Urgent ICD-10 Reminder and Update for Personal Injury and Work Comp

Personal Injury payers are not governed by HIPAA, they do get to elect on an individual basis whether or not to transition to ICD-10 diagnosis as of 10/01/2015.

Providers are urged to contact those Work Comp and PI payers as soon as possible so as to determine which diagnosis code set must be included on claims. Understand that without this information, claims submit with the incorrect diagnosis code set will be either rejected or denied, affecting your practice cash flow and creating additional work for your billing personnel.

State Farm Insurance: Will transition to ICD-10 on 10/01/2015. All claims submit with ICD-10 will be processed accordingly. Additionally, State Farm will continue to process as usual, all claims submit with ICD-9 diagnosis for an indefinite period of time.

American Family Insurance: American Family Insurance is prepared to accept ICD-10 effective 10/01/2015. American Family Insurance will also continue to accept and process claims with ICD-9 diagnosis for an undetermined but limited time after 10/1/2015.

Progressive Insurance: Progressive Insurance will be transitioning to ICD-10 on the mandated date of 10/01/2015. Claims submit with ICD-9 will be rejected. Providers will receive remittance explaining the rejection and requiring providers to resubmit the claim using ICD-10 diagnosis.

For providers that continue to submit claims using the ICD-9 diagnosis to payers that will still accept and process these claims such as American Family Insurance and State Farm, please be reminded that this will be for a limited time. It will be the responsibility of these providers to continue to reach out to these payers to confirm the designated end date for ICD-9 once that is determined. To avoid error and cash flow disruption down the road, providers are urged to submit ICD-10 diagnosis on all claims to those payers that will accept this code set on claims beginning on 10/01/2015.



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