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End-to-End Testing

Back To ICD 10

Welcome to Banner Health's ICD-10 webpage. Check back regularly for updates on Banner Health's transition to ICD-10.

Background:

By Oct. 1, 2015, every entity covered by HIPAA is required to transition from the ICD-9 code sets used to report medical diagnosis and inpatient procedures to the ICD-10 code set. To learn more about the requirements, visit the CMS website.

Testing Approach & Strategy

Banner Health operates as both a provider and a payer.

Banner Health's approach to testing is to complete full end-to-end testing. Banner Health’s definition of End-to-End Testing encompasses testing internal systems to create the natively coded test claims by submitting/receiving an 835 or equivalent claim through any clearinghouses as needed. To complete end-to-end testing, Banner Health needs to receive/send acknowledgement reports (277CA or 999) and 837,ERA,EFT or equivalent. This testing process will assist in testing the connectivity between Banner Health and all trading partners.

The Banner ICD-10 test team desires to complete testing with as many trading partners as possible. Upon go-live, Banner Health's goal is to receive and send timely payment remittances with no significant increase in denials in an effort to maintain cash flow.

From a provider perspective, to facilitate end-to-end testing with as many trading partners as possible, Banner will send generic test claims. Payers' member data can be utilized in the test claims to facilitate processing with our trading partners. The number of claims tested is dependent on the amount of claims sent on a regular basis.

For trading partners that desire to send test claims to BHN/BPA, please contact us by email.

Testing Opportunities

Banner Health recognizes the need to conduct thorough testing with its trading partners. A team analyzed and identified trading partners to conduct end-to-end testing for ICD-10. We are in the process of contacting those trading partners.

If your organization is interested in testing with Banner Health, send an email.

Testing Results

  • Initial testing with internal payer started in February 2014.
  • CMS – Acknowledgement Testing: March 3-7, 2014
    • Banner Health participated in Acknowledgment testing and received positive results.
  • Banner Health's top six payers (based on contract details, Banner is not at liberty to list specific payer organizations in the summary below.)
    • End-to-End testing completed with positive results. Banner is a direct submitter to this payer. Results were received within 3 weeks. Banner will test with a subset of test claims in 2015. This payer organization has been great to work with as we had great collaboration and the team was responsive to our emails.
    • Banner submitted test claims to payer at the end of May 2014. ERAs expected in August 2014. Test claims were submitted with ICD-9 and again with ICD-10 codes.
    • Stage 1 & 2 spreadsheet testing was completed. Banner is waiting for Stage 3 (End-to-End testing) to begin. Testing discussions estimated to start end of summer 2014. This payer is willing to test using 50 re-coded claims. Claims originally submitted using ICD9 codes will be re-coded using ICD-10 codes.
    • The test team at Banner was in the process of creating test claims for another payer when the ICD-10 delay was announced. Many hours were already spent on this process. The payer decided to postpone testing. Banner Health encountered a financial cost as a result of the postponement.
    • Testing with this payer is tentatively scheduled for the first half of 2015.
    • One payer is only willing to do a DRG shift analysis.
  • Additional payers
    • Two rounds of end-to-end testing has been completed. For round one, 90 percent of the test claims were rejected--not for the ICD-10 codes. However, if the implementation date was here, Banner would not have received the reimbursement, which is crucial to maintaining operations. Banner's claims were correct. For our second round of testing, there was 100 percent success in all claims submitted. We had great collaboration with this payer. Our experience with testing illustrates how important end-to-end testing is needed.
    • Banner submitted about 100 claims to a payer and results were expected in July; however, the payer organization experienced some issues. Claims results (ERAs) should be sent sometime August 2014.
    • Test claims were submitted to a payer at the end of June 2014. This payer experienced issues with their claims adjudication process and is working with their vendor now to get the issue resolved.
    • With one payer, Banner conducted connectivity testing with the submission of test claims. During our discussions regarding end-to-end testing is when the ICD-10 delay was announced. Testing has been postponed until 2015.
    • Banner submitted test claims to another payer and after submission (around the time of the announcement of the delay), the payer decided to postpone testing until 2015. 

Value of End-to-End (E2E) Testing

Testing with multiple payers provides value as it:

  • Verifies trade partner ICD-10 readiness
  • Builds rapport among trading partners
  • Testing completed at Banner Health indicates how important end-to-end testing is for ICD-10

Email us with questions or if your organization is interested in conducting ICD-10 End-to-End testing.