Q1 Is your software capable of generating ICD-10 test claims?

Transcription

1 Q1 Is your software capable of generating ICD-10 test claims? Answered: 55 Skipped: % % 8 Total 55 # If no, is there a scheduled month when it will be ready? (If it is not scheduled, please indicate "not scheduled") Date 1 6/15 6/11/ :05 AM 2 July 6/10/2015 2:04 PM 3 6/5/ :16 AM 4 have not successfully generated test claims yet 6/4/2015 2:23 PM 5 July 6/4/2015 2:07 PM 6 July 6/4/2015 1:46 PM 1 / 22

2 Q2 Have you, your clearinghouse or system vendor conducted full end-to-end testing with Medicaid? [NOTE: End-to-end testing is defined as complete adjudication, including 835.] Answered: 55 Skipped: % % 20 Total 55 # If yes, specify state(s) and date(s) Date 1 CO 6/10/2015 2:04 PM 2 In the fall of 2014 for Virginia, and is going to be testing again either in July or August depending on Virginia Department of Medical Assistance timelines 6/10/ :50 PM 3 Don't know 6/5/ :16 AM 4, however, it is scheduled for this month. 6/4/2015 6:03 PM 5 06/04/2015, New Mexico (clearinghouse/system vendor, but not our charges) 6/4/2015 2:37 PM 6 California 6/4/2015 1:55 PM 7 National and May 22nd I think was the date. 6/4/2015 1:53 PM 8 Gateway clearing house has 6/4/2015 1:46 PM 9 Idaho /4/ :40 AM 2 / 22

3 Q3 Was it successful? Answered: 14 Skipped: % 14 Total 14 # If no, provide specific issues, by state Date 1 I was told initial testing was successful. 6/10/ :53 PM 3 / 22

4 Q4 Has any state Medicaid agency indicated they will NOT be ready for ICD-10 on October 1? Answered: 41 Skipped: % % 2 Total 41 # If yes, specify state(s) and issue(s) Date 1 I ACTUALLY HAVE NO IDEA. YOU'D NEED TO CONTACT EMDEON/CAPARIO FOR MEDICAID INFORMATION OUTSIDE OF VIRGINIA 6/10/ :53 PM 2 Indiana, not sure of issue 6/10/ :59 AM 3 Have not heard from State any way in regards to readiness, unclear via information on website; Missouri 6/4/2015 2:26 PM 4 / 22

5 Q5 List the top 5 (by claim volume) Commercial Insurers to which you submit electronic claims: Answered: 41 Skipped: 14 # Date 1 Blue Shield, UHC, Aetna, 6/11/ :08 AM 2 BCBS, UHC/Ox, Aetna, Cigna, Emblem 6/10/2015 6:22 PM 3 BCBS IL, UHC, Cigna, Humana, Advocate 6/10/2015 6:13 PM 4 BCBS, UNITED HC, AETNA, CIGNA,QUALCARE 6/10/2015 5:20 PM 5 BCBS UHC Cigna Aetna Coventry 6/10/2015 5:15 PM 6 United Healthcare BCBS Colorado CIGNA Aetna Humana 6/10/2015 2:05 PM 7 UHC, Cigna, BCBS, Coventry, Aetna 6/10/2015 1:32 PM 8 ANTHEM AETNA CIGNA OPTIMA COVENTRY UNITED HEALTH CARE 6/10/ :53 PM 9 Anthem Blue Shield of Ca United Healthcare Aetna Cigna 6/10/ :08 PM 10 Anthem, Cigna, UHC, Aetna, Rocky Mtn Health Plan 6/10/ :51 AM 11 United Healthcare Oxford Aetna Cigna BC/BS 6/10/ :32 AM 12 aetna united health Blue Cross Cigna Value options 6/10/ :10 AM 13 Aetna United Healthcare Cigna Blue Cross Health Partners 6/10/ :08 AM 14 Blue Cross Blue Shield of IL United Healthcare Cigna Aetna Humana 6/10/ :59 AM 15 Anthem/BCBS Medicare Medicaid Humana United Healthcare 6/10/ :56 AM 16 Horizon NJ BCBS AmeriHealth United Healthcare CIGNA Aetna 6/10/ :56 AM 17 Aetna, Cigna, BCBS, UHC, Humana 6/10/ :52 AM 18 United Healthcare, Blue Cross, Blue Shield, Aetna, Hill Physicians 6/10/ :49 AM 19 BCBS of Florida Aetna United Humana Cigna 6/8/2015 8:48 AM 20 Aetna cigna 6/5/ :24 AM 21 Blue Cross Texas; United Healthcare; Aetna; Cigna; Firstcare 6/5/2015 9:55 AM 22 Medicare; Medicaid, Blue Cross Blue Shield of Michigan, Priority Health, Blue Care Network 6/5/2015 9:19 AM 23 MEDICAL MUTUAL OF OHIO ANTHEM AETNA CIGNA UNITED HEALTHCARE 6/5/2015 8:40 AM 24 BCBS Oxford HIP UHC GHI 6/5/2015 8:15 AM 25 BCBS Aetna Cigna United Humana 6/4/2015 9:05 PM 26 Regence BCBS of Oregon MODA Health (Oregon) United Health Care Kaiser Providence Health Plan 6/4/2015 6:23 PM 27 BC/BS Aetna Humana Geisinger UHC 6/4/2015 4:44 PM 28 Blue Cross, Blue Shield, Aetna, UHC, Health Net 6/4/2015 4:36 PM 29 Blue Cross United Health Care Humana Aetna Cigna 6/4/2015 4:35 PM 30 CareFirst, United Healthcare, Aetna, CIGNA 6/4/2015 3:41 PM 31 Presbyterian Health Plan Blue Cross Blue Sheild of New Mexico United Healthcare Molina Healthcare NM Health Connections 6/4/2015 2:39 PM 5 / 22

6 32 Medicare Illinois Medicaid Indiana Medicaid 6/4/2015 2:37 PM 33 Medicare Anthem BCBS UnitedHealthcare Coventry (Group Health Plan) HealthLink 6/4/2015 2:26 PM 34 UHC (all plans), CIGNA, CIP, Aetna and Coventry 6/4/2015 1:58 PM 35 Medicare, Medicaid, Blue Cross, United HealthCare, Aetna, Cigna, Blue Shield 6/4/2015 1:57 PM 36 Regence (Local Blue Shield affiliate) Premera (local Blue Cross affiliate) First Choice (local payer) Healthy Options plans (Medicaid type plans) 6/4/2015 1:55 PM 37 Blue Cross Aetna Humanna UHC 6/4/2015 1:53 PM 38 Medicare Medicaid BCBS Selecthealth CIGNA 6/4/2015 1:35 PM 39 bcbs, 6/4/2015 1:34 PM 40 Blue Cross Blue Shield UHC Humana PacificSource 6/4/ :41 AM /4/ :23 AM 6 / 22

7 Q6 Have you, your clearinghouse or system vendor conducted full end-to-end testing with commercial plans? [NOTE: End-to-end testing is defined as complete adjudication, including 835.] Answered: 41 Skipped: % % 13 Total 41 # If yes, specify payor(s) and state(s) Date 1 All Medicare Carriers I believe the following include 835s: Pinnacle Business Solutions Availity Anthem NC, AZ, MI and AL BCBS Premera Emdeon Claimsnet Ingenix/ENS/Optuminsight Medicaid - FL, TX, MI, CO, PA, MA, MD, CT, OH, DC, CA, MN, MY, OR 2 THE LIST IS TOO LONG TOO LIST. IT CAN BE FOUND ON EMDEONS WEBSITE UNDER ICD-10 READINESS 6/10/2015 2:05 PM 6/10/ :53 PM 3 t yet. Expecting to this month. 6/10/ :56 AM 4 Blue Cross of Texas 6/5/2015 9:55 AM 5 MODA (OR) Providence Health Plan (OR) Kaiser (OR) - in process Health Net (OR) - in process Although not commercial: Medicare E2E round #3 (OR) - in process DMAP Medicaid (OR) - in process CareOregon (OR) - Medicare and Medicaid HMO - in process 6/4/2015 6:23 PM 6 t sure. 6/4/2015 1:58 PM 7 / 22

8 Q7 Was it successful? Answered: 8 Skipped: 47, succcessful, unsucessful, succcessful, unsucessful 87.50% % 1 Total 8 # If no, provide specific issues, by payor/state Date 1 In process 6/4/2015 1:36 PM 8 / 22

9 Q8 Has any payor provided information that they will require more specificity than they do now and/or the most specific codes available in ICD-10 for payment? Answered: 38 Skipped: % % 6 Total 38 # If yes, specify payor/ plan and state Date 1 Blue Shield, rth Carolina Blue Shield, Kansas 6/11/ :10 AM 2 Humana, United Healthcare requesting more specificity. 6/10/2015 2:08 PM 3 response, either way. 6/4/2015 4:46 PM 4 Blue Cross of LA 6/4/2015 4:36 PM 5 Anthem BCBS/ Missouri 6/4/2015 2:26 PM 6 OPTUM Idaho 6/4/ :42 AM 9 / 22

10 Q9 Have there been any end-to-end testing denials that were not anticipated? Answered: 38 Skipped: % % 2 Total 38 # If yes, specify payor, state and issue Date 1 t that I'm aware of. 6/10/2015 2:08 PM 2 na - not end-to-end testing 6/5/2015 9:20 AM 3 N/A; have not performed testing 6/4/2015 2:26 PM 4 We have not been able to conduct ANY end to end testing with any private commercial payers, or our state Medicaid payer. 6/4/2015 1:55 PM 10 / 22

11 Q10 Has any payor stated they will reverse/back-map ICD-10 codes to ICD-9 internally in order to process claims? Answered: 34 Skipped: % % 2 Total 34 # If yes, specify payor and states Date 1 Lots of rumors that payors will but haven't seen anything specific. 6/10/2015 2:10 PM 2 I recall hearing this, but not sure which carrier. AETNA? 6/10/ :34 AM 3 Unknown 6/4/2015 9:06 PM 4 Aetna Others - unknown either way 6/4/2015 4:48 PM 11 / 22

12 Q11 Has any payor stated they reverse/back-mapped codes internally for testing? Answered: 34 Skipped: % % 2 Total 34 # If yes, specify payor and states Date 1 unknown 6/10/2015 2:10 PM 2 UNKNOWN 6/10/ :34 AM 3 Unknown, either way 6/4/2015 4:48 PM 4 Federal BX for Part A Idaho 6/4/ :45 AM 12 / 22

13 Q12 Does the payor adjudication system programming include all the new rules for code sequencing? Answered: 34 Skipped: 21 Unknown/ Do not know Unknown/ Do not know 2.94% % % 2 Total 34 # If no, specify payor and state Date 13 / 22

14 Q13 Is medical necessity and eligibility determined by all diagnosis codes on the claim? Answered: 34 Skipped: 21 Unknown / Do not know Unknown / Do not know 14.71% % % 1 Total / 22

15 Q14 If you answered yes to question 13, give specific examples tested Answered: 1 Skipped: 54 # Date 1 Monitored Anesthesia Care requires specific dx for Medicare 6/4/2015 6:35 PM 15 / 22

16 Q15 If you answered no to question 13, specify payor and state and give specific examples Answered: 0 Skipped: 55 # Date 16 / 22

17 Q16 Did/will claims deny if use additional codes are not included? Answered: 30 Skipped: 25 Unknown/ not tested Unknown/ not tested 3.33% % 29 Total 30 # If yes, specify payor, state and specific examples Date 17 / 22

18 Q17 Has your state Workers Compensation confirmed they will process ICD-10 claims on or before October 1, 2014? Answered: 30 Skipped: 25 Unknown/ Do not know Unknown/ Do not know 43.33% % % 4 Total 30 # If yes, specify state and date Date 1 CO 6/10/2015 2:12 PM 2 Do you mean 10/01/2015 (it says 2014 above)? This is a strange question... SAIF (OR) - States on website cutover on 10/1/15 Washington DOLI (WA) - States on website cutover on 10/1/15 6/4/2015 6:35 PM 3 IDAHO /4/ :53 AM 18 / 22

19 Q18 Have your major auto / no-fault payors confirmed they will process ICD-10 claims? Answered: 30 Skipped: 25 Unknown/ Do not know Confirmed will not process... Unknown/ Do not know Confirmed will not process ICD % % % 1 Total / 22

20 Q19 If you answered yes to question 18, please specify payors and states Answered: 0 Skipped: # 1 Date # 2 Date # 3 Date # 4 Date # 5 Date 20 / 22

21 Q20 If you answered confirmed will not process ICD-10 in question 18, please specify payors and state Answered: 0 Skipped: # 1 Date # 2 Date # 3 Date # 4 Date # 5 Date 21 / 22

22 Q21 Have you been denied an end-to-end testing opportunity by any payor? Answered: 28 Skipped: % % 11 Total 28 # If yes, list state and payor Date 1 Unknown 6/10/2015 2:14 PM 2 not to my knowledge 6/10/ :34 AM 3 Our clearinghouse is conducting testing and we are unable to receive adjudication reports for our specific test claims. 6/10/ :03 AM 4 But have not finished testing yet. 6/10/ :58 AM 5 Most payers other than Blue Cross of TX. Most wanted to have a select group test and then post the results of that group but not end to end test with everyone. 6/5/ :22 AM 6 payors have agreed to end-to-end testing 6/5/2015 9:22 AM 7 Cigna (OR) UHC (OR) Lifewise (OR) 6/4/2015 6:44 PM 8 Medicare - PA Medicaid - PA 6/4/2015 4:52 PM 9 response from local blue shield plans or local payers. 6/4/2015 1:56 PM 10 All commercial to date 6/4/ :53 AM 22 / 22