ICD-10

  • ICD-10 Compliance Date Change

    The U.S. Department of Health and Human Services (HHS) issued a rule on July 31, 2014, finalizing Oct. 1, 2015, as the new compliance date for healthcare providers, health plans, and healthcare clearinghouses to transition to ICD-10, the tenth revision of the International Classification of Diseases. We’re continuing to move forward with our planned testing with certain providers and clearinghouses in order to meet the federal compliance date. We are not able to accept ICD-10 codes on claims until Oct. 1, 2015. Claims sent using ICD-10 codes prior to the new compliance date will be returned.

    Important: Based on the recent delay, Premera will continue to accept the former 1500 Health Insurance Claim Form (version 08/05) through Sept. 30, 2015. Please take this opportunity to use up the forms you have on hand prior to Sept. 30, 2015. Effective Oct. 1, 2015, Premera will only accept claims submitted on the revised form (version 02/12).

    What is ICD-10?

    The International Classification of Diseases (ICD-10) is a system that facilitates a statistical classification of disease published by the World Health Organization and is one of several means for reporting procedures performed in acute care facilities.

    ICD-10 code sets have been widely-used internationally for more than a decade to report patient health conditions. It also is used for mortality reporting in the United States. The U.S currently uses ICD-9 coding both to report patient health conditions and facilitate claims processing and provider reimbursement.

    The U.S. Department of Health and Human Services (HHS) mandated the use of ICD-10 codes in the U.S. on all HIPAA transactions by Oct. 1, 2015, for both reporting and payment of claims. The adoption of ICD-10 coding is delayed to no sooner than Oct. 1, 2015.

    How is Premera preparing for ICD-10?

    For Premera, ICD-10 implementation will impact processes across the company; however, we are prepared. Our implementation planning is well underway, and we will meet the federal compliance date.

    • Our implementation approach allows us the operational capability to respond to any changes to the HHS requirements for the mandate, including an extension of the compliance date.
    • We understand this is a significant transition for providers. Our plan will include testing with key providers and clearinghouses in advance, and we will monitor claims closely post-implementation to ensure any impacts are identified and resolved early in the process.
    • Premera will work collaboratively with healthcare providers, associations and other external entities (where appropriate) to assist in their efforts of compliance regarding the ICD-10 mandate.

    How can providers prepare for ICD-10?

    Provider awareness and preparedness are crucial in making a smooth transition to ICD-10. Provider offices can minimize impacts if they have anticipated, learned, and prepared for the changes, as well as for the potential setbacks.

    • Premera encourages providers to develop an implementation strategy that includes an assessment of the impact on their organization, a detailed timeline and budget
    • We will continue to inform providers about steps they can take to prepare and direct them to ICD-10 resources
    • We are working with individual facilities to ensure that their contracts are compliant with ICD-10 requirements

    Key steps for provider readiness

    • Identify training needs
    • Familiarity with code sets for all physicians, nurses, employees
    • Refresh of medical terminology (and biomedical sciences) for billers, office staff and coders
    • ICD-10 certification training required for coders – estimated six to nine months before compliance date
    • Reach out to trading partners about ICD-10 to determine their readiness (clearinghouses, billing services, vendors, etc.)

    Resources