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EDI Services Testing Procedures
Testing electronic claim transmissions is required for providers prior to receiving approval to submit claims electronically for Medicare payment. Testing requirements are in compliance with the CMS Medicare Claims Processing Manual (CMS Pub. 100-04, Ch. 24, §50.4.1.)There are some exceptions when using a software product that is offered by a Cahaba Approved Vendor; however, it is still recommended that a voluntary test be submitted to ensure that your software is set up correctly and building the claim files appropriately.
Test claims will not be processed for payment. If you use actual claims for testing, you will need to resend them in production once you have completed the testing process and been approved for access to production by an EDI Services Customer Service Representative (CSR). For additional information, refer to the following topics:
Assistance
If you need assistance, go to the Telephone Us page of this Web site to access the Electronic Data Interchange phone number to contact an EDI Services CSR.
Testing Requirements
- Test files must include a minimum of 25 claims. Home health agencies need to send a Request for Anticipated Payment (RAP), (322 or 332 type of bills (TOBs)) and a final claim (329 or 339 TOBs). Hospice agencies need to test claims with 81x and 82x TOBs.
- Test files must pass 100 percent standard syntax editing (file layout, record sequencing, balancing, alpha-numeric/numeric/date file conventions, field values, and relational edits). Reports provided in your FTP mailbox will identify any errors encountered at this level.
- Test files must also pass, at a minimum, 95 percent accuracy in data testing for data validation (procedure codes/diagnosis codes/modifiers). Contact the EDI Services area to receive the results of this level of testing. An EDI CSR will check the results of your claims processing.
Submitting the Test File
It is not necessary to contact EDI Services before sending a test file. Test files must be named "tiai####.clm" where # is a numerical sequence beginning with zero and incrementing for each consecutive test file.
Test files transmitted prior to 3:30 p.m. Central Time (CT), Monday through Friday will process through Level 1 and Level 2 editing on the day of transmission.
Test files transmitted after 3:30 p.m. CT, Monday through Thursday will process through Level 1 and Level 2 editing the next day.
Test files transmitted after 3:30 p.m. CT on a Friday will process through Level 1 and Level 2 editing the following Monday.
Note: Test cycles do not run on weekends, the last day of the month, or holidays.
Test Results
Determining when the test files were transmitted will help you find out when your “Daily Log” report will be available. Generally, this is available two hours after transmission for files processed the same day as transmission and on the following processing day for all others.
Download the “Daily Log” report to determine if the test claims have passed Level 1 and Level 2 editing. Any errors encountered will be listed. Claims accepted will be processed through Level 3 and Level 4 editing with the next processing cycle and an “Audit Report” will be made available.
Download the Audit Report and call EDI Services. An EDI Services CSR will review your results with you, assist you with any errors on the Audit Report and provide you with feedback. If your test file meets the accuracy requirements (100 percent syntax, 95 percent data validation) and is accepted into the claims processing system, the EDI Services CSR will perform the necessary updates on our system to allow you to submit claims in production for payment.
Page last updated: May 17, 2010
