ICD-10 Updates – Testing with Providers
We are dedicated to testing the implementation of ICD-10. Our goals are to help ensure technical and business continuity while validating that the company and our trading partners are ready for ICD-10. Our Business and IT teams have begun a comprehensive process of identifying trading partners and internal areas of the company that require systems or process modifications and determining a test approach based on risk and volume.
By taking a risk-based approach to testing, we ensure that we are first targeting high value, critical partnerships as well as areas within the organization to demonstrate we are ready for ICD-10 on October 1, 2014. This testing approach helps assure that we are correctly and successfully able to execute and support our business, partners, providers, customers and communities.
Our testing approach is divided into two areas:
1. Technical Integrity test: These are designed to exercise our systems, databases, interfaces, applications and supporting processes to verify they are correctly implemented and function to maintain continuity of critical systems for us. This technical integrity testing is conducted in our test environments including the claims entry points, our claims processing platforms, and the interfaces to other systems.
2. Business Integrity test: These are designed to verify that our critical business processes, functions and supporting services maintain business continuity and have identified the risks and impacts anticipated with the implementation of ICD-10. Our Business Integrity testing exercises business processes and functions that manage our claims processing and reporting functions.
Currently we are actively planning the details for our external trading partner test strategy and we will begin testing in early 2014.
Self-Tested File Validation
We have chosen Validator as our primary testing tool for EDI direct-submitters. Validator is a self-guided, web-based processing tool that is equipped to test file formats and edits as they pertain to ICD-10. The tool will be available to our partners beginning 1st quarter 2014.
An End-to-End test of our systems and business functions which demonstrates ICD-10 readiness levels both internally and externally launches in 1st quarter 2014. The End-to-End test will engage selected providers, hospitals, clinical EMR providers, vendors, data trading partners and others to help ensure we are ready for ICD-10 across the industry. We will share guidance and learning gained from these tests with you as we prepare for ICD-10.
Outcomes of Testing
By conducting both our Self-Tested File Validation testing and End-to-End testing of our systems with our External Partners, Provider Community and others, we will verify:
1. Claims files are correctly processed in our EDI Gateway.
2. Claims are correctly processed through the transaction flow of platforms/systems. Claims are correctly populated with the right codes for ICD-10 (they’ve mapped/coded as expected)
3. Claims are correctly processed for expected business outcome for us and the Provider.
Look for a more details on our test strategy in 4th quarter 2013.
Make sure to check back for updates! We look forward to sharing our progress.