Getting ready for ICD-10 testing is going to require more than getting a good night's sleep and two No. 2 pencils.
To help you prepare, the Centers for Medicare and Medicaid Services (CMS) outlines the ICD-10 testing process for medical practices:
- Transaction through a practice management services (PMS), clearinghouse or payer
- A request for patient’s eligibility for date of service through the ASC X12 270 transaction
- Patient claim encounter ASC X12 837
- A request for the claims status through an ASC X12 276 transaction
- Receives claim encounter from PMS, provider or clearinghouse
- Edits the patient claim encounter file
- Transfers the patienct claim endounter file
- Transfers the patient claim encounter o an ASC X12 837 claim submission file or stores it until the payer picks up the file
- Transactions from PMS, provider or clearinghouse
- Inquiry on patient’s eligibility for date of service on an ASC X12 270 transaction
- And accepts the ASC X12 837 file and transfers file into the claims processing system for adjudication
- Inquiry for claim status through an ASC X12 276 transaction
Payer then sends:
- Response to transaction to PMS, provider or clearinghouse
- Response for patient’s eligibility through ASC X12 271 transaction
- Acknowledgement (TA1, 999, 277CA) that the file has been accepted
- The TA1 and 999 reflect technical problems that must be addressed by the software preparing the EDI transmission.
- The 277CA reflects a data problem that must be addressed by resources in billing.
- A claim status response through an ASC X12 277 transaction
- A claim payment/advice through an ASC X12 835 transaction
- Sends response to PMS, provider or clearinghouse that the file has been accepted
- Receives acknowledgement (TA1, 999, 277CA) from the payer
- Receives the ASC X12 835 transaction
- Stores, transfers and sends an ASC X12 835 to the provider
- Transaction from PMS, clearinghouse or payer
- Response for patient’s eligibility through an ASC X12 271 transaction
- Acknowledgement (TA1, 999, 277CA)
- Claim status response through an ASC X12 277 transaction (Receives the ASC X12 835 transaction)
- ASC X12 270: Contacting a healthcare payer about a patient’s eligibility and benefits
- ASC X12 271: Info from a healthcare payer about a patient’s eligibility and benefits
- ASC X12 276: Request to healthcare payer about the status of a medical claim
- ASC X12 277: Info about the status of a claim from healthcare payer
- ASC X12 835: Medical claim payment and/or remittance info from healthcare payer.
- ASC X12 837: Medical claim submitted to the healthcare payer.