Apex EDI ICD-10 Review

1. – Which type of ICD-10 claims are you able to process?
Which type of transactions are you able to perform:

– 270/271 Eligibility Inquiry/ Response?

We do eligibility, but don’t include Dx codes at this time.
– 278 Auth. Request & Response?
Not at this time.
– 837P Claims Submission?
Yes – ICD-10 Ready
– 835 Claims Remittance?
– Non-Standard Transactions?

2. – Is ICD-10 end-to-end testing open to all clients?
End-to-end testing is open to all clients, but it is payer dependent, and so far payers have offered limited access.

a. – How is payer-specific testing handled?
We have successfully tested with many payers to ensure our system is ICD-10 ready. When a provider requests testing with a payer we investigate if the payer is doing any testing and we facilitate testing between the provider and payer.

b. – How does a practice participate in testing?
A practice can email icd10@apexedi.com to request testing instructions. Test files can be submitted through the usual submission process. We report results of test and pursue payer testing with the provider’s top payers.

3. – Do you have a physician outreach plan in play?

a. – Are there any special instructions for processing ICD-10 claims?
Providers can submit ICD-10 claims like they would any other claim. We only ask that they notify us by email or phone so we can report the results of their test file.

b. – Are there any new or separate fees for updates or processing?
No. We realize the ICD-10 transition will likely be expensive. We want to help our clients by reducing costs and worry.

c. – What percentage of practices do you estimate have/are testing?
So far a small percentage of providers have tested. We continue to encourage and assist provider. We are confident our system is ICD-10 ready.

4. – Specifically, how will your technology help practices transition to ICD-10?
Our technology validates codes against the date of service to ensure valid codes are used before getting to the payer. We also allow providers to update/change claims prior to payer submission, including setting the ICD indicator. Some providers have had a hard time providing the ICD indicator on their claims we will process the claims with the correct indicator based on the date of service.

5. – What type of ICD-10 claim reports are you able to provide:

a. – Claim rejections and denials by CPT, diagnosis code, and by payer?
We will continue to validate CPT codes, diagnosis codes and deliver all payer status reports back to our clients as we currently do.

b. – Commonly used unspecified diagnosis codes?

c. – Other?

6. – What type of resources and education do you have available?
We have an ICD-10 dedicated website and ICD-10 trained staff ready to answer questions and assist with ICD-10 testing.


7. – Is your support staff fully ramped up?
Yes. Our support staff is ready to assist providers to minimize impact of ICD-10 issues.

8. – What % of customers have you communicated your ICD-10 strategy and details with?
100% of our clients have easy access to our strategy and can readily receive ICD-10 support via email our from our support staff. Our ICD-10 dedicated web page informs our clients of our strategy and our support staff informs clients while encouraging clients to test their ICD-10 readiness.

9. – What % of EHR/PM vendors have you participated with in testing?
We are working closely with most PM vendors to ensure they are ICD-10 ready. We provide support and assist with understanding ICD-10 requirements with our partner vendors.

10. – Do you know of payers that have not tested, or are still unable to test?
Many payers have offered limited testing, but the general sense is that payers will be ready for the ICD-10 transition.

General Comments:
We understand the massive undertaking and potential impact that the ICD-10 transition will have on our client’s practices. We have taken steps to ensure our system is ready to handle ICD-10 claims and successfully deliver ICD-10 claims to payers. If our clients experience problems with payers, our support staff is ready to help. We will do all we can to minimize the pain of transitioning to ICD-10 codes.




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