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!- Last update date – This will be an automatic date stamp feature, useful for running reports.
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Payer name – Initially, inputters with provide the payer name, but as more payers are entered, this will become a pre-populated dropdown list.
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Line of business – A dropdown will ask for a designation of professional, institutional, or both.
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Payer edit dates (deployment) – This important data will allow for choosing multiple days and will provide vital information when setting up your testing plan.
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Testing date (beginning).
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Testing date (end).
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Payer websites – A URL will go to the payer’s ICD-10 general info page.
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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.
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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.
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Will you be rejecting or denying claims for unspecified diagnosis codes? – Answered as a yes or no.
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Provider registration required? – Answered as a yes or no. If yes is entered, it will direct you to the payer’s testing plan.
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Will you be supporting testing with… – You will choose all submitters, selected providers, selected clearinghouses, or none.
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What is the payer returning – You will choose all that apply: 277, 835, 999, and/or other. There will also be a comments section.
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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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