Why this project is needed

Why this project is needed Past implementation challenges

Upcoming regulatory requirements

– Need for further clarification of terms in ACA

January 1, 2014 Compliance date for EFT/ERA standard and operating rules

October 1, 2014 Compliance date for ICD-10

December 31, 2013 and December 31, 2015 Health plans certify compliance

November 7, 2016 Compliance date for Health Plan Identifier (HPID)

End-to-end (E2E) testing process

Regulatory requirement

Implementation

End-to-end (E2E) testing • Level 1 testing • Level 2 testing • Level 3 testing

Transition to production

Compliance date

Successful implementation

What we set out to do

To develop and implement a process and methodology for end-to-end testing of the transaction standards, operating rules, code sets, identifiers, and other Administrative Simplification requirements based on industry feedback and participation.

To develop an industry-wide “Best Practice” for end-to-end testing that lays the ground work for a more efficient and less time consuming method for health care industry testing of future standards, leading to more rapid adoption of the future standards.

Intended outcomes Documents for all industry segments outlining the critical

checkpoints needed to ensure compliance. Checklist drafts are published and available and continue to be refined and published.

Universal testing process and methodology that can be adopted by all industry segments

─ Included in the checklists that continue to be refined and published.

─ Variation may occur depending on the requirement

Framework with definitions for end-to-end testing process, readiness, and compliance. Complete and published.

What we have completed to date

Pilot definitions approved Term Definition

End-to-end testing End-to-End testing is a focused process within a defined area, using new or revised applicable products, operating rules or transactions, throughout the entire business and/or clinical exchange cycle, for the purpose of measuring operational predictability and readiness. The End-to-End testing process should be performed in an environment which mirrors actual production as closely as possible, confirming the validation of performance metrics and analytics (reporting).

Readiness Readiness is a state of preparedness in which an Entity has completed verification and validation of applicable policies, procedures, guidelines, laws, regulations, and contractual arrangements with expected results. Additionally, entities will demonstrate readiness by completing internal documentation, establishing communication mechanisms and validation with external trading partners, training of appropriate personnel , scheduled deployments, and software migration for each regulatory requirements.

Compliance Demonstrated adherence to those policies, procedures, guidelines, laws, regulations to which the business process is subject in advance of, by or after the regulatory implementation date.

Levels definedLevel Explanation of purpose

1 The period during which entities perform all of their internal readiness activities in preparation for testing the new versions of the standards with their Trading Partners. When an entity has attained Level 1 compliance, it has completed all internal readiness activities and is fully prepared to initiate testing of the new versions in a test or production environment, pursuant to its standard protocols for testing and implementing new software or data exchanges.

2 The period during which entities are preparing to reach full production readiness with Trading Partners. When an entity is in compliance with Level 2, it has completed some end-to-end testing with external Trading Partners. Key difference between Level 1 and Level 2: Level 2 is done in a “production-like” environment that may not be exactly a replicate of the production system.

3 The period during which end-to-end testing is performed with external Trading Partners and the Trading Partner is able to operate in production/production-like mode with the new versions of the standards by the end of that period. By ‘‘production/production-like mode”, we mean that entities can successfully exchange (accept and/or send) standard transactions and, as appropriate, be able to process them successfully. Key difference between Level 2 and Level 3: Level 3 is conducted in the same environment that is used when going “live” and into production.

Levels and Elements assigned

Transition

Planning Assessment Design Development Testing Transition

Level 1 is the period during which entities perform all of their internal readiness activities in preparation for testing the new versions of the standards with their Trading Partners. When an entity has attained Level 1 compliance, it has completed all internal readiness activities and is fully prepared to initiate testing of the new versions in a test or production environment, pursuant to its standard protocols for testing and implementing new software or data exchanges.

Assessment Design Testing Transition

Level 2 is the period during which entities are preparing to reach full production readiness with Trading Partners. When an entity is in compliance with Level 2, it has completed some end-to-end testing with external Trading Partners. Key difference between Level 1 and Level 2: Level 2 is done in a “production-like” environment that may not be exactly a replicate of the production system.

Planning Testing

Level 3 is the period during which end-to-end testing is performed with external Trading Partners and the Trading Partner is able to operate in production/production-like mode with the new versions of the standards by the end of that period. By ‘‘production/production-like mode,’’ we mean that entities can successfully exchange (accept and/or send) standard transactions and, as appropriate, be able to process them successfully. Key difference between Level 2 and Level 3: Level 3 is conducted in the same environment that is used when going “live” and into production.

What we continue to do

Checklists

Industry segmentsAt this time there are five industry segments being addressed in this

project.

Small Provider Large Provider Payer Vendor-to-Payer Vendor-to-Provider

These industry segment checklists are all in continuous development

and revision.

High level documentsThe High Level End-to-End Testing Documents provide more of an overview than the “detailed” checklists.

There are two high level documents created for each industry segment (ICD-10 and Administrative Simplification).

Each High Level End-to-End Testing Document includes a Process Flow chart as a visual aid for the user.

These documents are available from the CMS End-to-End Testing web page located at http://www.cms.gov/Regulations-and-Guidance/HIPAA-Administrative-Simplification/Affordable-Care-Act/End-to-End-Testing.html.

High Level ICD-10 End-to-End Testing Documents

Detailed checklistsThe “detailed” checklists are Excel workbooks. Each identified industry segment has a detailed checklist.

Within the detailed checklists there are tabs for each of the following:

Instructions Definitions Initial Assessment checklist Administrative Simplification checklist ICD-10 checklist Testing Guidance checklist

These checklists are available from the CMS End-to-End Testing web page located at http://www.cms.gov/Regulations-and-Guidance/HIPAA-Administrative-Simplification/Affordable-Care-Act/End-to-End-Testing.html.

Large Provider

Small Provider

Vendor-to-Payer

Vendor-to-Provider

ICD-10 End-to-End Testing Checklists

Microsoft Excel Worksheet

Collaboration(Industry input, outreach, and participation)

Industry Collaborative Partners (ICPs) Aetna* American Health Insurance Plans (AHIP)* American Hospital Association (AHA) American Medical Association (AMA) CMS Medicaid CMS Medicare Fee For Service Emdeon Healthcare Billing & Management Association (HBMA) IVANS Medicaid – CSG Government Solutions Medical Group Management Association (MGMA) Nachimson Advisors, LLC Providence Health and Services TIBCO Foresight TRICARE UNC Health Care Walgreens WellPoint Veteran’s Affairs

* Count as one ICP.

ICP Webinars Participation by invitation; there are 18 ICPs Weekly or semi-weekly webinars (Tuesdays and Thursdays) as

needed Review and input forum for the following:

– Checklists– Related materials– Q&A from mailbox, webinars, and other special presentations

# Sessions # ICPs Avg # registered Avg # attend % Reg vs. attend

31 17 17 11 67%

Listening Sessions Weekly or semi-weekly webinars (Tuesdays and Thursdays); more

sessions and other days as needed to meet demand Open sessions; invitation requests via email to

ngs.compliancetesting@wellpoint.com NGS presentations with Q&A session following All registered attendees receive a copy of the presentation and the

related checklists via email; the checklists are also available on the CMS End-to-End Testing web page

Listening Sessions are on a break until July 2013 to allow the team to incorporate feedback and suggestions

Upcoming sessions will be listed on the CMS End-to-End Testing web page.

Listening Sessions

Listening Sessions # Sessions to date Total attendance Average attendance

Small Provider 14 963 69

Large Provider 12 1,128 94

Vendor 12 764 64

Payer 9 765 85

Special sessions 3 302 101

Total 50 3,922 78

Other outreach Questions, comments, and requests via email (

ngs.compliancetesting@wellpoint.com)

NGS Surveys

– Round 1 – January 2013

– Round 2 – March 2013

NGS Listening Session Real Time Polls

– Began April 16, 2013

– Continue when Listening Sessions resume in July 2013

Other collaborations(CMS, HIMSS, NGS, WEDI)

Collaboration

CMS/NGS and HIMSS/WEDI collaboration CMS materials will be included in HIMSS/WEDI ICD-10 National

Pilot Program

HIMSS/WEDI participants will review and provide feedback on the checklists

CMS/NGS will review the products and results of the pilot program

Differences

CMS/NGS and HIMSS/WEDI processes CMS/NGS is developing definitions and a description and

framework of end-to-end testing for all Administrative Simplification requirements, including ICD-10

HIMSS/WEDI is an actual application of testing specific to ICD-10

– Pilot sandbox to play in to test process

CMS End-to-End Testing Pilot

What it does NOT include. A software package or application that will create test claims for the

industry

Test data to be used by the industry

A testing environment or universal testing platform

CMS/NGS timelineNGS Pilot for End-to-End Testing Phase I – Business and Gap Analysis - September 24, 2012 through

December 21, 2012 (Complete) Phase II - Development of Pilot Testing (Artifacts, Definitions, Process and

Methodology) - December 10, 2012 through June 27, 2013 (approximately six months)*

Phase III - Implementation and Quality Assurance is July 1, 2013, and will run through September 23, 2013 (approximately three months)*

HIMSS ICD-10 National Pilot Program Early Phase – April 2013 through July 2013 Second or Middle Phase – August 2013 through December 2013 Third or Late Adopter Phase – January 2014 through June 2014

CMS/NGS timeline

More information

CMS ICD-10 web page located at http://www.cms.gov/Medicare/Coding/ICD10/

CMS End-to-End Testing web page located at http://www.cms.gov/Regulations-and-Guidance/HIPAA-Administrative-Simplification/Affordable-Care-Act/End-to-End-Testing.html has links to all the checklists.

CMS Email Updates (CMS ListServ) feature is availableon all CMS web pages. Submitting your email addressensures notification of CMS updates including End-to-EndTesting checklists and other related documents.

Medscape Education modules link is available from the CMS ICD-10 web page (https://login.medscape.com/login/sso/getlogin?urlCache=aHR0cDovL3d3dy5tZWRzY2FwZS5vcmcvdmlld2FydGljbGUvNzY1NzU0&ac=401). Note that “Continuing medical education (CME) credits are available to physicians who complete the modules, but anyone can take them and receive a certificate of completion.”

Contact information All questions may be sent to ngs.compliancetesting@wellpoint.com

– Our expected level of service is to respond within one business day

Additional contact resources . . .

Resource Role Email addresses Work phone Cell phone

David Carrier Lead BA David.Carrier@WellPoint.com (207) 253-1203 (207) 210-2340

Dean Cook Advisor/SME Dean.Cook@WellPoint.com (502) 889-4762 (502) 376-6510

Julie McBee BA/POE Julie.McBee@WellPoint.com (317) 595-4908 (317) 586-0021

Questions?

end-to-end testing for icd-10 june 18, 2013. proprietary and confidential...

date slide

endtoend testing process

testing transition

universal testing process

industry segments

operating rules

focused process

industry feedback

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