A: User Acceptance Testing for nursing homes is scheduled for approximately the last week of September 2009, and should take about one week. We will then spend a couple weeks working with nursing homes to configure their systems, which will take another two to three weeks. Testing will begin then (we’re estimating Oct. 20) and will run until the ProviderOne “freeze” starts on November 20.

Q: What is the testing timeline?

A: The pilot ended August 28. EDI testing will continue until the cutover “freeze” begins. No, during the cutover “freeze”, testing will not be possible.

Q: Are there plans to Stress and Performance Test the new system?

A: A performance and load test was performed using simulation tools. The results exceeded DSHS performance standards in the vendor’s contract.

Q: It looks like the access to the pre-production system has been removed. How can we continue to have access to online eligibility?

A: The only time before go-live when eligibility data was available through the ProviderOne portal (direct data entry) was during the pilot. The next time the portal and other live eligibility data will be available to providers is when ProviderOne goes live.

During the transition to ProviderOne, you can continue to confirm eligibility through the current MMIS, although that confirmation will not include the new ProviderOne client ID.

Also, EDI testing is still available, so you can test that claims will process and pay correctly.

Q: Will we be able to test Electronic batch inquiry (EEV) transactions with Vendor Relay Health and Provider One before go-live?

A: Yes, Relay Health is part of the ProviderOne pre-production (pilot) testing activities underway currently. UW Medicine needs to work with Relay Health to submit test batch 270/271 transactions to ProviderOne.

Q: Will we be able to test Medicare crossover claims before go-live?

A: DSHS will be testing Medicare crossover claims with our Medicare Intermediary contractor, later this summer.

Q: Please describe what exactly gets “tested” when providers finish Security and Registration and the “test” with ProviderOne.

A: Only organizations who plan to submit HIPAA batch transactions to ProviderOne (270, 276, 278, 837I, 837P, and 837D) will “test.” There are two levels of testing for HIPAA batch file submitters: format and content. Testing is done in an EDI (Electronic Data Interchange) test environment. Format testing monitors inbound transactions to ensure format compliance with both Federal HIPAA Implementation Guides and DSHS Companion Guides. Each transaction type must successfully pass format testing before a production transaction can be submitted in ProviderOne. Once a transaction successfully passes format testing, it will continue on to verify file content. In the case of 837 claim files, the file is tested for content compliance (including new identifier requirements such as NPI, taxonomy and new ProviderOne client IDs), and pricing. An electronic Remittance Advice (835) will be generated for you to compare what was submitted and the results. Batch submitters can test an unlimited number of transactions for content to ensure your own system and processes are in place to exchange the National Provider Identifier, the new ProviderOne client ID number and DSHS-approved taxonomy codes with ProviderOne.

However, you should be aware that there are some limitations to the data in the EDI test environment including: there is no claims history; the rate data is as of June 29, 2009; and the limited data set needs to be considered when evaluating an 835. For example, if a provider obtained a new prior authorization number after June 29, it is not in the data set. You should expect the claim to adjudicate as if there was not an authorization on the claim. For more information on HIPAA batch transaction testing, visit http://hrsa.dshs.wa.gov/providerone/HIPAAtesting.htm

If you submit claims by paper, direct data entry (entering single claim information in WAMedWeb – ProviderOne in the future), or use a billing agent or clearinghouse for all of your transactions, you do not need to test.

EDI

Q: What have been the most common errors/rejects from testing in the EDI environment?

A: The most common error/rejects are due to variances from the DSHS Companion Guides. We strongly urge you to review these documents and modify your systems accordingly. We are also in the process of identifying the most problematic loops and segments of the 837 transactions to help providers avoid the same pitfalls. This information will be published in a separate communication geared to EDI testing.

Q: We have been having problems with the “EDI 835” checkbox in Step 16. Every time after it is approved, the checkbox always ends up being unchecked. Did ProviderOne disapprove it?

A: If the user selects both 835 checkbox in Step 16 and clearinghouse to receive 835 in Step (11-14), the 835 will go to the clearinghouse. The 835 checkbox is ignored by the system in this scenario.

Q: There’s still no date of when they might have a 277U transaction ready. We asked “end of October?” and heard “hopefully.” This is the transaction communicating what claims are in process.

A: The 277U transaction will be available in the EDI test environment in October 2009.

Pre-Production

Q: What does the end of preproduction mean? What does Pilot mean?

A: The pilot or pre-production test period (from 6/12 to 8/28) was a period of time for DSHS to compare adjudication results from the legacy MMIS to adjudication results in ProviderOne (a form of parallel testing). Providers were invited to participate in the pilot who represented a wide range of provider types and specialties. The pilot includes claims submitted via HIPAA batches, direct data entry, and paper. Only claims processed through the legacy MMIS produced payments.

Now that the pilot has concluded, all electronic batch submitters should test to make sure their claims comply with HIPAA format requirements (referred to as “EDI testing”). The objective of the pilot was for DSHS to test the claims engine. The objective of EDI testing is for providers to verify their systems are ready.

Q: Can we still test post pilot and preproduction?

A: Yes; although the pilot (also called “preproduction”) ended on August 28, 2009, you can still do EDI testing. The EDI testing environment will be available until the cutover “freeze”. After implementation, EDI testing will be a permanent environment, available to providers who are either new or make system changes that they need to verify. Please visit the implementation schedule area of our Web site for updated information: http://hrsa.dshs.wa.gov/providerone/Projected%20Schedule.htm

Q: What have been the most common errors/rejects from testing in the Pre-Production environment?

A: We are pleased that the adjudication process worked very well. Except for minor exceptions, a comparison of claims in the legacy MMIS to ProviderOne revealed that edits and pricing were as expected in both systems. The biggest issue that caused claims to deny was missing or inaccurate taxonomy codes, NPI and/or client ID. When claims contained the correct identifiers and codes, they paid as expected.

Q: We were told that the environment used for pilot testing has been taken down, and we will therefore never be getting an 835 from it for review. They have another test environment that we can try to submit claims and get an 835 out of, but we can’t get an 835 to review for all the test claims already submitted. They communicated the clarification that the pilot testing was to meet their needs, not those of the providers.

A: DSHS had a very limited window of time for the pre-production pilot test environment funded 90 percent by the federal Centers for Medicare and Medicaid Services. While DSHS had specific objectives it met during the pilot, the objectives support the overall goal to implement ProviderOne without interruption of services to clients or payments to providers. Unfortunately, successful HIPAA Batch format testing took longer than anticipated for providers and we were unable to return 835 transactions. However, you can submit the same successful batch of claims in the permanent ProviderOne EDI test environment and an 835 will be returned to you.