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Volunteer Testing Form

This form must be submitted by March 24, 2014.

BACKGROUND

Effective with dates of service on or after October 1, 2014, the ICD-9 code sets will be replaced by ICD-10 code sets. To help prepare for this transition, the Centers for Medicare & Medicaid Services (CMS) is soliciting volunteers to conduct limited end-to-end testing with the Medicare Administrative Contractors (MACs) July 21-25, 2014. The sample of 32 participants for each MAC will be selected from the volunteers to represent a broad cross-section of provider types, claims types, and submitter types. Selected testers will be notified that they have been selected by April 14, 2014. Those selected will be provided specific details regarding how to test and who to contact for testing support.

The MAC systems will be able to accommodate future dates of service for this testing. Test claims with ICD-10 codes must be submitted with dates of service October 1, 2014 through October 15, 2014. Each selected submitter may send up to 50 test claims over the course of the testing week. Test claims accepted into the system will be processed by the MAC and a remittance advice will be generated.
For those electronic submitter/trading partners who serve in multiple states, and multiple Medicare jurisdictions, CMS reserves the right to limit a particular submitter to test with only one MAC.

More information is available in MLN Matters® Article MM8602.

To be considered for this testing effort, please complete this volunteer form by March 24, 2014.

MINIMUM TESTING REQUIREMENTS

All volunteers for participation in the July 2014 end-to-end testing for ICD-10 must be able to meet the following testing requirements: 

  1. Testers must be established electronic submitters, with active Medicare submitter IDs, and capable of receiving electronic remittance advices (ERAs) to be eligible for this testing. Electronic submitters are defined as clearinghouses, billing agencies, or a professional or institutional provider that submits directly to Medicare.
  2. Providers who submit through a clearinghouse will have to work with their clearinghouse to test, if the clearinghouse is chosen for testing, and may not submit a volunteer form.
  3. Vendors cannot volunteer to test directly because they do not have a submitter ID.   Vendors must work with a chosen submitter to test.
  4. Testers must be ready to test ICD-10, meaning, all vendor and practice management software needed to test has been updated and internally tested prior to conducting end-to-end testing with Medicare.
  5. Testers must be able to submit future dated claims.
  6. Testers must be able to provide the National Provider Identifiers (NPIs) and beneficiary Health Insurance Claim Numbers (HICNs) they will use for test claims when requested by the MAC.  This information will be needed several months prior to the start of testing for set- up purposes.

Volunteer Information and Primary Contact

Company Name: *
Type of Organization:        *
Submitter ID/Trading Partner ID: *
Primary Contact Name: *
Telephone Number: . . *
E-Mail Address: *
State(s) where you furnish services: *
Type of Submitter (Choose one):        *

Additional Information from Direct Provider Submitter Volunteers

Please select your provider type:       
Size of Organization:       
If applicable, how many beds does your institution support?       
What types of 837 claims would you submit for testing? Provide bill types and/or specialty.
Are you a rural provider or located in a health professional shortage area?
YES:
NO:
Did you participate in the March Testing Week?
YES:
NO:
If No, do you plan on conducting acknowledgement testing with CMS prior to July 2014?
YES:
NO:
Are you a certified Electronic Health Record (EHR) User?
YES:
NO:
If Yes, what is your certified EHR product vendor?


Find out about certification

Additional Information from Clearinghouse and Billing Company Submitter Volunteers

How many providers do you represent?
Specific to the MAC jurisdiction, in what States are those providers located?
How many claims do you submit to Medicare on a monthly basis?
Did you participate in the March Testing Week?
YES:
NO:
If No, do you plan on conducting acknowledgement testing with CMS prior to July 2014? Yes/No
YES:
NO:
Have you signed up for MAC listserv?
YES:
NO:

If you are not currently signed up for the CGS listserv and would like to register for it, click here.

Thank you for volunteering for ICD-10 end-to-end testing.

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