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Broker News | October 2015 | Vol. 10 No. 9
Broker News | October 2015 | Vol. 10 No. 9

ICD-10 Health Plan Progress and General Information

As of October 1, we are ready to accept the new ICD-10 codes on claims based on dates of service. Providers will be required to submit Health Insurance Portability and Accountability Act (HIPAA)-compliant transactions in version 5010. As of October 1, all HIPAA-covered entities must use the new ICD-10 code sets. The current ICD-9 code sets are out-of-date due to their limited ability to accommodate new procedures and diagnoses. ICD-10 incorporates greater specificity of codes - more clinical information contained in the codes - and updated terminology.

Use of ICD-10 will:

  • Improve the ability to measure health care services
  • Enhance the ability to monitor the populations' health
  • Provide better overall data and decrease the need for supporting documentation needed when submitting claims

What this means for groups and brokers:

  • Members may experience a slight claims processing delay as all parties gain familiarity with the new process
  • Members may see differences in claim payment as this change may result in reimbursement methodologies that more accurately reflect patient status and care
  • The transition to ICD-10 has no impact on pending authorizations

For more specific information about ICD-10 please visit http://www.cms.gov/ICD10

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