end-to-end (e2e) testing july 8, 2015end-to-end (e2e) testing july 8, 2015 1 background all hipaa...
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End-to-End (E2E) Testing
July 8, 2015
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Background All HIPAA covered entities are required to begin using ICD-10
codes, rather than ICD-9 codes, for claim transactions with a date of service on or after October 1, 2015
For Professional, Dental and other outpatient claims, this means a change to use of ICD-10 diagnosis codes, but no change in procedure codes
Our goals: provide continued access to care by Medicaid program beneficiaries and continued revenues to our provider community for covered services they perform
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ICD-10 End-to-End Testing Objectives Verify State systems and interfaces address defined processing
requirements in accordance with ICD-10 design documents
Verify State staff can employ business processes that support overall MDHHS departmental objectives and system functions
Ensure system and procedure changes result in acceptable overall financial and operational program performance
Verify Providers, Business Partners, and Trading Partners can communicate with the State using ICD-10 coded transactions via the Data Exchange Gateway (DEG), web portal and custom interfaces
Ensure that Business Partners are ICD-10 compliant with their contracted systems and information processing functions
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B2B Testing
Goals Verify successful processing of ICD-10 HIPAA EDI transactions
with Providers and Trading Partners (Billing Agents and Service Bureaus)
Support Provider testing activities – either through use of our Trading Partners or via direct communication with our provider portal
Support our Business Partners, Trading Partners and Providers as they remediate their systems and procedures and conduct B2B Testing to ensure readiness by the ICD-10 compliance date
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B2B Testing (cont’d)
Key Success Factors Establish Provider and Trading Partner access to the CHAMPS
ICD-10 B2B test system, via a test version of the provider portal
Work with the MDHHS Awareness & Training Team in their early and frequent discussions with health plans, providers and associations to encourage their system remediation and testing with us
Assess Provider and Trading Partner feedback quickly; communicate revisions and re-test necessary changes as soon as possible
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B2B Testing (cont’d)
Approach Allow existing billing agents to upload ICD-10 (or ICD-9) coded 837
test transactions, obtain/review processing results
Allow enrolled providers to submit new ICD-10 claims or adjust (recode, re-date) ICD-9 claims and resubmit as ICD-10 claims
Michigan’s ICD-10 B2B environment is a snapshot of production, with 17 months of ICD-9 claims history; eligibility data updated from production on a daily basis
We use a “dummy compliance date” of 6/1/2014 in the B2B Test Environment for cutover from ICD-9 to ICD-10
Managed care plans are encouraged to test processing of ICD-10 claims with their providers and ICD-10 encounters with MDHHS
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Outpatient Scenario-based Testing A coding/awareness exercise for our providers Survey Monkey is the platform for our anonymous
survey Physician/PA/Nurse Practitioner or Coder/Biller options 66 scenarios created, within 11 provider specialty areas Participants can specify up to 8 ICD-10 diagnosis codes
per scenario Participants receive an email in response, comparing
their responses to other survey participants No “right answers” are supplied by MDHHS
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Survey – Introductory Information
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Survey - Provider Specialty Areas
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Survey – Example Outpatient Scenario
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Survey – Sample Survey Response
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www.Michigan.gov/TradingPartners
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Questions? We welcome your questions about Michigan’s ICD-10
testing strategy and look forward to testing with you
For further information, feel free to contact: [email protected]
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