TO: Providers, Vendors and Clearinghouses
Providers may begin ICD-10 testing on August 26, 2013. Providers and vendors are encouraged to test to ensure file layout information is in the correct format prior to the federal mandate date for ICD-10, which is currently, October 1, 2014. It is critical that providers and trading partners test with Alabama Medicaid prior to implementation. We encourage early testing from August 26, 2013 through October 11, 2013. However, testing will continue until the ICD-10 federal mandate date. Testing will ensure our readiness and your readiness and will reduce the impact of this implementation for all parties.
What transactions are affected by ICD-10 changes?
· 837I (Institutional claims)
· 837P (Professional claims)
· 278 (Prior Authorization)
· 835 Remittance Advice and 835 Electronic remittance advice
o No specific changes were made but new Explanation of Benefit (EOB) codes and corresponding Claim Adjustment Reason Code (CARC)/Remittance Advice Remark Codes (RARC) will be returned related to ICD-10
What do I need to do prior to testing if I use a vendor or clearinghouse, or if I am a vendor or clearinghouse?
ICD-10 changes must be made to your system first. If you work with a software vendor or clearinghouse, work with that vendor or clearinghouse to understand when the ICD-10 software upgrade will be available.
Review and understand the changes being made by Alabama Medicaid and how they affect you and the transactions you submit.
Understand the use of the ICD-9 end dates and ICD-10 effective dates.
Contact HP Enterprise Services (HP), who is the fiscal agent for Alabama Medicaid, in advance to ensure you are set up to test with us.
Obtain a copy of the spreadsheet required to record and submit testing activities and outcomes so we can better support you.
How do I begin testing if I use a vendor or clearinghouse?
If you have tested with HP in the past, attempt to logon to the secure web site by selecting the Secure Site link at https://www.alabama-uat.com/ALPortal/ and answer the security questions to reset the password. If this is unsuccessful, contact the EMC Helpdesk to ensure you are set up to test with us.
If you have never tested with HP, contact the EMC Helpdesk to obtain a Trading Partner ID for testing. The telephone number is 1-800-456-1242 and the e-mail address is AlabamaSystemsEMC@hp.com.
How will I test after I am assigned a Trading Partner ID?
Once a Trading Partner ID has been issued to you from the EMC helpdesk:
- Logon to the secure web site by selecting the Secure Site link at https://www.alabama-uat.com/ALPortal/ and select the setup account button.
- Enter the Login ID (Trading Partner ID) and Personal Identification Number (PIN) that has been issued and select setup account button.
- Enter data in all required fields to set up the web account and select submit.
The Medicaid Home Page will be displayed and you are now set up to begin submitting batch files for testing.
For those with an existing testing ID, if you are unable to logon, please attempt to answer the security questions and reset the password. If this is unsuccessful, please contact the EMC help desk for further assistance.
I use Provider Electronic Solutions, how do I test?
Ensure you have Version 3.02 of the Provider Electronic Solutions software which is ICD-10 compliant. Follow the instructions above to obtain a Trading Partner ID. Once a Trading Partner ID is obtained go through the steps to set up the web account establishing a user ID and password.
- Open Provider Electronic Solutions, select tools/options and under the Batch tab enter your Trading Partner ID, Web Logon ID (this is the user id you created on the web portal) and your Web Password.
- Lastly, select the Web tab, and change the Environment Indicator (Environment Ind) from a ‘P’ to a ‘T’ and select OK.
- You are ready to submit test files.
NOTE: Be sure to change the User ID and Web Password back to your production logon details and Environment Indicator back to ‘P’ if you need to submit production claims.
I use Medicaid’s Interactive Web Portal to submit claims, how do I test?
What other information do I need to know for ICD-10 testing?
ü Submit “real” data, if possible. Use production data and submit it on the testing site with ICD-10 codes and compare results.
ü Dates of service on the claims should be changed prior to submission based on ICD-9 end dates and ICD-10 effective dates listed below.
ü Try conditions that you feel will be accepted and validate they are paid.
ü Try conditions that you feel will fail and validate that they do deny.
ü Keep track of the ICN’s returned to help us research identified issues.
ü For issues concerning submission errors (TA1 or 999) note the tracking number to assist with research.
The ICD-9 and ICD-10 Testing Effective Dates are as follows:
August 26, 2013 – March 31, 2014
- ICD-9 end date = August 25, 2013 & ICD-10 start date = August 26, 2013
April 1, 2014 – September 30, 2014
- ICD-9 end date = March 31, 2014 & ICD-10 start date = April 1, 2014
October 1, 2014 and thereafter
- ICD-9 end date = September 30, 2014 & ICD-10 start date = October 1, 2014
The ICD-9 end date indicates the last date where ICD-9 codes may be submitted without error.
The ICD-10 start date indicates the first date where ICD-10 codes may be submitted without error.
The schedule is also available on the ICD-10 testing page of the Alabama Medicaid website at: http://medicaid.alabama.gov/CONTENT/6.0_Providers/6.12_ICD-10/6.12.3_ICD-10_Testing.aspx
How will testing be monitored?
Monitoring will occur to ensure testing activity has begun. If we are not seeing transactions submitted, we will be contacting you to ensure there are no issues and offer assistance if needed.
Contact the EMC help desk for setup and account access issues.
Document any other issues on the Test Results Feedback spreadsheet located at the following link: http://www.medicaid.alabama.gov/CONTENT/6.0_Providers/6.12_ICD-10/126.96.36.199_ICD-10_Secure_Testing_Web_Site.aspx
Please submit your testing spreadsheet on a regular basis to the EMC Helpdesk by e-mailing the information to email@example.com
How can I obtain additional information about ICD-10 testing?
Please be sure to visit this site for more information that you will need for testing.
The ICD-10 testing link on the Alabama Medicaid website may be accessed from the general page at: http://www.medicaid.alabama.gov/CONTENT/6.0_Providers/6.12_ICD-10/6.12.3_ICD-10_Testing.aspx
A webinar will soon be available on the Alabama Medicaid website on the ICD-10 webpage.