ICD-10 Testing with CMS
CMS is offering two different levels of testing for ICD-10. The first level,
Acknowledgement-Based Testing, allows healthcare stakeholders that submit
claims to Medicare to determine if their claims will be accepted by the Medicare
Administrative Contractors (MACs). The second level, Limited End-to-End Testing,
allows selected industry stakeholders to submit ICD-10 test claims to the MACs and
receive a Remittance Advice (RA) in return.
Acknowledgement-Based Testing
Acknowledgment-based testing is meant to ensure providers’ claims and files with
ICD-10 codes will pass into their MAC’s adjudication system and to demonstrate that
CMS as well as the MACs are prepared for the ICD-10 implementation. For this
testing, claims will be validated that they meet the HIPAA 5010 transaction standard,
ICD-9 and ICD-10 edits plus transaction dates. Once the claim file is submitted, CMS
will return a 277CA or 999 acknowledgement to confirm that the claim was accepted or
rejected by Medicare.
Acknowledgement-based test claims may be submitted up to the implementation date
of October 1, 2015. Leading up to the implementation date, MACs will host special
acknowledgement testing weeks. During those weeks, the MACs will increase the help
desk staff to handle increased call volume and offer real-time support during the hours
between 9:00 AM and 4:00 PM. Acknowledgement-based testing will also allow CMS
to analyze the testing data submitted to gauge industry readiness.
Limited End-to-End Testing
CMS will be doing limited end-to-end testing with 850 providers in three testing weeks.
Registration for this testing is required. CMS recommends using claim examples that
will go through the adjudication process without additional documentation to support
the services billed. To participate in the Limited End-to-End testing, claims from the
selected providers will need to meet specific criteria:
 Each provider will be allowed to test 50 claims over the course of the week. To
allow the MACs to set up their test systems, the selected providers must submit
the
• Medicare Beneficiary ID Numbers (HICNs) – up to ten numbers
• MAC PTAN and NPI – you may use up to five NPIs
 Test files must have a “T” in the ISA15 field
 ICD-10 codes should be on test claims with a date of service on or after 10/1/2015
 ICD-9 codes should be on test claims with a date of service before 10/1/2015
The MACs will return the RA three days after submission of the test file. These files will
be marked as test with a “T” in the ISA15 field. Pricing on the RA will be the pricing
contained in the test environment at the time the test claims are processed. Every
tester will be limited to 50 claims: therefore, if you do not submit claims directly to
Medicare, you will need to work with your clearinghouse or practice management
vendor to determine if your claims will be tested. Each level of testing offers slightly
different validation for providers. If selected for the Limited End-to-End testing,
consider using claims that represent your most frequently billed services. The testing
environment is also a good opportunity to test your policies and procedures.
North Carolina Healthcare Information and Communications Alliance, Inc.
RED ALERT
COUNTDOWN
260 Days
(As of January 13, 2015)
Acknowledgement
Testing Dates
March 2 -6, 2015
June 1-5, 2015
End-to-End
Testing Dates
January 26 -30, 2015
April 27 - May 1, 2015
July 20 -24, 2015
ICD-10 Training
Wake AHEC
Comprehensive
Coding Using ICD-10CM for the
Physician’s Office
February 17, 2015
Raleigh, NC
AHIMA Advanced
ICD-10-PCS Skills
Workshop
March 4-6, 2015
Morrisville, NC
NCHICA formed the
ICD-10 Taskforce in
February 2009 to
assist members in
their ICD-10
implementation efforts.
If you would like
additional information,
click here.
PO Box 13048, 3200 NC Hwy 54, Cape Fear Bldg., Suite 200, Research Triangle Park, NC 27709-3048