ICD-10. New Mexico Medicaid. Presenter: Xerox State Healthcare LLC Provider Field Representative

Transcription

1 ICD-10 New Mexico Medicaid Presenter: Xerox State Healthcare LLC Provider Field Representative

2 Purpose This training will provide an overview ICD-10 and what providers should do to prepare for the transition to ICD-10. The training will also cover provider end-to- end testing and what ICD-10 compliance means. 2

3 Objectives ICD-10 compliance date What does ICD-10 compliance mean? End-to-End testing through EDI to include effective dates Contacts for ICD-10 testing Differences between ICD-09 and ICD-10 Provide CMS ICD-10 links Provide information on the new ICD-10 section on the Web Portal. 3

4 Resources New Mexico Medicaid Online Provider Information Provider Login Screen Notices Provider E-News Newsletters Medicaid HIPAA Helpdesk Provider Communication Updates Provider Field Representative Provider Webinars Open Forums and Live Training Sessions 4

5 Compliance Deadline The Centers for Medicare and Medicaid Services (CMS) continue to affirm the October 1, 2015 compliance deadline with no signs of it being delayed.. December 1, 2014 August 31, 2015 October 1,

6 What does ICD-10 compliance mean? ICD-10 compliance means that providers covered by HIPAA are able to successfully conduct health care transactions using ICD-10 codes. 6

7 Provider End-to-End Testing Based on the ICD-10 survey results, Providers continue to make progress, but some tasks are slipping into 2015, particularly those related to testing. HSD / Xerox plan to conduct external end-to-end testing with Providers who are ICD-10 compliant beginning December 1st, 2014 through August 31, HSD / Xerox recommend that Providers perform testing of their billing functionality (both translation as well as edits) well in advance of the Oct. 1, 2015 deadline. Providers who submit claims through a clearinghouse or billing agent should contact them for information on their ICD-10 conversion and testing plans. 7

8 Testing Instructions and Resources Additional information may be found on the Link provided below: For testing purposes, please provide the following information to HIPAA Desk NM, : 1. Provider ID or NPI 2. Phone Number 3. Submitter ID/ Trading Partner ID 4. Anticipated date the test file will be uploaded Production Site for Testing: 8

9 Contacts for End-to-End Testing If you can successfully perform health care transactions using ICD-10 codes and submit claims under your own Submitter ID please send an to and provide the following information; Provider ID (or NPI), Phone Number and Submitter ID. If you are a provider who works through a clearinghouse or Billing agent and have successfully conducted health care transactions using ICD-10 codes with your clearinghouse or billing agent please send an to [email protected] and provide the following information; Clearinghouse or billing agent submitter ID and your phone number. 9

10 Contacts for End-to-End Testing (continued) If you use a Submitter or Clearinghouse to send your claims to Xerox, please note our Testing Policy for New Mexico Medicaid Submitters and Clearinghouses: Xerox must receive an ICD-10 test file or a testing attestation form prior to October 1 st Submitters who fail to do so will have their 837 transactions suspended on 10/1/2015 until such time as they successfully complete a test ICD-10 submission with Xerox or submit to Xerox a testing Attestation form. To minimize the risk of revenue loss your organizations must to be ready to submit claims using ICD-10 codes effective October 1st, All other ICD-10 questions concerning implementation should be directed to Xerox HIPAA Helpdesk or Phone: (800) Option #6 then #4 10

11 11 Difference between ICD-09 and ICD-10

12 CMS Links and information To find out more, see the CMS implementation timelines and implementation handbooks tailored for specific audiences, which are available at or CMS has resources to help vendors and their customers prepare for a smooth transition to ICD-10. Visit or to find out more. The ICD-10-CM, ICD-10-PCS code sets and the ICD-10-CM official guidelines are available free of charge at ICD-10 resources and training materials will be available through CMS, professional associations and societies, and software/system vendors. Visit or regularly throughout the course of the transition to access the latest information on training opportunities. 12

13 ICD-10 Section on the Web Portal 13

14 New Mexico Medicaid Resources New Mexico Medicaid Portal Claim Inquiries, Eligibility Verification, Electronic Claim Submission, Provider Manuals, E-News NM Human Services Department Supplements, Memos, Provider Billing Packets and Policy Xerox State Healthcare, LLC: Provider Relations Call Center (800) option 6 or (505) option 6. Claim Status, Eligibility, Prior Authorization, Medicaid Updates Xerox State Healthcare, LLC. Provider Relations Helpdesk [email protected] Claim research assistance and general Medicaid inquiries Xerox State Healthcare, LLC. HIPAA Helpdesk [email protected] Assistance on NM Web Portal, EDI inquiries, and Online Claim Submission with DDE (Direct Data Entry) Xerox State Healthcare, LLC. Provider Enrollment Helpdesk - [email protected] Provider Enrollment Applications, Forms & Instructions NM Medicaid Recipient Helpdesk (888) or (505) Eligibility inquiries, Fee-for-Service Replacement Medicaid Identification Card, Enroll or change a Managed Care Organization and Eligibility application status 14

15 Summary Identified the ICD-10 Compliance date End-to-end testing time frame Explained the differences between the ICD-10-CM and ICD-9-CM diagnosis codes Provided the appropriate contacts for any questions and\or any concerns 15

16 Thank You