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There’s been an industrywide concern among healthcare providers during recent months about the lack of knowledge on what to expect in testing from payers.

To help facilitate ICD-10 testing during the remaining transition period, the Cooperative Exchange (CE) will gather information on payers regarding their testing parameters. This is a value-add for Cooperative Exchange clearinghouse clients and all providers and clearinghouses, as this will reveal information that can be useful to them for their implementation processes.

The Cooperative Exchange will use an online survey tool in order to accomplish this, making information available via a public, one-stop resource on the CE website.

All information will remain confidential as to the contributor. Only the Cooperative Exchange’s executive director will have access to each contributor’s information, and it will only be used to contact a contributor if information from another contributor about the same payer is vastly different. Answers to all survey questions will be submitted anonymously using a username and password. Inputters will only have access to update information about payers they have already recorded and to add new payers. There also will be a “last input date,” which will be an automatic date/time stamp feature useful for running reports. And the data will be presented either via a single data point, multiple data points, or a full spreadsheet;

Providers and clearinghouses will populate the database by providing information about 10 key metrics:

  1. Payer name/line of business.
  2. Is the payer indicating that it will map from ICD-10 to ICD-9?
  3. Is the payer indicating that it will dual code in ICD-9 and ICD-10?
  4. Testing type/testing date/returning information/triggering ICD-10 edits/dates of service.
  5. The URL from the payer’s website where information on their ICD-10 testing (including the testing plan) can be found.
  6. Does the payer allow for the scheduling of future service testing dates?
  7. Will a clearinghouse need to set up a new connection for ICD-10 testing?
  8. Will the payer be rejecting or denying claims for unspecified diagnosis codes? 
  9. Is provider and submitter registration required? 
  10. With whom will the payer be supporting testing?

“As more and more payers’ testing information goes online, this will be the most dynamic tool for providers and clearinghouses to have as they plan and execute their testing strategies,” said CE Executive Director Tim McMullen.

The Cooperative Exchange’s 24 clearinghouse members include ACS EDI Gateway; Apex EDI: Availity; ClaimRemedi; Emdon; eProvider Solutions; GE Healthcare; Greenway Health; HDM Corp.; Health-e-Web; Instamed; Jopari Solutions; NextGen Healthcare; OfficeAlly; OptumInsight; Passport Health; Practice Insight; RelayHealth; Secure EDI; Siemens HDX; The SSI Group, Inc.; TriZetto Provider Solutions; Utah Health Information Network (UHIN); and ZirMed.

The Cooperative Exchange was established in 2002 to promote and advance electronic data exchange for the healthcare industry. It is the recognized resource and representative of the clearinghouse industry for the media, governmental entities, and other industry stakeholders. The association is committed to promoting and advancing electronic data exchange for the healthcare industry by improving efficiency, advocacy, and education for industry stakeholders and government entities.

About the Author

Tim McMullen, JD CAE, is the executive director of the Cooperative Exchange.

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