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ICD-10 information for providers

On July 31, 2014, the U.S. Department of Health and Human Services (HHS) issued a rule finalizing Oct. 1, 2015 as the new compliance date for health care providers, health plans, and health care clearinghouses to transition to ICD-10. This deadline allowed all of us additional time to ensure our systems and business processes were ready on Oct. 1, 2015.

Answering your questions

Will both ICD-9 and ICD-10 be accepted after Oct. 1?

  • Claims with an Oct. 1, 2015, date of service and after must use ICD-10 coding as applicable.
  • ICD-9 codes will only be accepted for dates of services of Sept. 30, 2015, and prior.
  • Professional providers billing for services that span dates both before and after Oct. 1 should split their claims. Bill the portion on or before Sept. 30, 2015 with ICD-9 codes. Bill the portion from Oct. 1 forward with ICD-10 codes.
  • Facilities billing on a UB claim form for inpatient stays should be billed based on discharge date. Stays with a discharge date of Oct. 1, 2015 and after should be billed using ICD-10.
  • Claims with the wrong ICD coding will be rejected for incorrect coding.

Will prior authorizations received before Oct. 1 need to be resubmitted?

No, you will not need to resubmit prior authorizations. Prior authorizations received before Oct. 1 for procedures/services done on or after Oct. 1, 2015 are valid.

What qualifier do I use for ICD-10 diagnosis codes on electronic claims?

  • Claims with ICD-10 diagnosis codes must use ICD-10 qualifiers; all claims for services on or after October 1, 2015, must use ICD-10
  • Claims with ICD-9 diagnosis codes must use ICD-9 qualifiers; only claims for services before October 1, 2015, can use ICD-9

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ICD-10 webinar series library

Priority Health, Humana, Blue Cross Blue Shield of Michigan, United HealthCare and Health Alliance Plan (HAP) offered a series of 1-hour webinars. View them below.

Specialty focus Thursdays,
Noon - 1 p.m. on:

Register
or
Download
the summary

Family Practice/General Practice/Internal Medicine
Host: HAP
Mar. 5 Webinar recording
Pediatric Medicine
Host: Humana
Mar. 19 Webinar recording 
OB-GYN/Midwifery
Host: BCBSM
Apr. 2 Webinar recording
Chiropractic
Host: Priority Health
Apr. 16 Webinar recording 
Orthopedics/Orthopedic Surgery/Podiatry
Host: UHC
Apr. 30  Webinar recording  
Psychiatry/Clinical Psychology/Psychology
Host: Humana
May 14 Webinar recording
password: Humana (case sensitive)
OT/PT/Speech Therapy/Physical Medicine/
Rehabilitation

Host: HAP
May 28 Webinar recording
Ophthalmology/Optometry/ENT/Audiology
Host: BCBSM
Jun. 11  Webinar recording
Allergy Immunology Rheumatology Endocrine
Host: HAP
Jun. 23 Webinar recording
Dermatology
Host: Priority Health
Jun. 25 Webinar recording
Surgery: General/Vascular/Thoracic/Plastic
Host: UHC
Jul. 9  Webinar recording 
Allergy/Immunology/Rheumatology/Endocrinology
Host: HAP
Jul. 23 Webinar recording
Urology/Nephrology/Gastroenterology
Host: Humana
Aug. 6 Webinar recording
password Humana (case sensitive)
Cardiology/Pulmonary Medicine
Host BCBSM
Aug. 20 Webinar recording
Radiation Oncology/Hematology/Oncology
Host: Priority Health
Sept. 3 Webinar recording
Internal Medicine/Infectious Disease
Host: UHC
Sept. 17 Webinar recording 

More ICD-9 to ICD-10 communications & support

Post-implementation, we have dedicated ICD-10 support resources available to help you. We know that communication is critical to a successful switchover to ICD-10. If you have questions, feel free to contact the ICD-10 team directly: Email icd-10@priorityhealth.com.

Resources online

Contracts

As much as possible, we are working to keep ICD-10 implementation budget-neutral. Our system will be updated as a part of our contract with you. No charge will be passed to providers. Some vendor contracts may be affected.

Last modified: 11/4/2015
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