Optum ICD-10 Testing - Electronic Network Systems
Contents
1. Optum Clearinghouse also known as ENS ICD 10 Testing February 28 2014 External Client Document Contents Document Introduction How to test if you are a Health e Claim HEC submitter Print Image PI and Direct Data Entry DDE How to test if you are an X12 5010 ANSI submitter File upload Integrated Method API HTTP Post STFP FTP via Communedi Premium CP What types of reports will receive How do retrieve my reports How do retrieve my Electronic Remittance Advices ERA When will receive my Electronic Remittance Advice as a result of my testing How will know what payers are testing for ICD 10 Proprietary and Confidential Do not distribute 2 Document Introduction e Optum has created a solution to support ICD 10 testing between providers and payers e Front end testing is already offered via the Communedi Premium self testing tool The front end testing will allow providers to submit 5010 test files containing ICD 10 codes Validation of the qualifiers and diagnosis code will be performed Validation report will be generated for providers to review e End to End testing will be supported for payers requiring ICD 10 testing Providers will be able to participate as long as the payer will allow it or has requested it CD 10 testing will be initiated by the payer Payers will determine the type of responses that will be supported during testing including the return of Electronic Remittance Advice ERA2. Testing e Please see 5010 Testing User Guide on how to set up your test file to use in this environment A 5010 FAQ document is available as well Proprietary and Confidential Do not distribute How to test if you are an X12 5010 ANSI submitter via Communedi Premium Continued e Once you have entered into the testing application you will enter your current production credentials again eUser name current production username Password current production password e f your user name and password does not work please contact Customer Service for assistance at 866 367 9778 e STEP TWO e You may have to register please refer to the User Manual or FAQ document for assistance e During registration you will be asked to enter in an NPI This NPI is not used for anything within the test environment but it must be a valid NPI that follows the NPI logic e You will also be asked to enter a TIN this TIN can only be registered once within CP so if you register for two separate accounts one for 837P and one for 8371 a different TIN must be used e The above also applies to the email contact it can only be used once you will need to enter a different email address if using two test accounts e If you have already registered simply click on Submit a File on the right side of the HOME TAB and browse to the file you want to test and then submit e The Sender Id in the ISA06 must be the same as the Org ID e The Receiver Id in the ISA0
3. secure editest enshealth com aphrodite AphroditeServiet page type HEALTH E NETWORK NOTE If the Windows Security popup appears please select cancel Web pages may appear slightly different than the normal production website Login using e Current User name e New test environment Password e Current Organization ID e Test reports will be delivered to the Message Center Proprietary and Confidential Do not distribute 11 How do I retrieve my reports Continued e How willl retrieve my reports after testing for ICD 10 e Website File Upload will need to access the below testing URL and will need to contact Customer Support 866 367 9778 to obtain a test environment password to retrieve any ENS Reporting https secure editest enshealth com aphrodite AphroditeServiet page type HEALTH E NETWORK NOTE If the Windows Security popup appears please select cancel Web pages may appear slightly different than the normal production website Login using e Current User name e New test environment Password e Current Organization ID e Test reports will be delivered to the Message Center e Gateway Partner amp Secure FTP Submitters Access the current Secure FTP directory and look for folders titled TEST or Reports Test to retrieve any ENS Reporting Note If you do not see a test folder in your Secure FTP directory please contact Customer support 866 367 9778 for one to be set up Proprie
4. reporting returned and will not be sent to any payer participating in the END2END testing HEC Print Image amp DDE may receive rejected claims in the website in the View Claim Errors tab Submitters will also receive the ENS Level Two Reports containing any payer level rejections from ENS Integrated Method API HTTP Post will receive the ENS Level Two Reports containing any payer level rejections from ENS Ansi X12 Website File Upload submitters will receive the ENS Level Two Reports containing any payer level rejections from ENS Gateway Partner amp Secure FTP Submitters will receive the ENS Level Two Reports containing any payer level rejections from ENS For all testing claims submitted to payers and based on the type of response received from payers you might see a 999 rejection 277 claim status report and or a ERA 835 NOTE All reports will be returned in the Optum standard text format Proprietary and Confidential Do not distribute 10 How do I retrieve my reports e How willl retrieve my reports after testing for ICD 10 For HEC Print Image and DDE submitters that used the Optum Testing URL to test claims you will use the same Testing URL to retrieve your reports from the Message Center e Integrated Method API HTTP Post will need to access the below testing URL and will need to contact Customer Support 866 367 9778 to obtain a test environment password to retrieve any ENS Reporting https
5. 8 must be INGENIX Proprietary and Confidential Do not distribute How to test if you are an X12 5010 ANSI submitter via Communedi Premium Continued STEP THREE Validation reports will generate once the file is processed within a few minutes of submitting the file Reports can be seen under the Response TAB This report will contain front end Optum validation only e If you receive a business error for the following reason that means your test was successful due to the fact that ICD10 codes are not allowed at this time You will see the error code on your validation report e B25099 Code List Qualifier Code ICD 10 codes are not implemented at this time NOTE ANSIx12 claims submitted with ICD 9 codes will show as accepted in the front end validation however will not have any additional reporting returned and will not be sent to any payer participating in the END2END testing Proprietary and Confidential Do not distribute What types of reports will I receive e What types of reports will I receive Providers submitting ANSIx12 test claims via the Communedi Premium application will get the standard file structure validation reports from the Communedi Premium Self Testing tool This validation report will be the equivalent to the front end Clearinghouse reports received in production today e Note ANSIx12 claims submitted with ICD 9 codes will show as accepted in the front end validation however will not have any additional
6. ESTING MAKE SURE TO NAME THEM INA FASHION YOU WILL RECONGNIZE AS ICD 10 Testing NOTE Any Manage Provider Information and change to the production environment made after the February 15 2014 will not be present in the testing environment Please make sure addition of new information is added to the testing environment if the test requires you to use that new information NOTE Any claims submitted with ICD 09 codes will reject on the screen as this testing environment only supports the submission of claims containing CD 10 codes only Proprietary and Confidential Do not distribute How to test if you are a HEC submitter DDE e STEP ONE Contact support to obtain a NEW password for the TEST environment Customer Support number 866 367 9778 e STEP TWO Navigate to the below new TESTING URL https secure editest enshealth com aphrodite AphroditeServlet page tyoe HEALTH E NETWORK e NOTE If the Windows Security popup appears please select cancel Web pages may appear slightly different than the normal production website e Login using your e Current production User name e Test environment New Password e Current production Organization ID e STEP THREE From the menu navigate to Health E Claim then select CREATE A CLAIM e Proceed with testing by populating all necessary data elements and submit the claim e NOTE Any Manage Provider Information Subscriber Patient information and change to the p
7. Payers should contact providers directly to participate in ICD 10 End to End testing Providers can contact payers and request to participate in their ICD 10 testing e End to End testing will only be available for ICD 10 testing until 10 01 2014 e Providers can use the returned ERA to compare insurance payments to previous ERA s that contained ICD 9 codes e Dual testing of claims containing ICD 9 and ICD 10 codes will not be supported via this solution e Testing through this environment will only support Non UHG payers no UnitedHealth Care claims will be supported in the test environment e Optum will only support a single code set per claim in the test environment e Optum will not be providing conversion from ICD 9 to ICD 10 or vice versa e Payers will define testing dates and testing requirements Optum will make those available to providers Proprietary and Confidential Do not distribute 3 Document Introduction Continued A list of participating payers and additional information can be found in the Optum website http enshealth com ICD10Documentation Claims in the 4010 format should not be used to test ICD 10 code sets Inbound claims test files will only be process during the business hours of 8 00 AM to 5 00 PM MST Payer test files will be created and exported once per day out of the Optum test environment During the CMS National Testing week of March 3 7 2014 All test claims MUST be received by 9 00 AM M
8. ST on March 7 for claims to be included in the last round of test files to Medicare on March 7 Additional links regarding ICD 10 Preparation Centers for Medicare and Medicaid Services http www cms gov Outreach and Education Medicare Learning Network MLN MLNMattersArticles Downloads MM8465 pdf Proprietary and Confidential Do not distribute 4 How to test if you are a HEC submitter Print Image e STEP ONE As a submitter wanting to test ICD 10 your practice management software MUST be remediated to support the new form PRIOR to engaging in testing activities Once your PMS is updated please contact service and support to ensure all mapping changes have been made and you are prepared to test Customer Support number 866 367 9778 Contact support to obtain a NEW password for the TEST environment e STEP TWO Now you are ready to test Navigate to the following URL to begin e https secure editest enshealth com aphrodite AphroditeServiet page tyoe HEALTH E NETWORK e NOTE If the Windows Security popup appears please select cancel Web pages may appear slightly different than the normal production website Login using your e Current production User name e Test environment New Password e Current production Organization ID e STEP THREE Enter the test environment and navigate to Health E Claims Then select SEND CLAIM FILE as you would in production NOTE WHEN CREATING YOUR FILES TO UPLOAD FOR T
9. roduction environment made after February 15 2014 will not be present in the testing environment Please make sure addition of new information is added to the testing environment if the test requires you to use that new information e NOTE Any claims submitted with ICD 09 codes will reject on the screen as this testing environment only supports the submission of claims containing CD 10 codes only Proprietary and Confidential Do not distribute 6 How to test if you are an X12 5010 ANSI Website File upload Integrated API HTTP Post STFP FTP including Gateway Partner submitter via Communedi Premium Who should use this method of testing for ICD 10 Any provider that submits 8371 amp 837P AnsiX12 claims using the following submission methods e File Upload via the ENS Heatlh com Website e Integrated Channel Partners that submit via an HTTP post API e SFTP FTP Submitters e Gateway Partners that submit via FTP or SFTP e STEP ONE e Asa submitter when ready to test ICD 10 using X12 ANSI format click on the link below http enshealth com ICD10Documentation Select ICD 10 Solutions e Direct submitters can select Health E Network e Integrated Vendors can select Channel Partner amp Vendors e Gateways can select Gateway amp Clearinghouses e You will then be prompted to log in using your current production username and password e Once logged in select Click here to begin testing 5010 Transactions under 5010 Transaction
10. tary and Confidential Do not distribute 12 How do I retrieve my 835s e How will receive my Electronic Remittance Advice as a result of my testing e For HEC Print Image and DDE submitters that used the Optum Testing URL to test claims you will use the same Testing URL to retrieve your ERA s from the Electronic Remittance Advice Tab in the menu e Website File upload submitters amp Integrated API HTTP Post submitters will need to access the below testing URL and use the same test environment password obtained from Customer Support to retrieve the ENS Reporting https secure editest enshealth com aphrodite AphroditeServiet page type HEALTH E NETWORK NOTE If the Windows Security popup appears please select cancel Web pages may appear slightly different than the normal production website Login using e Current User name e New test environment Password e Current Organization ID Test ERA s will be delivered to the Electronic Remittance Advice Tab in the menu e Gateway Partners amp Secure FTP Submitters Access the current Secure FTP directory and look for folders titled TEST Reports Test or 835 to retrieve any ENS Reporting Note If you do not see a test folder in your Secure FTP directory please contact Customer support 866 367 9778 for one to be set up Proprietary and Confidential Do not distribute 13 When willl receive my Electronic Remittance Advice as a res
11. ult of my testing e When will receive my Electronic Remittance Advice as a result of my testing ERA s will only be returned if the payer is supplying ERA s during the End to End testing There is no way to determine the timing of the payers delivery of the ERA s Proprietary and Confidential Do not distribute 14 How will know what payers are testing for ICD 10 e How will know what payers are testing for ICD 10 The Optum ICD 10 Testing Payers List will be available in the Optum ENSHealth com Website at the following link http enshealth com ICD10Documentation the list will be under ICD 10 Documentation The list will provide pertinent testing information that each payer will require Ongoing changes will be applied to the Optum ICD 10 Testing Payers list as payer information is available The updated list will be available weekly Test claims submitted for payers not included in the ICD 10 Testing payers list will receive rejections for invalid payer Proprietary and Confidential Do not distribute 15
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