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.  

SOAPware highly recommends that you start preparing for the transition to ICD-10 immediately.  The information below details some of the steps you can take to begin preparing your documentation.  The most up-to-date SOAPware version is required for the transition to ICD-10.

At this time, greater than 90% of the 7000 core, customized diagnosis SMARText items that SOAPware users are actually using are coded for ICD-9 as well as billable ICD-10 (and SNOMED-CT) codes.

This lesson will describe the workflow used when the response of Denied - New Rx to Follow is selected for an EPCS refill request.