HP points of contact for EDI technical support. HP point of contact for extracts. Questions or concerns. Testing timeline

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1 ICD-10 Implementation Vendor Testing Expectations Hoosier Healthwise/Healthy Indiana Plan (HIP) Managed Care Entities (MCEs) Electronic Data Interchange (EDI) Encounters and Extracts HP points of contact for EDI technical support Marcia Reed: option Linda Stahl: option to inxixtradingpartner@hp.com HP point of contact for extracts Julie Baca at julie.a.baca@hp.com o Questions or concerns Submit questions/concerns to the ICD-10 SharePoint site at You must be granted access to the ICD-10 SharePoint site. To obtain access contact Julie Bandy at Julie.Bandy@FSSA.in.gov. Testing timeline Dates Type of testing Description/impact to vendor Hewlett-Packard Development Company, LP 1 January 2013

2 Dates Type of testing Description/impact to vendor January 1, March 30, 2013 Regression Testing HP will pull MCE and EDI trading partner production files and copy them to the user acceptance testing (UAT) test environment to be processed as new-day claims. This includes all claim types: inpatient, outpatient, medical and crossover claims. The MCEs and EDI trading partners are welcome to submit both ICD-9 and ICD-10 claim files during this timeframe. Please contact Marcia Reed or Linda Stahl for regression testing setup. HP will not provide vendor test plans. April 1, 2013 June 30, 2013 Vendor Extract Testing HP will generate the extract files and place them on File Exchange for vendors to pick up and process in their system. May 1, 2013 August 31, 2013 Formal EDI Transactional Testing Extract vendors will be expected to pick up the extracts from File Exchange, load them into their system and process them based on program needs. This includes validation of the new fields and or expanded field lengths. See last page of document for greater detail. HP will provide vendor test plans. HP will select one MCE and a few of the larger clearinghouses/trading partners to submit ICD-9 and ICD-10 claim files. EDI vendors will be expected to submit ICD-9 and ICD-10 claim files with the correct qualifiers and dates of service. See additional information below for MCE testing expectations during this timeframe. HP will provide formal transactional vendor test plans. October 1, 2013 ICD-10 Implementation ICD-10 fields and format qualifiers go live. October 1, 2013 December 31, 2013 January 1, 2014-June 30, 2014 January 1, 2014 March 31, 2014` Continue Transactional Testing Focused ICD-10 Vendor Testing Natively Coded ICD-10 1 day file submission testing EDI vendors will continue to submit ICD-9 and ICD-10 claim files. (See section above for details) HP will begin focused testing with the vendors in the following areas: 3M All Patient Refined Diagnosis Related Group (APR DRG) New/updated policies Myers and Stauffer reimbursement rate updates HP will provide focused vendor test plans. MCE trading partners to submit a full file of one day s worth of natively coded ICD-10 claims. Hewlett-Packard Development Company, LP 2 January 2013

3 Dates Type of testing Description/impact to vendor Dates To Be Determined External Vendor Testing Walkthroughs HP, Office of Medicaid Policy and Planning (OMPP) and vendors will review vendor testing results for all types of vendor testing: MCE, extracts, EDI 837 transactions October 1, 2014 Implementation of ICD-10 components General information for EDI encounter claims testing ICD-10 effective date that will be used for vendor testing is June 1, MCE vendor testing expectations APR DRG, Policy, Myers and Stauffer reimbursement rate updates will be implemented. This is the ICD-10 implementation go live. Test transactions must contain all possible fields that are applicable to your business for ICD-10 vendor testing. The following is a summary of the ICD-10 changes for the 837I and 837P Transactions. o ICD-10 diagnosis codes up to 7 characters alphanumeric (A/N) o ICD-10 procedure codes changed to 7 characters A/N o Up to 12 diagnosis codes on 837P Transaction o Up to 4 related diagnosis pointers at up to 2 A/N characters each on 837P transaction o ICD-10 qualifiers must be: 837I Transaction ICD-10 code qualifiers ABK: Principal Diagnosis ABJ: Admitting Diagnosis APR: Patient s Reason for Visit (only outpatient) ABN: External Cause of Injury ABF: Other Diagnosis BBR: Principal Procedure Code BBQ: Other Procedure Code 837P Professional ICD-10 code qualifiers ABK: Principal Diagnosis ABF: Other Diagnosis Test files should contain at least 5 claims, but not exceed 25 claims. It is the responsibility of the tester to submit all claim scenarios based on your business practices or those of your Indiana Medicaid clients. For example, replacements, voids, TPL, Medicare Crossovers, etc. Checking claims status during ICD-10 vendor testing o 835s will be available via File Exchange after weekly financial cycle (Mondays). You will be notified via by HP EDI technical support when they are available. o If necessary to review claim status prior to 835s - Complete the Claim Status Request spreadsheet. A maximum of 10 claims per file may be requested. Send the spreadsheet via secure to inxixtradingpartner@hp.com. The spreadsheet containing the ICN # and claim status will be returned via secure . Hewlett-Packard Development Company, LP 3 January 2013

4 1987 Claim Status Request-ICD-10 testin A 999 and a Submission Summary Report (SSR) will be placed in the trading partner s Home folder on File Exchange for each test file submitted. Provide a representative to participate in the vendor testing status meetings Complete vendor testing within the established timeframe set for vendor testing Send completed vendor test plan to Julie Baca at julie.a.baca@hp.com with name/date in the validation column, also include actual result information in the actual result column New rejection error codes claim is rejected reported on the SSR 837I Transactions: Error 269 Claim submitted with a mixture of ICD-9 and ICD-10 qualifiers on the ICD diagnosis and/or procedure codes. This is not permitted. 837P Transactions: Error 267 Claim submitted with a mixture of ICD-9 and ICd-10 qualifiers on the ICD diagnosis. This is not permitted. New denial edit claim is denied in adjudication process reported on the 835 Edit 0243 Span Dates Before and After ICD-10 Effective Date. Specific to Outpatient, Home Health and Crossover C. The claim will deny for this edit when the transaction is submitted with a From date that is before the ICD-10 effective date and the Through date is after the ICD-10 effective date. ICD-10 diagnosis codes, procedure codes and ICD-10 code qualifiers will be included on the claim. Edit 0245 ICD version indicator invalid for this diagnosis code. Specific to all claim types: Inpatient, Outpatient, Home Health, Long Term Care, Medical. The claim will deny for this edit when the transaction is submitted with incorrect claim version indicator and diagnosis code combination. For example: An outpatient claim is submitted with ICD-9 diagnosis codes & qualifiers. However one of the codes is actually a ICD-10 code. The system will validate that yes the diagnosis code is present but not for ICD-9. NOTES: o New processing logic will require vendors to split Outpatient, Home Health and Crossover C Claims if the service dates span the before/after ICD-10 effective date. o The validity of the ICD diagnosis code and or ICD procedure code will be determined during claims adjudication based on the dates of service on the claim. HP will leverage existing edits for validity. See attached documents Business Design 03 - Business Design 1987 Business Design1987 Business Design Focused vendor testing Focused ICD-10 Vendor Testing will begin January This phase will include testing of the following: APR-DRG Hewlett-Packard Development Company, LP 4 January 2013

5 Policy, i.e., sterilization, hysterectomy, and policies mandated by federal regulations (list will be provided) Specific reimbursement policies, such as exam code rates, EPSDT (list will be provided) Natively coded ICD-10 one day transactional file testing. MCEs to submit a file containing an average day s submission containing only ICD-10 coded claims. HP vendor testing expectations: Provide point of contact(s) to assist in testing Notify MCEs when 999s, SSRs and 835s are placed in MCE s File Exchange folder Validate a sample of the 837I and 837P transactions to ensure that the MCE is submitting 837I and 837P transactions with the appropriate ICD diagnosis and/or procedure codes. This includes replacements/voids. HP point of contact for extracts Julie Baca at Julie.a.baca@hp.com General information for extract testing Extract changes ICD-10 diagnosis codes up to 7 characters A/N o Previously 3-5 characters ICD-10 procedure codes changed to 7 A/N characters o Previously 4 characters Up to 12 diagnosis codes on Physician claim o Previously 8 diagnosis codes Up to 4 related diagnosis pointers at up to 2 A/N characters each on 837P transaction o Previously 4 pointers at 1 character each Institutional claim may have up to 27 diagnosis codes o Previously only 10-plus Admitting and E codes were reported MCE extract testing expectations Provide HP one primary point of contact as well as ancillary contact. Ensure vendor system has been fully remediated for ICD-10 prior to the start of assigned testing period. Pick up files within 24 hours of notification Complete all testing during the vendor s assigned testing period Send completed vendor test plan to Julie Baca at julie.a.baca@hp.com with name/date in the validation column, including actual result information in the actual result column Ensure extract is placed in correct folder by HP Extract contains data fields in correct position/sequence and format Hewlett-Packard Development Company, LP 5 January 2013

6 Extract contains data appropriate to the vendor (each vendor gets only the information they are allowed to see for their population) Extract is compatible with their planned system changes HP testing expectations HP enters test data for time frame after ICD-10 is effective so extract files will contain a mixture of claims with either ICD-9 or ICD-10 information. Provide Point of Contact for assistance during vendor extract testing. Revision history Date Author Revision 7/27/12 Julie Baca Create document. 8/13/2012 Julie Baca Updates based on internal review. 8/17/2012 Julie Baca Additional updates per internal review/accept updates from internal review 9/20/2012 Julie Baca Archive copy due to OMPP/HP revised approach for vendor testing. 10/3/2012 Julie Baca Removed reference to EDI error 267, CC# 677 to combine multiple EDI level 7 edits into one edit for 837I (269) and (267) for 837P. 10/8/2012 Rebecca Liming and Vanessa Ransom 10/11/12 Rebecca Liming and Vanessa Ransom Updated document from HP ICD-10 Lead deliverables review. Updated documents from FSSA ICD-10 Lead deliverables review 03/20/2013 Julie Baca Updated Marcia Reed, Linda Stahl and Julie Baca phone numbers. Hewlett-Packard Development Company, LP 6 January 2013