The ICD-10 compliance date is October 1, 2015, AmeriHealth is now requiring ICD-10 codes on all authorizations, referrals, and claims. Below are some of the frequently asked questions (FAQ) we received from providers. The answers can assist you in the new ICD-10 landscape.

Authorizations and referrals

Q: How will AmeriHealth handle authorizations and referrals for services that occur on or after the ICD-10 compliance date of October 1, 2015? A: Changes were recently made to the way authorizations and referrals are processed in regards to ICD-9/ICD-10 coding, as reflected in the recent enhancements to the NaviNet^® web portal. Please use the updated guidelines below when submitting an authorization and/or referral for services that occur on or around the October 1, 2015, ICD-10 compliance date:

• All authorization and referral requests submitted with an anticipated/proposed date of service prior to and including September 30, 2015, are required to use ICD-9 codes.
• All authorization and referral requests submitted with an anticipated/proposed date of service on or after October 1, 2015, are required to use ICD-10 codes.

Important: If you already have an authorization or referral that was submitted with an ICD-9 code and the actual date of service is on or after October 1, 2015, you do not need to resubmit a new request. AmeriHealth will take steps to ensure claims processing is not impacted. If you already have an authorization that was submitted with an ICD-9 code with a beginning date of service on or before to September 30, 2015, and you need to request an extension (e.g., additional services or additional days) for dates of service on or after October 1, 2015, you do not need to update the diagnosis code to ICD-10. Note: When submitting an authorization request through NaviNet, please do not include the decimal point when entering diagnosis codes. Use the ICD-9 code (for dates of service prior to October 1, 2015) or ICD-10 code (for dates of service on or after October 1, 2015).

Claims submission

Q: Will AmeriHealth accept ICD-9 codes after October 1, 2015, for dates of service that were prior to October 1, 2015? A: Yes, ICD-9 codes should be submitted on claims with dates of service prior to October 1, 2015. Current regulations require the use of ICD-9 codes for dates of service prior to the mandated implementation date. Inpatient claims with discharge dates on or after the mandated implementation date must be coded in ICD-10. All outpatient and professional claims with dates of service on or after the mandated implementation date must contain ICD-10 diagnosis codes. Q: Will both ICD-9 and ICD-10 codes be accepted on a single claim? A: No, in accordance with the Centers for Medicare & Medicaid Services (CMS) billing guidelines, ICD-9 and ICD-10 codes cannot be submitted as part of a single claim. Q: What happens if an incorrect code is submitted on a claim? A: If your office submits an invalid code on a claim (i.e., an ICD-9 code is submitted for a date of service on or after October 1, 2015), your claim will be denied and sent back to you for compliant coding. Depending on your clearinghouse, these invalid claims may either be rejected directly by your clearinghouse or, if passed by the clearinghouse, may be rejected by AmeriHealth. Providers should closely monitor the front-end reports from their clearinghouses and AmeriHealth. For a full listing of all provider FAQs related to ICD-10, please refer to the Transition to ICD-10: Frequently Asked Questions document available for AmeriHealth New Jersey and AmeriHealth Pennsylvania. Additional information on ICD-10 can be found at the CMS ICD-10 dedicated website.

NaviNet is a registered trademark of NaviNet, Inc.