Emdeon Office ICD-10 Testing Guide. Published Q2 2014

Transcription

1 Emdeon Office ICD-10 Testing Guide Published Q2 2014

2 Preface This information is provided by Emdeon for education and awareness use only. Even though Emdeon believes that all the information in this document is correct as of the date of the publication of this version, Emdeon does not warrant the accuracy, completeness, or fitness for any particular purpose of this information. All use is at the reader s own risk. The information provided here is for reference use only and does not constitute the rendering of legal, financial, or other professional advice or recommendations by Emdeon Emdeon Business Services LLC, 3055 Lebanon Pike Suite 1000, Nashville, TN All Rights Reserved. Printed in the USA.

3 Contents Emdeon Office ICD-10 Testing Solution... 4 Emdeon Office ICD-10 Testing Overview... 5 Testing Instructions by Claim Submission Method... 6 HIPAA X V NSF Upload... 6 Online Claim Creation... 6 CMS and HCFA 1500 Forms (Print Image)... 7

4 Emdeon Office ICD-10 Testing Solution Emdeon is pleased to announce the Emdeon Testing Exchange for ICD-10, a free solution for testing claims coded with ICD-10 data content with Emdeon. Depending upon the specific manner in which you submit your claims, the Emdeon Testing Exchange for ICD-10 may be available for you to use. After reviewing the general explanation of what the Emdeon Testing Exchange can do for you, please review the section of this document that matches the way you create and send claims for detailed instructions. The ICD-10 Testing Exchange pathway: - Allows you to test directly with Emdeon in order to verify and validate your ability to generate valid ICD-10 coded claims and receive standard clearinghouse reporting feedback in the form of the reports commonly referred to as RPT02, RPT03, RPT04 and RPT05. For more information about these report types, please review the Claims User Guide, which can be found on the Emdeon Office home page. - Allows you to send ICD-10 coded test claims for a specific destination payer, if the payer has requested that Emdeon forward ICD-10 test claims to it. If you only need to test with Emdeon and do not wish to have your claims forwarded to participating payers, you should utilize the Payer ID ICD10 as the primary payer. Claims submitted using Payer ID ICD10, will receive generic Emdeon Exchange validation and reporting feedback. This allows you to test your ability to generate valid ICD-10 coded test claims without directing this testing to a given payer. On the other hand, if you do want to make your ICD-10 coded test claims available to payers, simply indicate the appropriate payer as you would on an ordinary claim. Emdeon will validate these claims and store accepted claims for delivery to participating payers upon their request. Emdeon encourages providers to collaborate directly with payers upon determining the payer's participation availability and testing criteria. Testing criteria might include supported membership data, specific claim types and dates of service. Providers should also collaborate with payers to discuss the specific ICD-10 codes and scenarios they want to test and analyze together. Coordinating with the payer prior to sending your test claims to Emdeon will dramatically increase the likelihood that the payer will request your ICD-10 test claims. Emdeon will ensure your test claims are made available to your specified payers whenever requested, but will not deliver them unprompted and cannot guarantee that payers will request or utilize your test claims. Regardless of whether you are testing with a payer or testing only with Emdeon, you will receive "RPT" reports ed to your Office secure mail account containing the results of the Emdeon test. For most customers, these reports will be just like reports received for real claims. However, some Emdeon Office customers do not receive RPT reports, as the Reporting & Analytics suite of reports is generally a superior way to receive the same information. However Reporting & Analytics will not contain information about your test claims. Therefore, if you have disabled receipt of RPT reports you may wish to re-enable them before you begin testing. Please visit the "Manage Users" and/or "My Accounts" options under the Emdeon Office Setup menu to adjust which RPT reports are delivered to you

5 Emdeon Office ICD-10 Testing Overview

6 Testing Instructions by Claim Submission Method Most of the options outlined below require that you contact Emdeon to assist with your test. The best way to do this is to select the option for "24/7 Online Support" on the Office home page. From there, you can create a ticket requesting assistance with your testing. HIPAA X V 5010 If the claims you upload to Emdeon are in the HIPAA version 5010 format at the time that you upload the file, then this section applies to you. If you are uploading X12 formatted claims but you are still using version 4010, you will need to upgrade to version 5010 or convert to one of the other submission methods outlined in this document before you will be able to submit ICD-10 codes. To submit version 5010 formatted claims to the ICD-10 Test Exchange, you have two options. The first option is to include a T (test indicator) value in the ISA-15 header. Emdeon will automatically route any claims carrying the T indicator to the test system. Alternately, if changing the header value is inconvenient for you, you may contact Emdeon to have your account placed into "test" mode. While in test mode, all claims received will be submitted to the test system. You will need to contact Emdeon again to have your account returned to the normal mode so that your real claims can be processed. NSF Upload If you are currently submitting claims to us that utilize the NSF format, you must upgrade to a newer format in order to submit ICD-10 codes. Please contact us for assistance in making this change or evaluating your options. Online Claim Creation If you create your claims within Emdeon Office, as opposed to uploading a file created in your practice management system, then this section applies to you. As the creation of claims containing ICD-10 codes will be accomplished by Emdeon, we will perform general testing on behalf of all of our customers to ensure that our system handles the new code set correctly. We anticipate beginning our testing in the fourth quarter of this year. Our testing will require no action on your part. However, if you would like to practice creating claims with the new codes or if you are interested in finding out how either Emdeon or a payer partner will handle various combinations of ICD-10 codes and specific encounter or patient attributes, you may be interested in using our test system. We anticipate that the test system will become available for your use near the end of this year. At that time, you should notice that we will have added the option to select an ICD-10 code to our claim screens. To test with the new codes, you must contact Emdeon to have your account placed in test mode. Once you've received confirmation that your account is in test mode, create and submit your test claims. Finally, contact us again to have your account reverted to normal mode. Emdeon reports will be delivered to your Emdeon Office secure mail box. If you are working with a participating payer, feedback from that payer should be obtained directly from that payer.

7 CMS and HCFA 1500 Forms (Print Image) If the file of claims you upload to Emdeon Office is created by using the print option in your practice management system, this section applies to you. We anticipate allowing ICD-10 codes to be submitted in print image files in two different ways. The preferred ICD-10 print image option will be for you to upgrade your practice management system to utilize the new print format for claims. This new form has an expanded diagnosis code area where longer ICD-10 codes will fit. In addition, it allows you to specify whether the ICD code indicated is a version 9 or version 10 code. If you are not able to update to the new print image form, then the alternative solution we plan to offer will require you to send the ICD code version indicator in an otherwise unused portion of the form. Although you will need to work with us to make this customization available, there is no charge for this adjustment. Under this strategy, you will output ICD-10 codes in the same fields you currently use to output ICD-9 codes. Before you begin sending claims files that utilize either of these solutions you must work with Emdeon to have your account updated. This will allow us to validate that we can read the new format. As indicated above, both solutions require that you include the ICD version indicator in your claim. This is because we expect there to be a period of time immediately following the ICD-10 compliance deadline where you will be submitting a mix of claims for dates of service before the deadline (expected to contain ICD-9 codes) and claims with dates of service after the deadline (expected to contain ICD-10 codes). Since the service dates are not an absolute guarantee of the type of code included with the claim, it is critical that you indicate on each and every claim which version of diagnosis code is intended. Once we have configured your account with the ability to send ICD-10 codes, the process for creating a test file containing ICD-10 coded claims is simple. You need only contact us to have your account moved to test mode. Then you will create a file containing ICD-10 codes. Once you've sent it to us, request that we revert your account to normal mode. Reports for the test claims will be delivered to your secure mail inbox. Emdeon is a leading provider of revenue and payment cycle management and clinical information exchange solutions, connecting payers, providers, and patients in the U.S. Healthcare system. Emdeon s product and service offerings integrate and automate key business and administrative functions of its payer and provider customers throughout the patient encounter. Through the use of Emdeon s comprehensive suite of products and services, which are designed to easily integrate with existing technology infrastructures, customers are able to improve efficiency, reduce costs, increase cash flow and more efficiently manage the complex revenue and payment cycle and clinical information exchange processes. For more information, visit Emdeon Business Services LLC. All rights reserved Lebanon Pike, Suite 1000 Nashville, TN EMDEON.6 ( )