Vendor-to-Provider Affordable Care Act End-to-End Testing Checklist

Transcription

1 Overview Vendor-to-Provider Affordable Care Act End-to-End Testing Checklist The purpose of this checklist is to aid the payers that interact with providers, payers, and other trading partners in organizing end-to-end testing. Level Timeline: 2 8 months from regulation implementation date Level of the end-to-end testing process includes the following Elements: Planning Review new Regulation and become educated on the requirements. Look to professional associations for information and resources to help your organization understand the impact of Administrative Simplification and how to prepare your practice. Obtain updated publications and tools with new regulation changes. Communicate changes with staff. Establish Administrative Simplification project team. Develop Administrative Simplification project plan. Assessment Identify impact of Administrative Simplification to your organization. Perform an assessment of the detailed regulation changes (all transactions). Assess integration of Administrative Simplification into all systems. Review Trading Partner Agreements and make changes as necessary. Determine if providers will be required to purchase new hardware system or make an update to their current hardware/system? Page

2 Vendor-to-Provider Affordable Care Act End-to-End Testing Checklist Design Define what processes are impacted internally/externally. Determine the changes that will affect processes with the providers at the state/national level. Define the version standard for testing platform. Create a detailed testing strategy to describe how testing will be performed. Development Testing Develop the migration process of the new coding specifications for system/application software that will be used for internal/external testing. Develop test files and test data. Develop the platform for internal/external testing environment. Create test scenarios that will produce positive and negative testing, define successful and unsuccessful test results, and include system edit/audit testing (pass/fail). Plan and schedule User Acceptance Testing (UAT). Perform regression testing to ensure new changes did not break any of the current process within the processing system. Perform a stress test on the system to test the performance level and response time. Transition Reach out to provider and external vendors for testing scenarios. Prepare testing environment for dry-run with new changes prior to implementation. Verify testing document is complete and accurate. Verify the testing environment has passed testing for Level 2 and is now ready for Level 3 testing. Before moving to the next phase, obtain sign-off at the end of the phase/level for accountability. Level 2 Timeline: 6 2 months from regulation implementation date Level 2 of the end-to-end testing process includes the following Elements: Development Verify migration for the hardware/application software has been completed and validated. Determine how to communicate downtime information, if necessary. 2 Page

3 Vendor-to-Provider Affordable Care Act End-to-End Testing Checklist Testing Confirm testing date and data with external payer, vendors, or providers. Establish meetings to determine testing information. Perform System Integration Testing (SIT); review test results and address defects and document your test results in your Test Plan. If you have a "mock" production environment, you should plan to conduct "mock" production moves to ensure that your code moves go smoothly. Track inconsistencies in errors by providers. Update Risk Management Plan. Transition Ensure transmitting of electronic claim response time is correct, according to the ACA regulations. Prepare vendor solution for providers. Update Post-Implementation Plan with Production Move Plan. Confirm any new workflows, business processes, and office flow changes have been implemented. Make adjustments as necessary. Verify the testing environment has passed testing for Level 2 and is now ready for Level 3 testing. Level 3 Timeline: 3 months from regulation implementation date Level 3 of the end-to-end testing process includes the following Elements: Development Testing Assess the amount of testing remaining by the external vendors or payers and those who are not ready to test. Confirm testing date with external vendors, or providers. Establish meetings to determine testing information. Perform System Integration Testing (SIT) for functionality of the entire system. Validate system changes have been updated for data mapping, field sizes, new/updated edits, new adjustment reason codes, etc. Verify all testing has been completed. 3 Page

4 Vendor-to-Provider Affordable Care Act End-to-End Testing Checklist Obtain sign-off that the testing is complete. Perform dry-run of mock scenarios with new changes prior to implementation. Transition Update Risk Management Plan. 4 Page

5 Vendor-to-Provider Administrative Simplification End-to-End Testing Checklist Overview The purpose of this checklist is to aid the payers that interact with providers, payers, and other trading partners in organizing end-to-end testing. Level Timeline: 2 8 months from regulation implementation date Level of the end-to-end testing process includes the following Elements: Planning Review new Regulation and become educated on the requirements. Look to professional associations for information and resources to help your organization understand the impact of Administrative Simplification and how to prepare your practice. Obtain updated publications and tools with new regulation changes. Communicate changes with staff. Establish Administrative Simplification project team. Develop Administrative Simplification project plan. Assessment Identify impact of Administrative Simplification to your organization. Perform an assessment of the detailed regulation changes (all transactions). Assess integration of Administrative Simplification into all systems. Review Trading Partner Agreements and make changes as necessary. Determine if providers will be required to purchase new hardware system or make an update to their current hardware/system? Page

6 Vendor-to-Provider Administrative Simplification End-to-End Testing Checklist Design Define what processes are impacted internally/externally. Document in detail, changes related to the Administrative Simplification regulation that affects the translators. Include changes to the ones your organization sends to providers and receives from providers. Define the version standard for testing platform. Create a detailed testing strategy to describe how testing will be performed. Development Testing Develop the migration process of the new coding specifications for system/application software that will be used for internal/external testing. Verify all codes have been successfully compiled, migrated, and properly formatted. Develop testing files and testing data. Create a test plan document with testing scenarios. Develop testing data that will be used to execute testing scenarios. Create test scenarios that will produce positive and negative testing, define successful and unsuccessful test results, and include system edit/audit testing (pass/fail). Decide on what percentage (%) of mission-critical providers and/or external vendors your organization will be testing with. Verify there are no changes to the information that needs to be sent or information that will be received on the translators. Before moving to the next phase, obtain sign-off at the end of this phase/level for accountability. Prepare testing environment for dry-run with new changes prior to implementation to the next phase/level. Transition Ensure staff has been trained on the business processes that have changed due to the Administrative Simplification rules. Create an Implementation/Migration Event Plan. Prepare and establish go-live environments for testing internally and some externally testers. Deliver ongoing support to the providers. Verify the testing environment has passed testing for Level and is now ready for Level 2 testing. 2 Page

7 Vendor-to-Provider Administrative Simplification End-to-End Testing Checklist Level 2 Timeline: 6 2 months from regulation implementation date Level 2 of the end-to-end testing process includes the following Elements: Development Testing Verify migration for the hardware/application software has been completed and validated. Confirm testing date and data with external payer, vendors, or providers. Establish meetings to determine testing information. Perform System Integration Testing (SIT); review test results and address defects and document your test results in your Test Plan. Test claim information received from provider that is transferred to your processing system. Validate the information is received correctly and with no delays. Test transferring claim information received from Provider and changing information to an 837 ASC X2 claim submission file. If you have a "mock" production environment, you should plan to conduct "mock" production moves to ensure that your code moves go smoothly. Add any lessons learned to the Lessons Learned document. Transition Deliver ongoing support to the providers. Validate the testing environment has passed testing for Level 2 and is now ready for level 3 testing. Ensure transmission of electronic claims is successful. Confirm any new workflows, business processes, and office flow changes have been implemented. Make adjustments as necessary. Level 3 Timeline: 3 months from regulation implementation date Level 3 of the end-to-end testing process includes the following Elements: Development Confirm testing date with external vendors, and providers. Continue with the meetings with external vendors and providers to discuss testing information. 3 Page

8 Vendor-to-Provider Administrative Simplification End-to-End Testing Checklist Testing Determine who is responsible for interpreting/reading the error reports and know which reports are produced by which payer. Determine test data for members, providers, procedure codes, diagnosis, etc. Assess the amount of testing remaining by the external vendors or payers, who are not ready for testing. Perform System Integration Testing (SIT) for functionality of the entire system. Validate system changes have been updated for data mapping, field sizes, new/updated edits, new adjustment reason codes, etc. Verify all testing has been completed. Obtain sign-off that the testing is complete. Perform dry-run of mock scenarios with new changes prior to implementation. Transition Update Risk Management Plan. Follow up on any issues (internally/externally) from testing. Confirm any new workflows, business processes, and office flow changes have been implemented make adjustments as necessary. Ensure all updates have been made to all processing manuals. Finalize Post-Implementation Plan. 4 Page

9 Vendor-to-Provider ICD-0 End-to-End Testing Checklist Overview The purpose of this checklist is to aid the payers that interact with providers, payers, and other trading partners in organizing end-to-end testing. Level Timeline: 2 8 months from regulation implementation date Level of the end-to-end testing process includes the following Elements: Planning Review new Regulation and become educated on the requirements. Look to professional associations for information and resources to help your organization understand the impact of ICD-0 and how to prepare your practice. Obtain updated publications and tools with new regulation changes. Determine if there is an Errata version for this regulation. Create an estimate budget document to track costs. Create documentation plans. Assessment Design Identify the impact of ICD-0 to your organization. Perform an assessment of the detailed regulation changes (all transactions). Assess integration of Administrative Simplification into all systems. Meet with providers to discuss transition strategy, testing and timeline. Evaluate the current contact to verify if there will be any change or new contract will be needed. Define what processes are impacted internally/externally. Page

10 Vendor-to-Provider ICD-0 End-to-End Testing Checklist Design changes related to the way the diagnosis, ICD-9/ICD-0, CPT/HCPCS, etc., are used or submitted from the hospital or physician office. Identify any delays in the translators in receiving claim or sending claims. Define the version standard for testing platform. Development Testing Develop the migration process of the new coding specifications for system/application software that will be used for internal/external testing. Determine the version standard platform for testing internally and with external vendor and providers. Develop the platform for internal/external testing environment. Create a test plan document with test scenarios. Create test scenarios that will produce positive and negative tests, define successful and unsuccessful test results, and include system edit/audit tests (pass/fail). Test any report that your organization generates or receives from an outside source. Perform regression testing to ensure new changes did not break any of the current process within the processing system. Perform a dry-run of a full production-like cycle in the testing environment with the new changes. Before moving to the next phase, obtain sign-off at the end of the phase/level for accountability. Transition Create a Post-Implementation Plan. Prepare and establish a go-live production-like environment. Determine how to deliver ongoing support to providers. Prepare testing environment for Level 2 internal testing. Level 2 Timeline: 6 2 months from regulation implementation date Level 2 of the end-to-end testing process includes the following Elements: Assessment Verify migration for the hardware/application software has been completed and validated. 2 Page

11 Vendor-to-Provider ICD-0 End-to-End Testing Checklist Design Testing Determine how to communicate downtime information if necessary. Confirm testing date(s) and data with external payer, vendors, or providers. Establish meetings to determine testing information. Confirm testing date(s) with external vendors and providers. Continue meetings with external vendors and providers to discuss testing information. Perform System Integration Testing (SIT); review test results and address defects and document your test results in your Test Plan. Validate system changes have been updated. Perform dry-run of mock scenarios with new changes prior to implementation. Test to ensure your organization is capable of submitting a claim with an ICD-0 diagnosis. Track inconsistencies in errors by providers. Transition Ensure transmitting of electronic claims is successful. Update Post Implementation Plan with Production Move Plan. Confirm any new workflows, business processes, and office flow changes have been implemented. Level 3 Timeline: 3 months from regulation implementation date Level 3 of the end-to-end testing process includes the following Elements: Planning Testing Assess the amount of testing remaining by the external vendors or payers and those who are not ready to test. Confirm testing date with external payer, vendors, or providers. Establish meetings to determine testing information. Determine test data for members, providers, procedure codes, diagnosis, etc. Track inconsistencies in errors by providers. 3 Page

12 Vendor-to-Provider ICD-0 End-to-End Testing Checklist Validate all testing has been completed. Get sign-off that the testing is complete. Perform dry-run of mock scenarios with new changes prior to implementation. Transition Finalize the Post Implementation Plan. Follow-up on any issues, internally/externally. Confirm any new workflows, business processes, and office flow changes have been implemented. Make adjustments as necessary. Ensure all updates have been made to all processing manuals. 4 Page

13 Admin Simplification General Acknowledgement Level Task Steps/Definitions Gen Element: General Information Gen G. Has your organization completed implementation of ASC X2 Version XXXX for HIPAA transactions? Gen G.2 Has your organization completed implementation of NCPDP Version X.X for HIPAA transactions? Gen G.3 Mark the types of transactions that you submit or receive shown to the right. Gen G.4 Mark the types of transactions that you will test shown to the right. Gen Element: General Information, HIPAA Compliance Gen G.5 Are you HIPAA compliant? Gen G.5.a Do you, or a third party billing company or clearinghouse, conduct any one of the following business transactions electronically? Claims or equivalent encounter information Payment and remittance advice Claim status Inquiry/response Eligibility inquiry/response Referral authorization inquiry/ response Yes No N/A NCPDP TA CA Proprietary Lessons Learned/Notes Links Gen G.5.b If Yes, continue with the checklist. Gen G.5.c IF NO, YOU DO NOT NEED TO COMPLETE THE CHECKLIST. Gen Element: General Information, CMS Waiver Gen G.6 Have you submitted an Administrative Simplification Compliance Act Waiver Application to CMS? Gen G.6.a If Yes, was the CMS waiver granted? Gen G.6.b IF THE CMS WAIVER WAS GRANTED, YOU DO NOT NEED TO COMPLETE THE CHECKLIST. Gen G.6.c If No, continue with the checklist. Page of 23

14 Administrative Simplification LEVEL The Level Testing is the period during which entities perform all of their internal readiness activities in preparation for testing the new versions of the standards with their Trading Partners. When an entity has attained Level compliance, it has completed all internal readiness activities and is fully prepared to initiate testing of the new versions in a test or production environment, pursuant to its standard protocols for testing and implementing new software or data exchanges. Element: Planning. Form an implementation team to review the new Regulation and become educated on the requirements to see if there are any effects to the Administrative Simplification rules..2 Determine product requirements and evaluate to see how the requirements are impacted by the Administrative Simplification regulations. You can obtain updated regulation information from CMS website..3 Create an estimate budget document to track cost related to: Providing education(include hours spent on education) Additional staffing needs (permanent/ temporary) New or upgrade to software system New or upgrade to the hardware system New or upgrade to the translators Guidance/Regulations-and-Guidance.html.4 Create a risk management document to track any risks may prevent or delay related to implementation.5 Create a communication plan to include the media of how information will be delivered to the providers..6 Develop a training plan to include internal training and how the training will be delivered to providers..7 Meet with internal staff to discuss the change and how it will affect the current process..8 Determine if the changes will require additional training and education internally and externally. Page 2 of 23

15 Administrative Simplification.9 Review the Administrative Simplification for an errata version for this regulation. 2 Element: Assessment 2. Do you submit claims through the NCPDP system? If yes, assess the affects to the NCPDP system from the regulations? 2.2 Determine the affects to the X2 837 D/I/P health care electronic claim/encounter information for impacts Determine the affects to the ASC X2 270/27 eligibility for a health planrequest/response transaction Determine the affects to the ASC X2 276/277 health care claim statusrequest/response transaction Determine the affects to the ASC X2 835 health care payment and remittance advice transaction Determine the affects to the ASC X2 278 referral certification and authorization transaction. 2.3 Assess file exchange to determine if there are any changes to the way you will send files or the way you will receive files. Errata is a list of errors and their corrections inserted, usually on a separate page or slip of paper, in a book or other publication; corrigenda. Errata(s) from CMS (see Links). Guidance/Regulations-and-Guidance.html 2.4 Assess your translator system to ensure there will be no effect on the way the file is receive and sent from the regulation change. 2.5 Evaluate the current contacts with provider to verify if there will be any change or if a new contract will be needed, related to the Administrative Simplification regulation. Page 3 of 23

16 Administrative Simplification 2.6 Review all code sets to assess the impact due the Administrative Simplification regulations like revenue codes, diagnosis and/or procedure codes. 2.7 Determine if there is a need for purchasing new hardware/software due to the regulation change. 2.8 Determine how the Administrative Simplification regulation will effect the Privacy and Security Act. 2.9 Review all contractz with trading partners and providers to ensure that these do not need to be updated, or if there will be a new contact. 2.0 Determine if providers will be required to purchase new software or make an update to current software? 2.0. Determine if providers will be required to purchase new hardware system or make an update to their current hardware/system? Determine who will be approve this purchase? Determine who will be install this new hardware/software. 3 Element: Design 3. Define what processes are impacted internally/externally: System impact Reports impact Data extracts Personnel ASC X2 transactions 3.2 Document in detail, changes related to the Administrative Simplification regulation that effects the translators. Include changes to the ones your organization sends to providers and receives from Providers. 3.3 Define the version standard for testing platform. Page 4 of 23

17 Administrative Simplification 3.4 Create a detailed testing strategy to describe how testing will be performed. 4 Element: Development 4. Migrate your system/application software with the new coding specification. 4.. Verify all codes have been successfully compiled and migrated Verify all codes have been properly formatted. 4.2 Prepare the system for testing internally Develop testing files and testing data. 4.3 Create a test plan document with testing scenarios Develop testing data that will be used to execute testing scenarios. 5 Element: Testing 5. Create test scenarios that will produce positive and negative testing, define successful and unsuccessful test results, and include system edit/audit testing (pass/fail). 5.2 Decide on what percentage (%) of missioncritical providers and/or external vendors your organization will be testing with. Document this percentage in a testing plan document. 5.3 Verify there are no delays in the translators. 5.4 Verify there are no changes to the information that needs to be sent or information that will be received on the translators. 5.5 Verify testing document is complete and accurate. 5.6 Before moving to the next phase, obtain signoff at the end of this phase/level for accountability. Page 5 of 23

18 Administrative Simplification 5.7 Prepare testing environment for dry run with new changes prior to implementation to the next phase/level. 5.8 Create a Lessons Learned document. 6 Element: Transition 6. Ensure staff has been trained over the business processes that have changed due to the Administrative Simplification rules. 6.. Ensure staff has been trained on the Privacy Rules and Security Rule related to the Administrative Simplification rules Ensure the appropriate staff is trained on the changes to the EDI transactions. 6.2 Create an Post-implementation Plan document Prepare and establish go-live environments for testing internally and some externally testers Deliver ongoing support to the providers Verify the testing environment has passed testing for Level and is now ready for Level 2 testing. Ensure that the internal testing was carried out successfully, with no major defects issue before moving to Level 2. LEVEL 2 The Level 2 Testing is the period during which entities are preparing to reach full production readiness with Trading Partners. When an entity is in compliance with Level 2, it has completed some end-to-end testing with external Trading Partners. 2 Element: Development 2. Verify migration for the hardware/application software has been completed and validated. 2.2 Confirm testing date and data with external payer, vendors, or providers. 2.3 Establish meetings to determine testing information Element: Testing 2 2. Perform regression testing for system functionality. Determine how to communicate downtime information, if necessary. Page 6 of 23

19 Administrative Simplification Perform end-to-end testing of the complete production-like environment Define successful and unsuccessful test Test claim information received from provider that is transferred to your processing system. Validate the information is received correctly and with no delays Test transferring claim information received from Provider and changing information to an 837 ASC X2 claim submission file Perform a stress test to the system to assess the maximum limits of an application Testing sending information from an 835 ASC X2 file can be transferred to the provider successfully Perform System Integration testing for functionality of the entire system Perform dry run of mock scenarios with new changes prior to implementation to the next phase/level Add any lessons learned to the Lessons Learned document Element: Transition 2 3. Deliver ongoing support to the providers Validate the testing environment has passed testing for Level 2 and is now ready for level 3 testing Ensure transmitting of electronic claim are successful Confirm any new workflows, business processes, and office flow changes have been implemented. Make adjustments as necessary. Ensure that the internal testing was tested and passed with successful testing with no major defects issue before moving to level 3 2 LEVEL 3 The Level 3 Testing is the period during which end-to-end testing is performed with external Trading Partners and the Trading Partner is able to operate in production/ Page 7 of 23

20 Administrative Simplification production-like mode with the new versions of the standards by the end of that period. By production/production-like mode, we mean that entities can successfully exchange (accept and/or send) standard transactions and, as appropriate, be able to process them successfully. 3 Element: Development 3. Confirm testing date with external vendors, and providers. 3.. Continue with the meetings with external vendors and providers to discuss testing information. 3.2 Verify version standard for the testing platform. 3.3 Determine who is responsible for interpreting/reading the error reports and know which reports are produced by which payer. 3.4 Determine test data for members, providers, procedure codes, diagnosis, etc. 3.5 Assess the amount of testing remaining by the external vendors or payers, who are not ready for testing Element: Testing 3 2. Perform System Integration testing for functionality of the entire system Validate system changes have been updated for data mapping, field sizes, new/updated edits, new adjustment reason codes, etc Track inconsistencies in errors by providers. Determine the feedback mechanism that will be used in communicating errors that are discovered while testing with providers Verify all testing has been completed Obtain sign-off that the testing is complete Perform dry run of mock scenarios with new changes prior to implementation Element: Transition 3 3. Update Risk Management Plan Follow up on any issues, internally/externally from testing. Page 8 of 23

21 Administrative Simplification Confirm any new workflows, business processes, and office flow changes have been implemented make adjustments as necessary Ensure all updates have been made to all processing manuals Finalize Post-Implementation Plan. 3 Page 9 of 23

22 Affordable Care Act General Level Task Steps/Definitions Gen G Element: General Information Gen G. Has your organization completed implementation of ASC X2 Version XXXX for HIPAA transactions? Gen G.2 Has your organization completed implementation of NCPDP Version X.X for HIPAA transactions? Gen G.3 Mark the types of transactions that you submit or receive shown to the right. Gen G.4 Mark the types of transactions that you will test shown to the right. Gen G Element: General Information, HIPAA Compliance Gen G.5 Are you HIPAA compliant? Gen G.5.a Do you, or a third party billing company or clearinghouse, conduct any one of the following business transactions electronically? Claims or equivalent encounter information Payment and remittance advice Claim status Inquiry/response Eligibility inquiry/response Referral authorization inquiry/ response Yes No N/A NCPDP Acknowledgement TA CA Proprietary Lessons Learned/Notes Links Gen G.5.b If Yes, continue with the checklist. Gen G.5.c IF NO, YOU DO NOT NEED TO COMPLETE THE CHECKLIST. Page 0 of 23

23 Affordable Care Act LEVEL The Level Testing is the period during which entities perform all of their internal readiness activities in preparation for testing the new versions of the standards with their Trading Partners. When an entity has attained Level compliance, it has completed all internal readiness activities and is fully prepared to initiate testing of the new versions in a test or production environment, pursuant to its standard protocols for testing and implementing new software or data exchanges. Element: Planning. Form an implementation team to review the new Regulation and become educated on the requirements and the effects to the Affordable Care Act (ACA) rules..2 Create an estimate budget document to track cost related to: Staffing education(include hours spent on education) Additional staffing needs (permanent/ temporary) New or upgrade to software system New or upgrade to the hardware system New or upgrade to the translators.3 Create documentation plans Risk Management Communication plan Implementation plan Contingency plan Contact personnel plan Training plan Privacy and security.4 Evaluate the Standard Operating Procedures (SOPs for process that will need to be updated..5 Ensure all staff is hired and trained and in place prior to implementation..6 Review bulletin/banners related to the ACA regulation posted by the payers. 2 Element: Assessment 2. Assess how the ACA regulation will effect current business rules and processes internally/externally. 2.2 Research options available for training on ACA regulations. Begin discussing media options for outreach and communication. Training may be offered through seminars, webinars, workshops, and local medical association meetings. Page of 23

24 Affordable Care Act 2.3 Evaluate how the changes will effect external vendors. 2.4 Evaluate the current contract to verify if there will be any change or new contract will be needed. 2.5 Verify changes to existing coverage determination files. 2.6 Determine which products your organization will offer and provide training on. Include providers and external vendors. 2.7 Define what processes are impacted internally/externally. System Reports Data extracts Personnel 2.8 Determine the impact the ACA regulation has on the response time for processing time in the translators. 2.9 Determine if there are any changes to the information that needs to be sent or received on the translators. 2.0 Determine if there will be a version standard change. 2. Determine if new hardware/software is needed for this regulation. 3 Element: Design 3. Define requirements, design process and system coding related to the ACA regulation. 3.2 Determine the changes that will effect processes with the providers at the state/national level. 3.3 Document a detailed testing strategy to describe how testing will be performed. 3.4 Document a Test Plan document with testing scenarios. 3.5 Define any changes to your operational processes. Page 2 of 23

25 Affordable Care Act 3.6 Define the version standard for the testing platform. 3.7 Reach out to providers and external vendors for testing scenarios. 3.8 Prepare a Lessons Learned document. 4 Development 4. Migrate your system/application software with the new coding specs. 4.2 Develop the version standard for testing 4.3 Develop testing files and testing data. 4.4 Develop the platform for internal/external testing environment. 5 Element: Testing 5. Create test scenarios that will produce positive and negative testing, define successful and unsuccessful test results, and include system edit/audit testing (pass/fail). 5.2 Plan and schedule User Acceptance Testing (UAT). 5.3 Perform regression testing to ensure new changes did not break any of the current process within the processing system. 5.4 Perform a stress test on the system to test the performance level and response time. 6 Element: Transition 6. Reach out to provider and external vendors for testing scenarios. 6.2 Prepare testing environment for dry run with new changes prior to implementation. 6.3 Verify testing document is complete and accurate. 6.4 Verify the testing environment has passed testing for Level 2 and is now ready for Level 3 testing. Page 3 of 23

26 Affordable Care Act 6.5 Before moving to the next phase, obtain signoff at the end of the phase/level for accountability. LEVEL 2 The Level 2 Testing is the period during which entities are preparing to reach full production readiness with Trading Partners. When an entity is in compliance with Level 2, it has completed some end-to-end testing with external Trading Partners. 2 Element: Development 2. Verify the migration for the hardware/application software has been completed and validated. 2.2 Determine how to communicate downtime information, if necessary. 2.3 Confirm testing date and data with external payer, vendors, or providers. 2.4 Establish meetings to determine testing information Element: Testing 2 2. Perform regression testing for system functionality Perform end-to-end testing of the complete Define successful and unsuccessful testing. production environment Perform a stress test to the system to assess the maximum limits of an application Perform System Integration testing for functionality of the entire system Perform dry run of mock scenarios with new changes prior to implementation Track inconsistencies in errors by providers. Determine the feedback mechanism that will be used in communicating errors that are discovered while testing with providers Update Risk Management Plan Element: Transition 2 3. Ensure transmitting of electronic claim response time is correct, according to the ACA regulations Prepare vendor solution for providers Update Post-Implementation Plan with Production Move Plan. Page 4 of 23

27 Affordable Care Act Confirm any new workflows, business processes, and office flow changes have been implemented. Make adjustments as necessary Verify the testing environment has passed testing for Level 2 and is now ready for Level 3 testing. 2 LEVEL 3 The Level 3 Testing is the period during which end-to-end testing is performed with external Trading Partners and the Trading Partner is able to operate in production/ production-like mode with the new versions of the standards by the end of that period. By production/production-like mode, we mean that entities can successfully exchange (accept and/or send) standard transactions and, as appropriate, be able to process them successfully. 3 Element: Development 3. Assess the amount of testing remaining by the external vendors or payers, who are not ready for testing. 3.2 Confirm testing date with external vendors, or providers. 3.3 Establish meetings to determine testing information Element: Testing 3 2. Perform a stress test to the system to assess the maximum limits of an application Perform System Integration Testing (SIT) for functionality of the entire system Validate system changes have been updated for data mapping, field sizes, new/updated edits, new adjustment reason codes, etc Track inconsistencies in errors by providers Verify all testing has been completed Obtain sign-off that the testing is complete Perform dry run of mock scenarios with new changes prior to implementation Element: Transition 3 3. Update Risk Management Plan. Page 5 of 23

28 Affordable Care Act Follow up on any issues, internally/externally from testing Confirm any new workflows, business processes, and office flow changes have been implemented. Make adjustments as necessary Ensure all updates have been made to all processing manuals Finalize Post-Implementation Plan. 3 Page 6 of 23

29 ICD-0 General Level Task Steps/Definitions Gen G Element: General Information Gen G. Has your organization completed implementation of ASC X2 Version XXXX for HIPAA transactions? Gen G.2 Has your organization completed implementation of NCPDP Version X.X for HIPAA transactions? Gen G.3 Mark the types of transactions that you submit or receive shown to the right. Yes No N/A NCPDP Acknowledgement TA CA Proprietary Lessons Learned/Notes Links Gen G.4 Mark the types of transactions that you will test shown to the right. Gen G Element: General Information, HIPAA Compliance Gen G.5 Are you HIPAA compliant? Gen G.5.a Do you, or a third party billing company or clearinghouse, conduct any one of the following business transactions electronically? Claims or equivalent encounter information Payment and remittance advice Claim status Inquiry/response Eligibility inquiry/response Referral authorization inquiry/ response Gen G.5.b If Yes, continue with the checklist. Gen G.5.c IF NO, YOU DO NOT NEED TO COMPLETE THE CHECKLIST. Page 7 of 23

30 ICD-0 LEVEL The Level Testing is the period during which entities perform all of their internal readiness activities in preparation for testing the new versions of the standards with their Trading Partners. When an entity has attained Level compliance, it has completed all internal readiness activities and is fully prepared to initiate testing of the new versions in a test or production environment, pursuant to its standard protocols for testing and implementing new software or data exchanges. Element: Planning. Form an implementation team to review the new Regulation and become educated on the requirements and the effects to the ICD-0 changes..2 Review ICD-0 resources from CMS, Trading Partners, external vendors and payers..3 Determine if there is an Errata version for this regulation. Some regulations will have Errata that are adopted and testing with the Errata changes may vary with each vendor as to when they are ready to implement the Errata changes. Check throughout the implementation levels to determine if Errata have been adopted. (See Notes) For ICD-0 billing is only accept through version standard 500. Errata is a list of errors and their corrections inserted, usually on a separate page or slip of paper, in a book or other publication; corrigenda. See CMS and Washington Publishing links. Guidance/Regulations-and-Guidance.html.4 Create an estimate budget document to track cost related to: Providing education(include hours spent on education) Additional staffing needs (permanent/ temporary) New or upgrade to software system New or upgrade to the hardware system New or upgrade to the translators Create documentation plans Risk Management Communication plan Implementation plan Contingency plan Contact personnel plan Training plan Privacy and security 2 Element: Assessment Begin discussing media options for outreach and communication. Page 8 of 23

31 ICD-0 2. Assess training needs by meeting with internal staff to discuss the change and how it will affect current processes. 2.2 Research options available for training on ICD-0 regulations. 2.3 Review bulletins/banner pages on the payers website relate to new regulation changes. Training may be offered through seminars, webinars, workshops, and local medical association meetings. Education/Training/NationalMedicareTrainin gprogram/index.html 2.4 Determine which products your organization will offer and those for which you will provide training. 2.5 Define what processes are impacted internally/externally. System Reports Data extracts Personnel 2.6 Review ICD-9 data elements compared to the changes for ICD-0 data elements through a gap analysis. 2.7 Perform an assessment between your organization, the provider and any external vendor, to determine the impact related to the ICD-0 regulation. 2.8 Will you be using a crosswalk? Include providers and external vendors. ICD-0 data elements may include diagnoses grouping and inpatient hospital codes. Determine how the outreach communication will be distributed to the provider and how communication will be set up with any external vendors. Include mapping and prior-authorization. If yes, determine how the crosswalk will process ICD-9 to ICD-0 and what will be reported (ICD-9 or ICD-0) to the provider. 2.9 Meet with providers to discuss transition strategy, testing and timeline. 2.0 Conduct product re-engineering analysis for your system. 2. Evaluate the current contact to verify if there will be any change or new contract will be needed. 3 Element: Design Discuss how payers will handle the transition of codes. Page 9 of 23

32 ICD-0 3. Define what processes are impacted internally/externally. Systems Reports Data extracts Personnel 3.2 Define requirements and design processes for the ICD-0 rules. 3.3 Design changes related to the way the diagnosis, ICD-9/ICD-0, CPT/HCPCS, etc. are used or submitted from the hospital or physician office. 3.4 Identify any delays in the translators in receiving claim or sending claims. 3.5 Define the version standard for the testing platform. 4 Element: Development 4. Migrate your system/application software with the new coding specification. 4.2 Determine the version standard platform for testing internally and with external vendor and providers. 4.4 Develop the platform for internal/external testing environment. 4.5 Create a test plan document with testing scenarios. 5 Element: Testing 5. Create test scenarios that will produce positive and negative testing, define successful and unsuccessful test results, and include system edit/audit testing (pass/fail). Develop testing data that will be used to execute testing scenarios. 5.2 Determine if there will be Errata testing. Ensure your organization is using the most current version. 5.3 Test any report that your organization generates or receives from an outside source. Page 20 of 23

33 ICD Perform regression testing to ensure new changes did not break any of the current process within the processing system. 5.5 Perform a stress test on the system to test the performance level. 5.7 Perform a dry run of a full production-like cycle in the testing environment with the new changes 5.8 Validate testing document is complete and accurate. 5.9 Before moving to the next phase, obtain signoff at the end of the phase/level for accountability. 5.0 Create a Lessons Learned document. 6 Element: Transition 6. Train and/or retrain internal staff on regulation changes. Re-evaluate helpdesk staffing to accommodate heavy call volumes due to implementation. 6.2 Create a Post-Implementation Plan. 6.3 Prepare and establish a go-live productionlike environment. 6.4 Determine how to deliver ongoing support to providers. 6.5 Prepare testing environment for level 2 internal testing. LEVEL 2 The Level 2 Testing is the period during which entities are preparing to reach full production readiness with Trading Partners. When an entity is in compliance with Level 2, it has completed some end-to-end testing with external Trading Partners. 2 Element: Assessment 2. Verify the migration for the hardware/application software has been completed and validated. 2.2 Determine how to communicate downtime information if necessary. 2.3 Confirm testing date and data with external payer, vendors, or providers Element: Design 2 2. Establish meetings to determine testing information. Page 2 of 23

34 ICD Confirm testing date with external vendors and providers Continue meetings with external vendors and providers to discuss testing information Element: Testing 2 3. Perform a stress test to the system to assess the maximum limits of an application Perform System Integration testing for functionality of the entire system Validate system changes have been updated. Data mapping Field sizes New/updated edits New adjustment reason codes Perform dry run of mock scenarios with new changes prior to implementation Test to ensure your organization is capable of submitting a claim with an ICD-0 diagnosis Track inconsistencies in errors by providers. Determine the feedback mechanism that will be used in communicating errors that are discovered while testing with providers Update Risk Management Plan Element: Transition 2 4. Ensure transmitting of electronic claim are successful Update Post- Implementation Plan with Production Move Plan Confirm any new workflows, business processes, and office flow changes have been implemented. Make adjustments as necessary. 2 LEVEL 3 The Level 3 Testing is the period during which end-to-end testing is performed with external Trading Partners and the Trading Partner is able to operate in production/ production-like mode with the new versions of the standards by the end of that period. By production/production-like mode, we mean that entities can successfully exchange (accept and/or send) standard transactions and, as appropriate, be able to process them successfully. 3 Element: Planning Page 22 of 23

35 ICD-0 3. Assess the amount of testing remaining by the external vendors or payers, who are not ready for testing. 3.2 Confirm testing date with external payer, vendors, or providers. 3.3 Establish meetings to determine testing information Element: Testing 3 2. Determine test data for members, providers, procedure codes, diagnosis, etc Track inconsistencies in errors by providers Validate all testing has been completed Get sign-off that the testing is complete Perform dry run of mock scenarios with new changes prior to implementation Element: Transition 3 3. Finalize the Post-implementation Plan Follow-up on any issues, internally/ externally Confirm any new workflows, business processes, and office flow changes have been implemented. Make adjustments as necessary Ensure all updates have been made to all processing manuals. 3 Page 23 of 23