1 1 Maine MeCMS Project Technical Advisory Group February 25, 2010 MIHMS Testing Approach – Pilot Providers

2 2 User Acceptance Testing (UAT) 7 UAT Testing Steps –Staged functional delivery into UAT –Builds incrementally in functionality and complexity Horizontal Testing –Claims submission, adjudication, pricing and remittance Variations of Provider Types, Specialties, Programs, Contracts and Benefits –Focuses on end-to-end transactional processing, connectivity and outcomes Vertical Testing –Tests MITA business Area Functionality –Focuses on detailed functional processes, inputs and outputs 2400 individual test scripts Validated by State SME’s FLEXI Advantage ME RA / Check Portal Paper FTP EDIQNXT Covered in Steps Included in Step 4 Included in Steps 5-7

3 3 Pilot Testing Goals –Test the end to end claims process –Test as many provider type and specialty combinations as possible –Build confidence within the Provider community –Obtain feedback on remittance advices Structure –Test All claims entry mediums DDE, 837, FTP Batch, Portal Onsite with Providers, via the testing “Lab” with MaineCare, coordinated electronic submission

4 4 Pilot Testing (continued) Participants –Selected participants based on provider type/specialty and grouped by claim types –Selection considerations include which “part” of the system will be tested –Historic “trouble spots” and MaineCare specific claims rules Timeline –UAT Steps 1-7 must be complete –Expected to be conducted during the last 2 weeks of UAT

5 5 Identified Pilot Testers Anesthesiologist Behavioral Health Clinician Group Billing Agent Boarding Home Case Management Clearinghouse Dentist Dialysis Center Durable Medical Equipment Family Planning Services Federally Qualified Health Center Home Health Hospice Hospital Indian Health Services Internal Partners Laboratory/Radiology Mental Health Clinic Nursing Facility Optometrist Out-of-State Provider Pharmacy Physical Therapist Physician Group Physician, Independent Private Non-Medical Institution Rehabilitation Center Rural Health Center Substance Abuse Transportation Waiver Services

6 6 Pilot Testing (continued) Gaps in Provider Types (From Original Pilots) –Indian Health Service Provider –Independent Physician –Optometrist –Anesthesiologist –Dialysis Center

7 7 Pilot Testing (continued) How to become a Pilot Testing Provider –Contact Cecile Eisenhart Phone #: (207)

8 8 EDI Testing - Ramp Providers have the option of testing their EDI transactions through the Ramp management site to help prepare them for final certification testing The Ramp site is a self-verification site, where providers can receive real time validation of HIPAA levels 1-6, and help prepare for EDI certification testing in MIHMS. The site can be found by going to: Although Ramp will prepare you for the final EDI testing for certification with MIHMS, it will not be checking for MaineCare Companion Guide requirements and… Testing in Ramp does not replace the required EDI testing for certification through the MIHMS MYHealthPAS portal.

9 9 EDI Testing - Portal 837 testing is fully available on the portal for providers to begin testing. Certification testing is a self-service process. Trading partners (TP) will use the “X12 Upload” link under “File Exchange” on the Trading Partner tab to locate and upload X12 files to Health PAS OnLine for processing. This will allow TPs to browse their local computer or network to locate the appropriate file to be submitted. When a file is selected, the user will have to confirm that they have selected the appropriate file

10 EDI Testing - Portal The Usage Indicator, element 15 of the Interchange Control Header (ISA) of an X12 file must indicate a “T” for a test file. Authorization will be granted on a per transaction basis. In order to process EDI transactions with MIHMS, this testing and file certification process must be completed for each transaction type that TPs want to process with the new system.

11 EDI Testing To assist you with either testing, the EDI Help Desk staff are available from 8:00 am – 5:00 pm, Monday through Friday and can be reached by calling: or you may contact them by at:

12 Questions