ICD-10 End to End Testing Volunteer Form

This form must be submitted by April 17, 2015

Note: If you are enrolled to test in January 2015 and April, do not submit this form. You are already enrolled in July 2015 testing.


Effective with dates of service on or after October 1, 2015, the ICD-9 code sets will be replaced by ICD-10 code sets. To help prepare for this transition, the Centers for Medicare & Medicaid Services (CMS) is soliciting volunteers to conduct limited end-to-end testing with the Medicare Administrative Contractors (MACs) July 20 through July 24, 2015. The sample of 50 participants for each MAC will be selected from the volunteers to represent a broad cross-section of provider types, claims types, and submitter types. Selected testers will be notified that they have been selected by May 8, 2015. Each selected submitter may send up to 50 test claims over the course of the testing week. Test claims accepted into the system will be processed by the MAC and a remittance advice will be generated. Those selected will be provided specific details regarding how to test and who to contact for testing support.

For those electronic submitter/trading partners who serve in multiple states, and multiple Medicare jurisdictions, CMS reserves the right to limit a particular submitter to test with only one MAC.


All volunteers for participation in the July 2015 end-to-end testing for ICD-10 must be able to meet the following testing requirements:

1. Testers must be established electronic submitters, with active Medicare submitter IDs, and capable of receiving electronic remittance advices (ERAs) to be eligible for this testing. Electronic submitters are defined as clearinghouses, billing agencies, or a professional or institutional provider that submits directly to Medicare.

2. Providers who submit through a clearinghouse may not submit a volunteer form. You must work with your clearinghouse to test, if the clearinghouse is chosen for testing.

3. Vendors cannot volunteer to test directly because they do not have a submitter ID. Vendors must work with a chosen submitter to test.

4. Testers must be ready to test ICD-10, meaning, all vendor and practice management software needed to test has been updated and internally tested prior to conducting end-to-end testing with Medicare.

5. Testers must be able to submit future dated claims.

6. Testers must be able to provide active, live testing data, including National Provider Identifiers (NPIs), Provider Transaction Access Numbers (PTANs), and beneficiary Health Insurance Claim Numbers (HICNs) they will use for testing. This information will be due May 8, 2015. If this information is not provided timely, you may be dropped from the testing. Incomplete forms will be rejected and returned for completion and resumbission.

Below is the form to volunteer for this testing.
1. Type of Organization {Select One}
2. Submitter ID/Trading Partner ID
3. Contact Information
4. State(s) where you furnish services:
5. Type of Submitter {Choose One}
6. Provider Number