Hello,

I have the task of seeking out COTS Claims Testing applications to assist in our organizations ICD-10 upgrade. Our healthcare core system is Facets v.4.81, and we have received a demo of the MDE Claims Test Pro tool, which seems like it would do the trick, but I am looking to see what else is out there in the COTS universe to be sure. I've had very little luck in Google searches.

The requirements of the tool are specific to base lining existing medical & hospital claims and then building them into reusable test suites that can be reinserted to our core system via an 837 file. Below is the long list of requirements I have put together.

If anybody out there is using any tools besides MDE, pls leave a post to let me know.

Thanks.

KJOOP36


CLAIM TESTING REQ'S:
Supports the Creation of an 837
Online editing of Test Claims Data
Test Claims can be Configured by ICD9 Codes
Test Claims can be Configured by ICD10 Codes
Test Claims can be Configured by Diagnosis
Supports Data Masking
Supports Data Masking for SSN
Supports Data Masking for Patient Name
Supports Data Masking for Address
Supports the Creation of an PDF Paper Claims
Test Data sets can be pushed to Multiple Environments
Supports Reporting of Test Claim Processing
Supports the comparison between actual and expected claims results
Supports Role/User Based Security
Supports ICD-9 to ICD-10 Code Mapping
Supports ICD-10 to ICD-9 Code Mapping
Upgrade from AP to APR (Optum)
Supports Custom Mapping from ICD-9 to ICD-10
Supports multi claims batch trending of testing
Supports Authorization of claims via diagnosis codes
Bulk execution of claims
Add additional Claims Charges to currently existing claims
Supports ICD-10 to ICD-9 Code Mapping
Custom User Classification of Claim Groupings for reusibility (Benchmarking)
Automated Loading & Processing of test claims data
Supports Audit Trail of test claims
Supports Custom Tagging of Claims Data
Test Claims can be Configured by Line of Business
Test Claims can be Configured by Gender
Test Claims can be Configured by Age
Test Claims can be Configured by Date of Service
Test Claims can be Configured by Products
Test Claims can be Configured by Servicing Provider
Test Claims can be Configured by Class Plan
Test Claims can be Configured by Group
Test Claims can be Configured by CPT Codes
Test Claims can be Configured by CPT Modifiers
Test Claims can be Configured by Rendering Provider
Test Claims can be Configured by Billing Provider
Test Claims can be configured by Place of Service (POS)
Test Claims can be configured by Revenue Code
Custom User Modifications to existing Claims Groupings to seed new Claim Groupings
Base Data sets can be collected from Multiple Environments
Supports Random or user defined sample size
Supports the reconciliation of Test Claims to 835 Files
Supports the Direct Population of EDI Tables
Supports Analysis of ICD-9 to ICD-10 code mapping
Supports the creation of ICD-10 Test Scenarios
Supports reimbursement mapping