To assist in the preparation for the transition to ICD-10, Medicare Advantage plans may begin submitting RAPS and Encounter test files effective July 8, 2015. Please refer to the appropriate checklists below for the required testing information. In the event you have questions, please contact CSSC Operations at 1-877-534-2772, or by email at
CSSCOperations@palmettogba.com.
RAPS Testing Specifications
- The AAA record, field 5, (PROD-TEST-IND), must be ’TEST’; and field 6, (FILE-DIAG-TYPE), must be ICD10.
- Plans must submit a valid beneficiary with valid MAO enrollment data for the diagnosis date of service.
- Diagnoses Service Thru Dates (SRVC_THRU_DT) must be greater than or equal to the ICD-10 test cut-over date of 3/1/2014, and less than or equal to the current date.
- All records with future dates will be rejected.
- All diagnoses in the ICD10 TEST file must be ICD-10 diagnosis codes (up to 7 characters).
- Any diagnoses with SRVC_THRU_DT greater than, or equal to '03/01/2014' should be an ICD-10 diagnosis code.
- The Palmetto Front End Risk Adjustment System (FERAS) will reject the ‘TEST’ file with error code 166 if it exceeds 3000 records.
Encounter Testing Specifications
- All files must conform to the standards outlined in the X12 5010 837 Companion Guides.
- All test files must have the ISA01 field set to ‘03’; the ISA02 field set to ‘8888888888’; and the ISA15 field set to ‘T’.
- Plans must submit a valid beneficiary with valid MAO enrollment data for the diagnosis date of service.
- Diagnoses Service Thru Dates must be greater than or equal to 10/1/2015.
- The Interchange Date in field ISA09 must not be a future date.
- The Palmetto Front End System will reject the ‘TEST’ file with an error message if it exceeds two thousand (2,000) encounters.