Testing ICD-10 Claims with SOAPware Practice Management

The workflow in this lesson show SOAPware PM users how to create and upload a test file to Trizetto using claims that are manually entered in our PM system, and have never been processed by the payers/insurance companies. Test claims will not be forwarded to payers when they are uploaded using the following instructions. Mock charges can also be used as long as they are created using actual patient data that will pass Trizetto scrubbers.

Charges can be posted from the patient chart if preferred. See ICD-10 Clinical Features for instructions.

The file should contain a minimum 25 claims for various payers, using only the ICD 10 code set.  

Each test claim will have to be corrected and resubmitted to payers using the ICD 9 codes prior to October 1, 2015. Mock claims should be deleted once the file is accepted and approved.  

Claims Options

Claims Options

Remove check mark from Auto Submit. Save Local Copy and Testing should be checked.

Make note of Output Path for manually uploading the file to Trizetto.

Add Charge(s)

In New Charges tab, select ICD 10 type. Add a Claim Comment to easily identify the claim as a test claim in Claims Manager and click Add Charge.

Select ICD-10 Codes

  1. Add Code
  2. Expand to view Advanced Search. Advanced Search will show a full list of the ICD 10 codes beginning with the letter typed and their description.
  3. As you begin typing the first letter of the code in Advanced Search, the list of available codes to select from will open along with the description. You may also search by description. Double click on code line to select, or use the Select button until all applicable ICD 10 codes are listed in Diagnosis Codes section, and Save charges.

Repeat until you have approximately 25 claims for various payer types.

Create Test File

Locate test claims by Claim Notes and make note of the claim numbers to identify claims for resubmission as production files.

Scrub the claims.

 

Bypass Scrub

Scrub Errors message will display for each claim when the Insurance Company setup is set to default to ICD 9 and the claim is using ICD 10 codes. This is one of the few rules that will allow users to bypass the scrub. The initial scrub is necessary to make certain the only error on the claim is the ICD Type.

After the claims are placed in the On Hold section, select and Rebuild each claim and move to the Pending Scrub section.

Change each claim Status to Bypass Scrub, highlight all claims to select and then Scrub.

Submit Selected

Highlight to select all test claims in Ready to Submit and click Submit Selected.

The file is created and claims are marked as Test and will not be processed by payers until resubmitted as Production files. The test file will not be automatically submitted to Trizetto since Auto Submit is unchecked and will have to be manually uploaded to Trizetto website.

Upload Test File

Upload Test File

Go to Trizetto's Website http://www.trizettoprovider.com

Click on the green ICD-10 tab and then Send ANSI 5010 test file.

Choose File to Upload

Choose File to Upload

Select the choose File button and find the folder and file selected in Claims Options Output path and Open the file created as a test file.

Upload Test Claims File

Upload Test Claims File

Click Upload. If you have any further questions regarding Trizetto Testing Process, please contact Trizetto Customer Service at 1-800-556-2231.

Warning!! Reset Claims Options  

Warning!! Reset Claims Options  

You will have to go back to Tools->Billing Maintenance->Claims Options in order to reset your submission options to the way they should be for automatically uploading Production claims to Trizetto. Place a check mark next to Auto Submit and remove the check mark from Testing. !!! Failure to do this will prevent all live claim files from automatically uploading to Trizetto !!!

Press OK to save changes.

Edit Test Claims and Rebuild or Delete

Charges must be changed back to ICD 9 codes set and resubmitted to the payers for processing if testing with actual. Payers will not accept production claims with ICD 10 code sets until October 1, 2015.

  1. Open Claims Manager to Submitted tab.
  2. Double click on the claim to edit in Claims tab.

Delete Claims if using mock charges

Double click on claim from Submitted tab in the Claims Manager and Delete from the list of claims if using mock claims for testing. Repeat for all mock claims within the Claims Manager.

Change Code Type to Edit Charges for Production

Select ICD9 and double click on charge to edit.

Select correct ICD 9 code(s)

Select correct ICD 9 code(s)

Click Add Code and select appropriate ICD 9 code(s).

Remove ICD 10 code(s)

Remove ICD 10 code(s)

Remove all the ICD 10 codes highlighted in red from the Diagnosis Codes section and Save. Repeat for additional charges, if applicable.

Place claim On Hold

Place claim On Hold

Place a check mark in On Hold to Rebuild claims and apply changes to claim.

Rebuild and Submit Claims for Processing

  1. Open Claims Manager to Working tab.
  2. Sort the Claim column header and locate all test claims by claim number in the On Hold section.
  3. Click to highlight claims.
  4. Rebuild, Scrub and submit claims as usual.