With the October 1, 2015, compliance deadline for ICD-10 only three months away, AmeriHealth would like to make sure that all provider offices are taking the necessary steps to get ready for ICD-10.

Compliance deadline

AmeriHealth would like to remind providers that we will not accept ICD-9 codes on any referrals, authorizations, or claims for dates of service on or after October 1, 2015. If your office submits an ICD-9 code after the compliance date, your referral, authorization, or claim will be denied and sent back to you for proper coding. Providers should work with their trading partners, clearinghouses, and billing vendors/billing software companies to ensure ICD-10 compliance and avoid claims rejections and processing delays.

Ensure successful claims payment

In order for your claims to process correctly, all providers must bill with ICD-10 codes for all dates of service on or after October 1, 2015. Any claims submitted for dates of service on or after October 1, 2015, with ICD-9 codes will be denied.

If the dates of service span the compliance date, the claim will need to be split. ICD-9 codes should be used for dates of service prior to October 1, 2015, and ICD-10 codes should be used for dates of service on or after October 1, 2015. Note: You cannot submit both ICD-9 and ICD-10 codes on a single claim.

As a reminder, all network providers are required to use the Health Insurance Portability and Accountability Act (HIPAA) 5010 electronic format and CMS-1500 (02/12) paper format in order to avoid denials.

Keeping you informed

For the most up-to-date information on ICD-10 rules and guidelines, including recently updated frequently asked questions, visit the AmeriHealth Pennsylvania ICD-10 website and the AmeriHealth New Jersey ICD-10 website.

We have also published information in Partners in Health Update^SM, including the following recent articles:

• External testing updates and tips for a successful conversion
• Clarification: The AmeriHealth guidelines for submitting authorizations and referrals

Additional resources

The Centers for Medicare & Medicaid Services (CMS) ICD-10 web page offers a plethora of resources for your use, including:

• Road to 10: The Small Physician Practice's Route to ICD-10
• ICD-10 Resources flyer
• Video tutorials:
  • – Introduction to ICD-10 Coding
  • – Road to 10: The Small Physician Practice's Route to ICD-10
• CMS ICD-10 Industry Email Updates