Wednesday, February 1, 2012

It’s October 2013 and Your Transition to ICD-10 is Over - Now what?

The short answer is: It’s not over yet!  For at least the remainder of 2013, various areas within your production operations should be monitored to assess how well you’ve effected the transition to ICD-10.

The following are some of the major areas and activities you’ll want monitor in the 4th quarter of 2013:

Claims Business Processing
1. Are claims containing ICD-9 codes with dates of service (professional) and discharge dates (institutional) on or after October 1, 2013 being rejected?

2. Do claims received from your trading partners and business partners adhere to agreed-upon formats and parameters?

3. Are member benefits, service limits and provider contract terms being correctly applied by your claim adjudication processes?

4. Is there a rise in specific claim edits or are there exceptional claim edits that may indicate unanticipated scenarios were not addressed?

Reporting/ Business Processing
1. Are operational reports produced off your production system and analytical reports produced from your data warehouse correct?

Inbound EDI
1. Have there been out of the ordinary exceptions related to processing files received from your vendors and business partners?

Outbound EDI
1. Have there been out of the ordinary exceptions related to creating files for your vendors and business partners?

Batch Processes
1. Have your batch processes been completing without exception?  Specifically claim adjudication, explanation of benefit statements and provider payment transactions? 


Identifying areas to monitor and defining how exceptions may manifest themselves in these areas will assist your organization with developing test strategies to mitigate or avoid heartburn in late 2013. 

For more information, see my previous posts on ICD-10 testing:





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