Q4. Is BCBSAZ going to update the HIPAA Version 5010 Companion Guide??

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1 An Independent Licensee of the Blue Cross and Blue Shield Association ICD-10 FAQs General Questions Q1. What are ICD-10-CM and ICD-10-PCS? A1. ICD-10-CM is the International Classification of Diseases, 10th Revision, and Clinical Modification. This new diagnosis classification system was developed by the Centers for Disease Control and Prevention (CDC) for use in all United States healthcare settings. ICD-10-CM replaces the existing diagnosis code set, ICD-9- CM (International Classification of Diseases, 9th Edition, Clinical Modification, Volumes 1 and 2). ICD-10-PCS is the Procedure Classification System developed by CMS for use in the United States for hospital inpatient setting. It replaces ICD-9-CM Volume 3 as the code set for reporting hospital inpatient procedures. ICD-10 code sets are alphanumeric and contain 3 to 7 characters. ICD-10 code sets are more robust and descriptive with one-to-many matches in numerous instances. There are nearly 5 times as many diagnosis codes in ICD-10-CM than in ICD-9-CM, and nearly 19 times as many procedure codes in ICD-10-PCS than in ICD-9-CM volume 3. Q2. What does ICD-10 compliance mean? A2. ICD-10 compliance means that a HIPAA covered entity is able to successfully conduct health care transactions using ICD-10 codes on or after October 1, Q3. Will BCBSAZ crosswalk ICD-10 codes from ICD-9 codes? A3. No, BCBSAZ will not crosswalk to ICD-10 from ICD-9. Q4. Is BCBSAZ going to update the HIPAA Version 5010 Companion Guide?? A4. BCBSAZ does not plan to update the HIPAA Version 5010 Companion Guide at this time. Visit or contact esolutions at esolutions@azblue.com or by phone at (602) , (800) , to obtain a current version of the companion guide. Post Office Box Phoenix, AZ West Las Palmaritas Drive Phoenix, AZ (602)

2 Testing Q5. When can organizations begin testing with BCBSAZ? A5. Providers, Clearinghouses and Corporate Health Service TPAs can begin testing now through August Q6. If an organization is interested in testing with BCBSAZ during third quarter 2015, who should they contact? A6. Providers and Clearinghouses Corporate Health Services (CHS) Third Party Administrator (TPA) Q7. Will BCBSAZ require testing with all Corporate Health Services Third Party Administrators (CHS TPAs), clearinghouses and providers? A7. BCBSAZ will be unable to test ICD-10 readiness with every CHS TPA, clearinghouse and provider. So, it is essential for providers to validate readiness on their own. 2

3 Claim Submissions Q8. On what date will BCBSAZ begin accepting claims with ICD-10 codes? A8. BCBSAZ will begin to accept claims with ICD-10 codes on claims for services provided on or after October 1, ICD-10 codes cannot be used to bill services provided before that date. BCBSAZ will not accept ICD-9 codes for services provided on or after Oct. 1, 2015 BCBSAZ will not accept ICD-10 codes before Oct. 1, 2015 Medical claims with Dates of Service (DOS) that span 2014 through 2015 must be split into two claims. o ICD-9 codes are to be billed for DOS through Sept. 30, 2015 o ICD-10 codes are to be billed for DOS Oct. 1, 2015 and later Inpatient DRG claims that span 2014 through 2015, should be billed with ICD-10 codes and will be priced based on the discharge and/or through date of service. NOTE: BCBSAZ will follow the CMS claim submission guidelines as outlined in the Medicare Learning Network (MLN) education articles: MLN/MLNMattersArticles/index.html?redirect=/MLNMattersArticles/ Q9. Will BCBSAZ require ICD-10 coding on both electronic and paper claims? A9. Yes, all claims need to be compliant. Q10. How will BCBSAZ process claims after Oct. 1, 2015? A10. BCBSAZ will only accept ICD-10 code sets for dates of service and/or discharge through dates on and after October 1,

4 Q11. How will BCBSAZ handle claims received with incorrect ICD code sets? A11. If the ICD-9 or ICD-10 code sets are billed incorrectly on an electronic claim, BCBSAZ will: Identify the claim error(s) on your CCAR report. The CCAR is a humanreadable report that contains information on all claims within a batch and includes a detailed status of rejected and accepted claims. Instruct you to correct the error(s) and resubmit electronically Apply one or more of the following set error messages. Electronic Claim ICD-10 Code Set Error Messages The ICD-9 Diagnosis code cannot be used on dates of service on or after to October 1, The Health Care Diagnosis Code, (2300, HI) ABK/ABF qualifier for ICD-10 code may not be used prior to the effective date of 10/1/2015. The ICD-9 Diagnosis code cannot be used on dates of service after October 1, The ICD-9 Procedure code cannot be used on dates of service after October 1, This claim is using both ICD-9 and ICD10 procedures and/or diagnosis codes. Only one version of the code set is allowed for use within the same claim. The ICD-10 Principal Diagnosis (2300, HI) may not be used prior to October 1, 2015 The ICD-9 Diagnosis code cannot be used on dates of service after October 1, The ICD-9 Diagnosis Code must not be used after October 1, If the ICD-9 or ICD-10 code sets are billed incorrectly on a paper claim, BCBSAZ will: Identify the claim error(s) on your Return Letter. The Return Letter will contain claim identifiable information, Claim ICN and description of error(s) contained on claim. Instruct you to correct the error(s) and resubmit electronically, if possible. Otherwise, correct and resubmit on a new paper claim. Apply one or more of the following set error messages. Paper Claim ICD-10 Code Set Error Messages ICD-9 Code set is not valid for date of service. ICD-10 Code set is not valid for date of service. Claim cannot have both ICD-9 and ICD-10 code sets. The discharge and/or through date for the ICD code set combination are invalid. 4

5 Transition Q12. How will precertification requests be handled for services that will not be performed until October 1, 2015? A12. Pre-cert requests received prior to Oct. 1, 2015 will be set-up using ICD-9 code sets. Pre-cert requests received on or after Oct. 1, 2015, will be set-up using ICD- 10 code sets. NOTE: Precertification requests obtained with an ICD-9 code set do not need to be updated or changed to an ICD-10 code set. However, if the claim DOS or discharge date, occur on or after Oct. 1, 2015, the claim must be submitted using an ICD-10 code set (even if the pre-cert was obtained using ICD-9). Q13. Does BCBSAZ anticipate any changes in medical policies resulting from the transition to ICD-10 code sets? A13. At this time, we have no specific updates, but we continually evaluate medical policies and such updates may occur. BCBSAZ will communicate any updates via online BluesLetter articles, communications and provider portal alerts and messages. 5

6 Claim Reimbursements Q14. Will reimbursement methodology be impacted by ICD-10? A14. BCBSAZ does not expect that ICD-10 will have any immediate impact on reimbursement methodology, i.e. the methods by which BCBSAZ pays claims (DRGs, per diems, fee schedules). BCBSAZ does expect, that over time, as we gather additional claims data using the more specific coding available through ICD-10, that we will evaluate both reimbursement amounts and reimbursement methods, for refinement and improvement. If you would like to put your specific concerns in writing, with examples and/or any related documentation, please send these to: Blue Cross Blue Shield of AZ Attn: Provider Network Relations Mailstop S102 Post Office Box Phoenix, Arizona Q15. Does BCBSAZ expect a delay in payment to providers during the ICD-10 transition? A15. No delays in payment are expected. Q16. What if I have questions about how the claim processed due to specific ICD-10 coding vs. old ICD-9 coding? A16. Please follow the normal process and call in to the appropriate customer service department for the line of business for the member whose claim you are calling about. 6

7 Resources & Training Q17. If an organization has questions regarding ICD-10 who should they contact? A17. Please visit the BCBSAZ ICD-10 site at: information Questions regarding ICD-10 can be referred to: Q18. Where can Providers, Clearinghouses and CHS TPAs, find additional information about ICD-10? A18. ICD-10 information is available on the following websites: The Centers for Medicare and Medicaid Services (CMS) ICD-10 site has dozens of educational materials, articles, videos and fact sheets CMS Medicare Learning Network MLN/MLNMattersArticles/index.html?redirect=/MLNMattersArticles/ The American Psychiatric Association ICD-10 website explains how behavioral health providers are impacted o The American Psychiatric Association document; Understanding ICD-10 and DSM-5 Quick Guide The DSM-5 site has resource information for behavioral health providers The American Academy of Family Physicians (AAFP) site has hundreds of informative articles and information. Simply enter in ICD-10 into their search feature to access. The American Academy of Professional Coders (AAPC) ICD-10 site has training, services and code books among other helpful tools and resources. The American Health Information Management Association (AHIMA) site has information about coding, clinical documentation tools and preparation checklists. The American Hospital Association (AHA) ICD-10 site has educational resources and articles. The American Medical Billing Association (AMBA) ICD-10 site has online courses and timelines. The Workgroup for Electronic Data Interchange (WEDI) ICD-10 site has information for a successful electronic implementation. 7

8 Q19. Where can I find ICD-10 compliant software? A19. There are vendors available that are ICD-10 compliant: Visit one of the following vendor sites to find out how they can help you submit compliant ICD-10 electronic claims: Availity FreeMedicalClaims.com Office Ally 8