The ICD-10 compliance date is October 1, 2015, Independence is now requiring
ICD-10 codes on all authorizations, referrals, and claims. Below are some of
the frequently asked questions (FAQ) we received from providers. The answers
can assist you in the new ICD-10 landscape.
Authorizations and referrals
Q: How will Independence handle authorizations and referrals for services that
occur on or after the ICD-10 compliance date of October 1, 2015?
A: Changes were recently made to the way authorizations and referrals are
processed in regards to ICD-9/ICD-10 coding, as reflected in the recent
enhancements to the NaviNet
® web portal.
Please use the updated guidelines below when submitting an authorization and/or
referral for services that occur on or around the October 1, 2015, ICD-10
compliance date:
-
All authorization and referral requests submitted with an anticipated/proposed
date of service prior to and including September 30, 2015, are required to use
ICD-9 codes.
-
All authorization and referral requests submitted with an anticipated/proposed
date of service on or after October 1, 2015, are required to use ICD-10 codes.
Important: If you already have an authorization or referral that was submitted
with an ICD-9 code and the actual date of service is on or after October 1,
2015, you do not need to resubmit a new request. Independence will take steps
to ensure claims processing is not impacted.
If you already have an authorization that was submitted with an ICD-9 code with
a beginning date of service on or before to September 30, 2015, and you need to
request an extension (e.g., additional services or additional days) for dates
of service on or after October 1, 2015, you do not need to update the diagnosis
code to ICD-10.
Note: When submitting an authorization request through NaviNet, please do not
include the decimal point when entering diagnosis codes. Use the ICD-9 code
(for dates of service prior to October 1, 2015) or ICD-10 code (for dates of
service on or after October 1, 2015).
Claims submission
Q: Will Independence accept ICD-9 codes after October 1, 2015, for dates of
service that were prior to October 1, 2015?
A: Yes, ICD-9 codes should be submitted on claims with dates of service prior
to October 1, 2015. Current regulations require the use of ICD-9 codes for
dates of service prior to the mandated implementation date. Inpatient claims
with discharge dates on or after the mandated implementation date must be coded
in ICD-10. All outpatient and professional claims with dates of service on or
after the mandated implementation date must contain ICD-10 diagnosis codes.
Q: Will both ICD-9 and ICD-10 codes be accepted on a single claim?
A: No, in accordance with the Centers for Medicare & Medicaid Services (CMS)
billing guidelines, ICD-9 and ICD-10 codes cannot be submitted as part of a
single claim.
Q: What happens if an incorrect code is submitted on a claim?
A: If your office submits an invalid code on a claim (i.e., an ICD-9 code is
submitted for a date of service on or after October 1, 2015), your claim will
be denied and sent back to you for compliant coding. Depending on your
clearinghouse, these invalid claims may either be rejected directly by your
clearinghouse or, if passed by the clearinghouse, may be rejected by
Independence. Providers should closely monitor the front-end reports from their
clearinghouses and Independence.
For a full listing of all provider FAQs related to ICD-10, please refer to the
Transition to ICD-10: Frequently Asked Questions
document on our
ICD-10
website. Additional information on ICD-10 can be found at the
CMS ICD-10 dedicated
website.
NaviNet is a registered trademark of NaviNet, Inc., an
independent company.