End-to-End (E2E) Testing

July 8, 2015

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Background All HIPAA covered entities are required to begin using ICD-10

codes, rather than ICD-9 codes, for claim transactions with a date of service on or after October 1, 2015

For Professional, Dental and other outpatient claims, this means a change to use of ICD-10 diagnosis codes, but no change in procedure codes

Our goals: provide continued access to care by Medicaid program beneficiaries and continued revenues to our provider community for covered services they perform

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ICD-10 End-to-End Testing Objectives Verify State systems and interfaces address defined processing

requirements in accordance with ICD-10 design documents

Verify State staff can employ business processes that support overall MDHHS departmental objectives and system functions

Ensure system and procedure changes result in acceptable overall financial and operational program performance

Verify Providers, Business Partners, and Trading Partners can communicate with the State using ICD-10 coded transactions via the Data Exchange Gateway (DEG), web portal and custom interfaces

Ensure that Business Partners are ICD-10 compliant with their contracted systems and information processing functions

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B2B Testing

Goals Verify successful processing of ICD-10 HIPAA EDI transactions

with Providers and Trading Partners (Billing Agents and Service Bureaus)

Support Provider testing activities – either through use of our Trading Partners or via direct communication with our provider portal

Support our Business Partners, Trading Partners and Providers as they remediate their systems and procedures and conduct B2B Testing to ensure readiness by the ICD-10 compliance date

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B2B Testing (cont’d)

Key Success Factors Establish Provider and Trading Partner access to the CHAMPS

ICD-10 B2B test system, via a test version of the provider portal

Work with the MDHHS Awareness & Training Team in their early and frequent discussions with health plans, providers and associations to encourage their system remediation and testing with us

Assess Provider and Trading Partner feedback quickly; communicate revisions and re-test necessary changes as soon as possible

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B2B Testing (cont’d)

Approach Allow existing billing agents to upload ICD-10 (or ICD-9) coded 837

test transactions, obtain/review processing results

Allow enrolled providers to submit new ICD-10 claims or adjust (recode, re-date) ICD-9 claims and resubmit as ICD-10 claims

Michigan’s ICD-10 B2B environment is a snapshot of production, with 17 months of ICD-9 claims history; eligibility data updated from production on a daily basis

We use a “dummy compliance date” of 6/1/2014 in the B2B Test Environment for cutover from ICD-9 to ICD-10

Managed care plans are encouraged to test processing of ICD-10 claims with their providers and ICD-10 encounters with MDHHS

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Outpatient Scenario-based Testing A coding/awareness exercise for our providers Survey Monkey is the platform for our anonymous

survey Physician/PA/Nurse Practitioner or Coder/Biller options 66 scenarios created, within 11 provider specialty areas Participants can specify up to 8 ICD-10 diagnosis codes

per scenario Participants receive an email in response, comparing

their responses to other survey participants No “right answers” are supplied by MDHHS

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Survey – Introductory Information

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Survey - Provider Specialty Areas

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Survey – Example Outpatient Scenario

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Survey – Sample Survey Response

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www.Michigan.gov/TradingPartners

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Questions? We welcome your questions about Michigan’s ICD-10

testing strategy and look forward to testing with you

For further information, feel free to contact: MDCH-B2B-Testing@Michigan.gov

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