For those of you who have been diligently preparing for ICD-10, you have perhaps noticed a curious and frustrating lack of clarity on behalf of how payers are responding (or not responding) to the transition process.
At my recent ICD-10 Intensive Workshops, a few common questions kept coming up in regards to how different payers were handling ICD-10 preparations and claims processing. Unfortunately, while we know a good deal about Medicare, other payers have not been as transparent in their transition plans.
But for chiropractors who provide services for Regence BCBS, there is good news. In a recent announcement in The Connection newsletter, Regence (finally) revealed some details as to how they will be implementing ICD-10.
Here are some highlights:
- Use ICD-9 for claims with DOS Before October 1: Continue to use valid ICD-9 diagnosis codes for claims with dates of service prior to October 1. Claims submitted using ICD-10 codes with dates of service before October 1 will be rejected.
- Use ICD-10 for Claims with DOS After October 1: For claims incurred on or after October 1 (date of service), use only valid ICD-10 diagnosis codes. Claims submitted with dates of service on or after October 1 that do not include valid ICD-10 codes will be rejected.
- No Changes to Pre-Authorization: The Regence pre-authorization process is not changing and you will not need to submit a new pre-authorization request if you submitted a request using ICD-9 codes prior to October 1 for a date of service on or after October 1. Regence will continue to accept pre-authorizations 60 days prior to service. Pre-authorization requests submitted on or after October 1 must use ICD-10 coding.
- No Grace Period: Regence is not participating and is not impacted by Medicare’s announcement to implement a grace period. All claims need to be coded to the highest level of specificity known at the time of each health care encounter.
- Testing is Now Ready: Regence stated that their external end-to-end testing with key clearinghouses, providers and facilities will be completed by the end of August. This means that you should be able to now test claims through your clearinghouses or to Regence to make sure your system is communicating in ICD-10 properly.
- Questions? If you still have specific questions related to ICD-10 implementation or testing, Regence has a dedicated email: ICD-10ProviderReadiness@regence.com
What to Do Next
As I mentioned in my ICD-10 Intensive Workshops (there’s still time to catch one in the Northwest if you hurry!), I would recommend that you test ICD-10 claims with your largest payers. Certainly, Regence is one for many chiropractors.
Unfortunately, other payers have not been so transparent with their transition plans, so it behooves you to contact them to discuss their testing and implementation plans for claims processing. As with Regence, commercial payers are not obligated to offer the grace period like Medicare and they may choose to administer their plans differently.
And perhaps the biggest “next step” of all is to make sure that you complete your ICD-10 preparations ASAP! We’re getting incredibly close to the big day so be sure to train yourself and your staff to be ready. If a live workshop suits you, attend one of our upcoming ICD-10 Intensive seminars. If you prefer online, consider our ICD-10 Implementation Course for Chiropractors & Staff online.
Either or both will help get you ready and give you a format for getting your questions answered and getting prepared in the most efficient way possible!