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ICD-10 Beta Testing Results

December 31, 2014

Medi-Cal recently completed ICD-10 beta testing with selected provider and submitter participants. The beta testing validated participants’ practice electronic files for claims containing ICD-10-CM and ICD-10-PCS codes and the readiness of the Medi-Cal claims processing system to successfully process ICD-10 coded electronic claims.

Participants
Thirty Medi-Cal submitters completed testing with Medi-Cal. The group of participants included the following types of providers:

  • Hospital
  • Federally Qualified Health Center (FQHC)
  • Medical group
  • Long Term Care
  • Laboratory

Submissions also included test claims from clearinghouses and billing services.

Test Scenarios
Testing focused on electronic claims which included Professional (837P), Institutional (837I) Inpatient/Long-Term Care (LTC) and Institutional (837I) Outpatient claims. Test scenarios included both valid claim submissions and invalid claim submissions.

Medi-Cal reviewed the adjudication status for all test claims and communicated the status back to the submitters for validation.

Results
Participants submitted a total of 119 files representing the following claim types:

  • Inpatient: 38 files
  • Outpatient: 57 files
  • LTC: 3 files
  • Medical: 21 files

All tests passed with expected results.

Conclusion
Medi-Cal did not identify any issues with the ICD-10 code business rules in the system as a result of the beta testing effort.

Future Provider Readiness Testing
Medi-Cal is in the process of defining additional provider readiness testing to take place in 2015. Requests for participants will be made in future Medi-Cal and Family PACT Update bulletins and announced via other communication methods, as appropriate.