March 10, 2014

Cooperative Exchange to Provide Online Information Regarding Payers’ ICD-10 Testing

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Cooperative Exchange members have more than 5,000 direct payer connections. Imagine the amount of testing that will be going on in the next few months and all the different testing plans. Well, actually you don’t have to imagine – you will be able to find out for yourself!

To help facilitate ICD-10 testing during the remaining transition period, the Cooperative Exchange will gather information on payers regarding their testing parameters. There has been industry concern about the lack of knowledge regarding what to expect in testing from payers, and this will be a public one-stop resource hosted on the Cooperative Exchange’s website. This is a value add for Cooperative Exchange clearinghouse clients and all providers and clearinghouses, as this will be information that can be useful to them for their implementation processes.

Providers and clearinghouses will populate the database in 14 key areas. Information will be submitted anonymously using a username and password. Inputters will only have access to update payers they have already recorded and to add new payers. Reports will have the capability of presenting the data either by a single data point, multiple data points, or via a full spreadsheet. The key areas for input include:

  1.  Last update date – This will be an automatic date stamp feature, useful for running reports.
  2. Payer name – Initially, inputters with provide the payer name, but as more payers are entered, this will become a pre-populated dropdown list.

  3. Line of business – A dropdown will ask for a designation of professional, institutional, or both.

  4. Payer edit dates (deployment) – This important data will allow for choosing multiple days and will provide vital information when setting up your testing plan.

  5. Testing date (beginning).

  6. Testing date (end).

  7. Payer websites – A URL will go to the payer’s ICD-10 general info page.

  8. Allows future date testing? – Answered as a yes or no. If you enter no, you’ll be asked to supply which dates will trigger ICD-10 edits.

  9. Will a clearinghouse need to set up a new connection for ICD-10 testing? – Answered as a yes or no. If yes is entered, it will direct you to the payer’s testing plan.

  10. Will you be rejecting or denying claims for unspecified diagnosis codes? – Answered as a yes or no.

  11. Provider registration required? – Answered as a yes or no. If yes is entered, it will direct you to the payer’s testing plan.

  12. Will you be supporting testing with… – You will choose all submitters, selected providers, selected clearinghouses, or none.

  13. What is the payer returning – You will choose all that apply: 277, 835, 999, and/or other. There will also be a comments section.

  14. Payer testing plan – This is where you attach the payer’s testing plan document (including contact info and payer-required test cases).

As more and more payers’ testing information goes online, this will be the most dynamic tool for providers and clearinghouses to have as they plan and execute their testing strategies. The Cooperative Exchange is the recognized resource and representative of the clearinghouse industry for the media, governmental bodies, and other outside interested parties.

Their 23 clearinghouse members include ACS EDI Gateway; Apex EDI: Availity; Capario; ClaimLogic; Claimsnet; eProvider Solutions; GE Healthcare; Greenway; HDM Corp.; Health-e-Web; Jopari Solutions; NextGen Healthcare; OfficeAlly; OptumInsight; Passport Health; RelayHealth, Secure EDI; Siemens HDX; The SSI Group, Inc.; TriZetto Provider Solutions; Utah Health Information Network (UHIN); and ZirMed.

About the Author

Tim McMullen is executive director of the Cooperative Exchange.

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Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.
Tim McMullen, JD, CAE

Tim McMullen is the executive director of the Healthcare Administrative Technology Association (HATA). The association represents healthcare administrative technology and other affiliated stakeholders to protect the interest of and to promote the core values of this key market segment.