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ICD-10 Updates

PW_E169267

In 2014, the U.S. Department of Health and Human Services (HHS) issued a rule finalizing October 1, 2015 as the compliance date for health care providers, health plans, and health care clearinghouses to transition to ICD-10. 
We will continue to work to help ensure that our systems, supporting business processes, policies and procedures successfully meet the implementation standards and deadlines without interruption to day-to-day business practices. We will be capable of accepting and processing ICD-10 diagnosis and inpatient procedure codes on the mandated compliance date. 
 
Key Information for Providers
We have made several key decisions you will need to know as you plan for 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 
 
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. 
 
eCast: Preparing for ICD-10: A Provider’s Perspective
Will you be ready?
Watch this informative eCast to see how ICD-10 will affect the daily activities of the physician’s office. 
 
June Topic: ICD-10 Preauthorizations for Service Dates 10/1/2015 or After 
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, the mandated ICD-10 compliance date.  
Note that you must continue to use ICD-9 codes to pre-authorize services scheduled through September 30, 2015.  
Some preauthorizations may span the October 1, 2015 compliance date. The code set of the preauthorization will vary, depending on the scenario. This chart will help you understand how to authorize services.  
A printable version of this chart is available here.  

Type of Service 
Begins 
Ends 
Pre-Authorization 
Claim 
Inpatient 
Admission begins on or after 10/1/2015 
Discharge on or after 10/1/2015 
Preauthorization must be requested with ICD-10 codes. 
Claim for services rendered on or after 10/1/2015 must be billed with ICD-10 codes. 
Inpatient with unknown discharge date 
Admission begins before 10/1/2015 
Discharge is unknown at the time of admission, then discharge occurs on or after 10/1/2015 
Preauthorization must be requested with ICD-9 codes. This preauthorization will be valid for the entire admission. 
The code set used on the claim will be based on the discharge date, so the entire claim must be billed with ICD-10 codes. 
Inpatient with known discharge date 
Admission begins before 10/1/2015 
Known discharge on or after 10/1/2015 
Preauthorization should be requested with ICD-10 codes. 
The code set used on the claim will be based on the discharge date, so the entire claim must be billed with ICD-10 codes. 
Outpatient Services 
Service on or after 10/1/2015 
NA 
Preauthorization should be requested with ICD-10 codes. 
Claim must be filed with ICD-10 codes. 
Long-term Outpatient Services (such as Physical Therapy, Radiation Therapy, Chemotherapy, etc.) 
Services begin before 10/1/2015 
Services end on or after 10/1/2015 
Preauthorization obtained in ICD-9 will be valid for services rendered on or after 10/1/2015. 
The claims for these services need to be separated and filed with the correct code set for the date(s) of service. Claims with both codes sets, or mixed claims, will not be accepted. 
 
ICD-10 Implementation Resources to assist you
Suggested resources to help with your ICD-10 transition and prior Monthly ICD-10 Topics 
 
Contact Us
For ICD-10 questions and surveys, email us at ICD10-Inquiry@anthem.com  
 
 
 
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Anthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In Ohio: Community Insurance Com pany. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin ("BCBSWi"), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation ("Compcare"), which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Use of the Anthem Web sites constitutes your agreement with our Terms of Use