ICD-10 Payor Readiness
Anthem
Readiness - We will be capable of accepting and processing ICD-10 diagnosis and inpatient procedure codes for claims
with dates of service on or after October 1, 2015. During 2014, Anthem completed all system development and
implementation as well as completed all business configuration and content type changes.
We are offering self-guided, web-based testing using the Validator tool to all EDI direct-submitters, not participating in
End-to-End testing. Validator is equipped to test file formats and edits as they pertain to ICD-10. All providers will have the
opportunity to partner with their clearinghouse to run claims through Validator
Key Project Information
We have made several key decisions that will guide our implementation strategy and will be useful as you plan your
transition to ICD-10.
ICD-10 Claims Processing
ICD-10 Pre-Authorizations and Claims Filing
ICD-10 FAQs for Providers
This FAQ contains educational information about ICD-10, as well as answers to questions about our ICD-10
implementation
Testing Lessons Learned - ICD-10 End to End Testing Summary
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Lesson Learned #1: We are able to accept and deliver electronic claim files with ICD-10 codes through our EDI
gateway. We successfully tested with 13 clearinghouses and received 91% of the claims submitted for testing.
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Lesson Learned #2: We can process claim files with ICD-10 codes on all claims systems tested. We successfully
tested with the five (5) local claims platforms that support our 14 Blue Markets and the two (2) national platforms,
FEP and NASCO. We were able to process over 6,900 test claims submitted by providers. Claim edits performed
as expected in our test environment.
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Lesson Learned #3: Our systems can process preauthorizations containing ICD-10 codes. Our care management
team conducted a successful testing effort with providers. Preauthorizations processed with no issues.
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Lesson Learned #4: From a medical management perspective, there was virtually no impact due to ICD-10
codes. Claims were reviewed for pay/pend/deny status to see if this would change with using ICD-10 codes. No
changes were found.
Suggested resources to help with your ICD-10 transition and prior Monthly ICD-10 Topics
Attention Professional Providers! Coding Practice Tool Available
To support ICD-10 readiness with professional providers, we are offering a free scenario-based coding practice tool
designed to give physicians and their coders the opportunity to test their knowledge of the ICD-10 codes set by applying it
to medical scenarios.
ICD-10 Claims Processing - Currently, we are not planning to accept ICD-9 codes for claims with dates of service (DOS)
or dates of discharge (DOD) after the compliance date
ICD-10 Pre-Authorizations and Claims Filing - Starting June 1, 2015, we will begin accepting and processing
preauthorization requests containing ICD-10 codes for services scheduled on or after October 1, 2015. ICD-9 codes
continue to be used must be used to pre-authorize services scheduled through September 30, 2015.
Contact Us
For ICD-10 questions and surveys, email us at ICD10-Inquiry@anthem.com
Humana
Humana Professional Provider Content-based Testing is an outpatient scenario-based testing site to support ICD-10
readiness and apply practical applications of the code set. Practitioners can access customized outpatient scenarios
(based on practitioner type and specialty) with narratives relevant to their practices.
Each medical scenario will present a unique combination of three narratives in a format that allows testers to enter ICD-10
diagnosis codes and submit them for feedback. Practitioners will receive peer reports along with coding feedback on the
primary and secondary ICD-10 codes submitted.
Sid Hebert, director of Humana’s ICD-10 implementation team, says that this testing approach allows for interested
physicians to evaluate their coding proficiency with real world examples, keyed to specialties, through a dynamic
interchange.
To register for Humana Professional Provider Content-based Testing, practitioners can go to
http://hureg.providercodingimpact.com.
The website will register testers from the practitioner’s organization, who will be sent an email with a link to begin their test
activity, along with a desktop procedure manual. Once registered, Humana asks that practitioners complete this activity
within 30 days.
Practitioners who have questions about the registration process or other concerns regarding Humana Professional
Provider Content-based Testing may contact Humana at OutpatientTesting@Humana.com.
Provider FAQ
ICD-10 training tips and provider checklist
ICD-10 Resources
ICD-10 questions may be submitted to one of the following Humana mailboxes:
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Facilities: ICD10Inquiries@humana.com
Physicians: ICD10Physician@humana.com
Claim delegates: IPAICD10Inquiries@humana.com
United Healthcare
ICD-10 Readiness and Provider Testing
UnitedHealthcare will conduct ICD-10 testing with selected providers starting in early 2015 and post lessons learned and
best practices from the testing on our ICD-10 web page. Please look for testing information to be posted after the first
quarter of 2015.
Recommendation for Providers to Prepare for ICD-10 Transition
Physicians and facilities should begin preparing immediately for the transition. To assist our providers, our ICD-10 web
page includes education, tools and resources to support you. For example, you can use the ICD-10 Provider Readiness
Checklist, which outlines all critical elements and actions needed for the ICD-10 transition. The ICD-10 Code Look up
Tool can help you understand how we will interpret and map ICD-9 codes to the new ICD-10 codes.ICD-10 updates will
continue to be posted as new information becomes available. If you have a question about the ICD-10 transition, please
email questions to: ICD10questions@uhc.com. Thank you.
Education
DRG Shifting Info Sheet
AAPC and UnitedHealthcare ICD-10 Clinical Documentation Improvement Presentation
Provider Readiness: Recommendations for Providers to be Ready for ICD-10 on Oct. 1, 2015
UnitedHealthcare's Medical Policies
Delay of ICD-10 Implementation to 2015
NEW! UnitedHealthcare ICD-10 PowerPoint. ICD-10 Finance and Delivery: Together Through Change
New 1500 Form 02/12 Version FAQS
On-Demand Training Session on UnitedHealthcare's Implementation of 5010 and ICD-10
Tools
Code Lookup Tool: ICD-10 and ICD-9 from UnitedHealthcare
ICD-10 Decision Tree Attention Deficit Hyperactivity Disorder
ICD-10 Decision Tree Acute Pancreatitis
ICD-10 Decision Tree Chalazion
ICD-10 Decision Tree Acute Tonsillitis
ICD-10 Decision Tree Alzheimer's Disease
ICD-10 Decision Tree Anorexia Nervosa
ICD-10 Decision Tree Acute Serous Otitis Media
ICD-10 Decision Tree Calcaneal Spur
ICD-10 Decision Tree Asthma
ICD10Questions@uhc.com
ICD-10 Decision Tree Sciatica
ICD-10 Decision Tree Acute Pharyngitis
ICD-10 Decision Tree Scoliosis
ICD-10 Decision Tree Sepsis
ICD-10 Decision Tree Overweight and Obesity
Provider Readiness Checklist: What Providers Can Do NOW to be ICD-10 Ready on Oct. 1, 2015
Resources
AHIMA ICD-10
AMA
Centers for Medicare and Medicaid Services "Road to ICD-10"
Complete Practice Resources
Health Data Consulting
HIMSS
ICD10 Watch
Medical Group Management Association
OptumInsight
RT Welter and Associates
contact: Jennifer Heuer, CPC at 303.534.0388 or email her by clicking here.
WEDI
Partnerships
You can access the UnitedHealthcare discounted prices on the AAPC's ICD-10 education and material by visiting this
website:www.aapc.com/uhc. Please note there is a (minimal) cost associated with the Optum "ICD-10 Self-Assessment Toolkit for
Physicians" as well as for the Optum "ICD-10 Self-Assessment Toolkit for Hospitals".
ICD-10 Self-Assessment Toolkit for Hospitals
ICD-10 Self-Assessment Toolkit for Physicians
NEW! UnitedHealthcare Teams with the AAPC for steep discounts on ICD-10 material!
Medicare
ICD-10 Compliance Date: October 1, 2015
CMS Releases “Road to 10” Online Resource for Small Practices
Jumpstart your ICD-10 transition with “Road to 10,” an online resource built with input from providers in small practices.
“Road to 10” includes specialty references and gives providers the capability to build ICD-10 action plans tailored for their
practice needs.
CMS Releases Two New ICD-10 Videos
CMS has released two animated shorts that explain key ICD-10 concepts:
• “Introduction to ICD-10 Coding” gives an overview of ICD-10’s features and explains the benefits of the new
code set to patients and to the health care community.
• “ICD-10 Coding and Diabetes” uses diabetes as an example to show how the code set captures important
clinical details.
Medscape Education Resources
CMS Medscape Education resources help providers prepare for ICD-10. Continuing medical education (CME) and
nursing continuing education (CE) credits are available to health care professionals who complete the learning
modules. Anyone can earn a certificate of completion. If you are a first-time visitor to Medscape, you will need to create a
free account to access these resources.
• Video: ICD-10: Getting From Here to There -- Navigating the Road Ahead
• Video: ICD-10 and Clinical Documentation
• Expert Column: Preparing for ICD-10: Now Is the Time
Understanding the Basics
These fact sheets will introduce you to ICD-10, explain why it’s necessary, and give you the information you’ll need to get
started on your transition.
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Intro Guide to ICD-10
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The ICD-10 Transition: An Introduction
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ICD-10 Basics for Medical Practices
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Talking to Your Vendors About ICD-10: Tips for Medical Practices
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ICD-10 and CMS eHealth: What’s the Connection?
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ICD-10 Basics for Small and Rural Practices
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Online ICD-10 Implementation Guide
Communicating About ICD-10
Communication between health care providers, software vendors, clearinghouses, and billing services is an important part
of the transition process. Learn how to get the conversation started.
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Talking to Your Vendors About ICD-10: Tips for Medical Practices
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Questions to Ask Your Systems Vendors about ICD-10
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The Role of Clearinghouses in ICD-10
Educational ICD-10 Videos
CMS has developed videos on a variety of topics to help you prepare for the ICD-10 transition:
• Road to 10: The Small Physician Practice's Route to ICD-10
• Medicare’s Testing Plan for ICD-10 Success
• Converting the Home Health Prospective Payment System Grouper to ICD-10-CM
Conferences, Meetings, and Webinars
CMS has partnered with several organizations to offer educational webinars on ICD-10:
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National Provider Call: ICD-10 Implementation and Medicare Testing (Feb. 26, 2015)
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Presentation Video
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PDF Presentation
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Written Transcript
ICD-10 and Clinical Documentation (Dec. 10, 2014)
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Webinar Recording (register to access)
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PDF Presentation
Transitioning to ICD-10 (Nov. 5, 2014)
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PDF Presentation
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Audio Recording [ZIP, 18MB]
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Written Transcript
ICD-10 Code-a-thon (Sep. 15, 2014)
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Presentation Video
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Presentation Audio Transcript
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Q&A Audio Transcript
ICD-10 Resources: Get on the Road to 10
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PDF Presentation
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Webinar Recording (Recording ID: DWGQ5G: Key:eHealth)
Stay up to date on ICD-10!Sign up for Email Update messages
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Follow us on Twitter
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Check out the list of CMS ICD-10 resources
Related Links
Version 5010 Industry Resources
MLN General Information
American Academy of Family Physicians (AAFP)
American College of Cardiology (ACC)
American Academy of Professional Coders (AAPC)
American College of Physicians (ACP)
American Health Information Management Association (AHIMA)
American Hospital Association (AHA)
American Medical Association (AMA)
American Medical Billing Association (AMBA)
Association of American Medical Colleges (AAMC)
Emdeon
Healthcare Billing and Management Association (HBMA)
Healthcare Information and Management Systems Society (HIMSS)
Leading Age
National Association of Community Health Centers (NACHC)
National Rural Health Association (NRHA)
Medical Group Management Association (MGMA)
ProfessionalAssociationofHealthCareOfficeManagers
Workgroup for Electronic Data Interchange (WEDI)
Medicaid
Future ICD-10 information, such as testing dates, testing environments and guidelines will be sent to the trading partner
contact you designate in your response.
Also read the General Provider Letter Regarding ICD-10 Readiness (Apr. 2, 2014)
State Medicaid Agencies Must Use ICD-10 Code Sets by October 1, 2014
As HIPAA covered entities, states must comply with use of the ICD-10 codes sets by the October 1, 2014 deadline
established by CMS.
To help states implement ICD-10, CMS has developed an ICD-10 training package for State Medicaid agencies. The
complete package includes 12 training segments that address federal requirements and other aspects of ICD-10
implementation.
The training is a high-level review, intended primarily for state Medicaid managers, that focuses on assessment and
planning, not the "nuts and bolts" of implementation. The 12 segments address the following topics:
1. What Is ICD-10?
2. Regulatory Requirements
3. Benefits of Using ICD-10
4. Further Movement Along the MITA Roadmap – Use of Clinical Data and Interoperability
5. Effective Implementation of ICD-10
6. Potential Programmatic and Technical Problems
7. Impact on MITA Business Processes
8. Forming the Implementation Team
9. The Implementation Team that Gets It Right
10. Where Are You In This Process and Timeline?
11. Partner and Vendor Considerations
12. Post Compliance Date Actions and Education and Training Processes