ICD-10 Updates – Testing with Providers
We are conducting File Validation Testing for providers who are EDI direct submitters. We have chosen TIBCO Validator® as our primary testing tool that offers unlimited testing of your EDI HIPAA transactions. This self-guided, web-based processing application is equipped to test file formats and edits as they pertain to ICD-10.
To get started
, visit our BCBSGa EDI Webpage
where you will find the “Free On-Line HIPAA Validation Testing” link to register for Validator® and more information and the guidelines for using the tool.
If you are not an EDI direct submitter, you will need to partner with your claims submission vendor (clearinghouse, billing company, etc.) to test with us.
As you develop your ICD-10 testing strategy, here are some suggested best practices to consider:
| Use real medical records to test systems. Make sure you're testing the types of cases you will actually be treating and submitting for reimbursement.|
| Submit test data that reflects your actual case load volume. |
| Dual coding will help create test data that can be used.|
| Have the documentation available that supports your test ICD-10 codes. |
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 outcomes for us and the Provider.