Ready for ICD-10 Transition? It’s just 57 days away!!

Novitas Solutions would like to encourage all providers billing directly, clearinghouses and billing services to test early and test often.  This will ensure you are prepared for October 1^st.

Information about testing:

• Test claims will be sent to the contractor the same as production claims.
• Claim files must be marked as “Test” in the ISA15 field with a “T”.
• Test claims with ICD-10 diagnosis codes must be submitted with current dates of service.
• Test claim volume is limited to a total of 50 claims per file.
• Test claims will be subject to all existing EDI front-end edits including Submitter authentication and NPI validation.
• Test claims will receive the 277CA or 999 acknowledgement as appropriate, to confirm that the claim was accepted or rejected in the system.
• Testing will not confirm claim payment or produce remittance advice.

Important tips for sending a test file:

• The file should contain a variety of the types of claims submitted on a normal basis
• The qualifiers for ICD-10 should be reported as ABK or ABF in the 2300 HI segment
• ICD-10 codes should only be used once per claim, duplicate codes will cause rejections
• Avoid sending claims with invalid NPIs, Procedure Codes, Zip codes.  These type of common billing errors have failed many test files.
• Work with your software vendor to ensure changes are loaded to your system and ready to test.

Test files can be sent any day from now until October 1^st.  For questions regarding testing, please contact the EDI Helpdesk.

Edit Changes for Part B Claims Effective September 30, 2015

Important edit changes for Professional claims effective September 30, 2015

CMS issued Change Request (CR) 9145 edit spreadsheet changes for Professional electronic claims. The Professional edit changes below will be implemented the evening of September 30, 2015.

Please note, the edit change notated with the * below will be implemented the evening of October 4, 2015.