TC 3 Health an Emdeon Company, ICD-10 Frequently Asked Questions. Published Q2 2014

Transcription

1 TC 3 Health an Emdeon Company, ICD-10 Frequently Asked Questions Published Q2 2014

2 Preface This information is provided by TC 3 Health, an Emdeon Company for education and awareness use only. Even though Emdeon believes that all the information in this document is correct as of the date of the publication of this version, Emdeon does not warrant the accuracy, completeness, or fitness for any particular purpose of this information. All use is at the reader s own risk. The information provided here is for reference use only and does not constitute the rendering of legal, financial, or other professional advice or recommendations by Emdeon. 2013, 2014 Emdeon Business Services LLC, 3055 Lebanon Pike Suite 1000, Nashville, TN All Rights Reserved. Printed in the USA.

3 Contents Customer Communications... 4 Readiness & Planning... 4 Cross-Walking Position... 6 External Testing Approach... 7

4 Customer Communications Q: How and when will your organization communicate its readiness status for the ICD- 10 conversion? A: TC³ s ICD-10 timeline is: o Gap Analysis (1st quarter 2012) o Design (2nd quarter 2012) o Remediation Development (3rd quarter 2012) o Internal Testing (4th quarter 2012) o External Beta Client Testing with 5010 and Proprietary Clients (1st quarter 2013) o Monitoring of ICD-9 and ICD-10 via Beta Client (1st quarter 2013) o External 5010 Client conversion (remainder of 2013 into 2014) Additionally, Emdeon, TC 3 Health s parent company published an "ICD-10 Playbook" that provides general education, remediation timetables, recommendations, and organizational approaches. The ICD-10 Playbook will be updated on an ongoing basis and is available at *Please Note: ICD-9 codes will continue to be supported for: Non-covered entities (i.e. Workers Compensation), corrected, resubmitted, run-out claims, secondary (COB) and subrogation claims. Q: Can we set up regular check-in meetings to keep progress on track? A: Specific requests for re-occurring communication and meetings can be arranged by contacting your established TC 3 Account Manager. Readiness & Planning Q: My current EDI interface with TC³ Health is via a proprietary file format. Will these changes to accommodate ICD-10 apply to my organization? A: Yes, the transmission and receipt of ICD-10 is applicable to your organization. Please Note: ICD-9 codes will continue to be supported for: Non-covered entities (i.e. Workers Compensation), corrected, resubmitted, run-out claims, secondary (COB) and subrogation claims.

5 Q: Who do I contact to verify if my proprietary file format is ICD-10 compliant? A: If you use a proprietary file format provided by your system vendor, please contact them to verify compliance. If the proprietary file was developed inhouse, please work with your internal compliance team for specifications and validation. Q: Does TC3 Health have any specific requirements of its customers for ICD-10 compliance? A: We do not require trading partner certification or testing for ICD-10. TC 3 Health expects all Clients, Channel Partners, and Payers to support ICD-10 data content. Q: What is your strategy for making TC 3 s products and services ICD-10 ready by the compliance date? A: TC 3 has inventoried its systems, services, and solutions to determine the impact of ICD-10 on them. TC 3 has actively remediated affected systems through modifications and enhancements. TC 3 has established an ICD-10 Program Team with supporting Functional and Executive Steering Committees to create an effective ICD-10 delivery framework. Q: When do you expect to start internal testing? A: TC 3 has already completed internal testing.

6 Cross-Walking Position Q: Will you cross-walk ICD-10 codes to ICD-9 codes, or ICD-9 codes to ICD-10 codes? A: TC 3 Health s standard offering will not include cross-walking to and/or from ICD-10. Q: Will TC3 Health require ICD-10 based on the service/discharge date on or after the compliance date? A: If a client sends an ICD-9 code with an ICD-9 qualifier after the ICD-10 compliance date, and the code is valid, TC³will pass the claim on to our partners. Q: How will TC³ distinguish an ICD-9 code vs. an ICD-10 code? A: Clients and Partners are expected to utilize the appropriate ICD qualifier (Diagnosis Type Code within the ASC X12 v5010 standard). TC³ will use the ICD qualifier to distinguish between ICD-9 and ICD-10 code submissions. Clients with proprietary EDIs will need to contact their system vendor for proper ICD recognition and or qualifier. Q: Will TC3 Health allow both ICD-9 and ICD-10 codes on the same claim? A: Yes, TC 3 Health will not reject claims containing both ICD-9 and ICD-10 diagnosis codes and/or procedure codes. However, please note, per CMS Guidance, both ICD-9 and ICD-10 codes cannot be submitted within the same claim. Claim files can contain ICD-9 coded claims and ICD-10 coded claims, but an individual claim cannot contain both ICD-9 and ICD-10 codes. Dates of Service that span the compliance date must be split into separate claims to ensure both ICD-9 and ICD-10 codes are not represented on the same claim.

7 External Testing Approach Q: When will TC 3 Health be ready for partner/client testing (external)? A: TC 3 is ready to test with external partners/clients. Q: What are your plans for testing claims containing ICD-10 codes? How will you involve your clients in that process? A: TC³ has an established testing process that we will complete with clients who are prepared to do so. Testing should be completed by 3 rd quarter of During the testing TC³ will: - Leverage existing claim testing infrastructure with partners/clients. - Request clients submit and receive test claims (20 claim max per set of files) containing ICD-10 codes in the clients existing format whether an or a proprietary format. - Accept, process and send claims with ICD-10 codes: o The first round of files will test the structural format for the ICD-10. o The second round of files will focus on verification of the data elements (this cycle may be repeated). o The third round of files will focus on scenario testing if needed. - Insure all TC³ partners are able to receive, process and return claims with ICD- 10 codes as well communicate any matters needing review. Emdeon is a leading provider of revenue and payment cycle management and clinical information exchange solutions, connecting payers, providers, and patients in the U.S. Healthcare system. Emdeon s product and service offerings integrate and automate key business and administrative functions of its payer and provider customers throughout the patient encounter. Through the use of Emdeon s comprehensive suite of products and services, which are designed to easily integrate with existing technology infrastructures, customers are able to improve efficiency, reduce costs, increase cash flow and more efficiently manage the complex revenue and payment cycle and clinical information exchange processes. For more information, visit , 2014 Emdeon Business Services LLC. All rights reserved Lebanon Pike, Suite 1000 Nashville, TN EMDEON.6 ( )