Payer News & Updates
Additional resources are available on Aetna’s provider education website at: www.aetnaeducation.com. A list of Aetna’s ICD-10 reject codes are: C34 – The ICD-9 or ICD-10 procedure code is invalid; C35 – ICDprocedure code is a mixed code set-ICD-9/ICD-10; C36 – ICD-9 code set is submitted.
Anthem’s EDI ICD-10 Edits Communications – a list of ICD-10 related edits by transaction can be found here.
UHC -Enhanced Claim Edits can be found here. ICD-10 inquiries to UHC can be sent to: [email protected]
Coding a Preauthorization – Some payers have required authorizations that span the Oct1, 2015 date be resubmitted with ICD-10 codes. It is important that providers contact the payer directly to determine whether or not this is required for current authorizations. Be sure to pay attention to the payer’s ICD-10 requirements when submitting backdated authorizations and referrals.
Centers for Medicare and Medicaid Services (CMS) announced they have “been carefully monitoring the transition and [are] pleased to report that claims are processing normally.” ACA has received notice of some issues in the following jurisdiction:
- Noridian Part B JE Claims Only- Procedure Codes: 98940-98943 Issue:
Claims are denying when billed with a payable primary diagnosis code of M99.01, M99.02, M99.03, M99.04 and M99.05. Status: The LCD is being updated to contain the appropriate diagnosis codes. As of Oct 26, Noridian has identified the claims denied incorrectly and is in the process of adjusting them.
If you need assistance with ICD-10 claims, CMS has provided the following resources:
- For general ICD-10 information, many resources are available on the Road to 10 website and www.cms.gov/icd10.
- A provider’s first line for help for Medicare claims questions should be their Medicare Administrative Contractor.
- Providers can also contact the ICD-10 Coordination Center.
- The ICD-10 Ombudsman, Dr. Bill Rogers, can act as the provider’s impartial advocate.
Don’t forget the ICD-10 Qualifiers on CMS Claims!
ELECTRONIC CLAIMS- According to CMS all electronic claims with ICD-10 diagnosis codes must use the assigned ICD-10 qualifiers. Information on which qualifiers to use can be found here.
PAPER CLAIMS- Initial claims for payment under Medicare must be submitted electronically unless a health care professional or supplier qualifies for a waiver or exception from the Administrative Simplification Compliance Act (ASCA) requirement for electronic submission of claims. If you fall into this category, be sure to update your software settings to include the ICD indicator (Item 21 of the 1500 claim form). This indicator is used to report the version of the diagnosis on your claims; ‘9’ for ICD-9 and ‘0’ for ICD-10. Additional information is available in ACA’s 1500 Claim Form Fact Sheet.
You can check your Medicare FFS claim status using one of the following options:
- Interactive Voice Response (IVR): IVR gives providers access to Medicare claims information through a toll-free telephone number. Visit your Medicare Administrative Contractor (MAC) website for information on the Provider Contact Center and IVR user guide.
- Customer Service Representative (CSR):Visit your MAC website for information on the Provider Contact Center only if you are unable to access claims information via IVR.
- MAC portal: Visit your MAC website for portal features and access.
- Direct Data Entry (DDE): Providers that bill institutional claims are also permitted to submit claims electronically via DDE screens. Visit your MAC website for more information.
- ASC X12: The ASC X12 Health Care Claim Status Request and Response (276/277) is a pair of electronic transactions you can use to request the status of claims (via the 276) and receive a response (via the 277). Visit your MAC website for more information.
Stay in the Know!
- Sign up for CMS ICD-10 Industry Email Updates
- Check your MACs website for coding requirements and updates
- WEDI’s State ICD-10 Readiness Resources. Find information on Medicaid readiness for your state HERE.
- Five ICD-10 State Readiness Scenarios for Workers’ Compensation – check your state HERE.
- Infinedi ‘s Common ICD-10 Error Messages-https://www.infinedi.
net/News/INews.aspx?newsId= 1381
