ATTENTION:
Recent changes were made to the way that authorizations and referrals are processed in regards to ICD-9/ICD-10 coding. Please review the
ICD-10 Quick Tips: Updated guidelines for submitting authorizations and referrals page for more information.
This article contains a clarification for information related to the time frame in which AmeriHealth will begin accepting ICD-10 codes on authorizations and referrals.
In response to questions from providers regarding the rules on how AmeriHealth will handle authorization and referral requests for dates of services that occur on or after the ICD-10 compliance date of October 1, 2015, we are clarifying our position as outlined below.
IMPORTANT
Please note that the following information applies only to AmeriHealth and does not represent the guidelines of any other health plan. We encourage you to visit the websites of each of the health plans your practice participates with to become familiar with their specific guidelines.
Authorization and referral guidelines
In regard to the submission of authorizations and referrals, AmeriHealth will follow its current process, which is to issue authorizations based on the request date.
All authorization and referral requests submitted prior to and including September 30, 2015, are required to use ICD-9 codes.
All authorization and referral requests submitted on or after October 1, 2015, are required to use ICD-10 codes.
Time lines for professional, inpatient, and outpatient services
| Authorization and/or referral submission date: | Date of service: | Code set to use: |
|---|
| Prior to and including September 30, 2015 | Prior to and including September 30, 2015 | ICD-9 |
| Prior to and including September 30, 2015 | On or after to October 1, 2015 | ICD-9 |
| On or after to October 1, 2015 | Prior to and including September 30, 2015 | ICD-10 |
| On or after October 1, 2015 | On or after to October 1, 2015 | ICD-10 |
Note: Providers should not bill with ICD-10 codes before the October 1, 2015, compliance date. Claims using ICD-10 codes prior to October 1, 2015, will be rejected.
More information
For the most up-to-date information on ICD-10 rules and guidelines, including frequently asked questions, please visit the AmeriHealth Pennsylvania ICD-10 website and the AmeriHealth New Jersey ICD-10 website.