ICD-10 Vendor Questions for Clearinghouses

Is Your Clearinghouse Prepared?

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?

– 278 Auth. Request & Response?

– 837P Claims Submission?

– 835 Claims Remittance?

– Non-Standard Transactions?

2. – Is ICD-10 end-to-end testing open to all clients?

a. – How is payer-specific testing handled?

b. – How does a practice participate in testing?

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

a. – Are there any special instructions for processing ICD-10 claims?

b. – Are there any new or separate fees for updates or processing?

c. – What percentage of practices do you estimate have/are testing?

4. – Specifically, how will your technology help practices transition to ICD-10?

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?

b. – Commonly used unspecified diagnosis codes?

c. – Other?

6. – What type of resources and education do you have available?

7. – Is your support staff fully ramped up?

8. – What % of customers have you communicated your ICD-10 strategy and details with?

9. – What % of EHR/PM vendors have you participated with in testing?

10. – Do you know of payers that have not tested, or are still unable to test?





Medical Claims Clearinghouse Ratings and Reviews