Independence's guidelines for submitting authorizations and referrals

May 1, 2015


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 Independence will begin accepting ICD-10 codes on authorizations and referrals.

In response to questions from providers regarding the rules on how Independence 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 Independence and does not represent the guidelines of any other health plan, including other Blue Plans. 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, Independence 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.

Requests 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, 2015Prior to and including September 30, 2015ICD-9
Prior to and including September 30, 2015On or after to October 1, 2015ICD-9
On or after to October 1, 2015Prior to and including September 30, 2015ICD-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 Independence?s ICD-10 rules and guidelines, please visit our dedicated ICD-10 web page. There you will find frequently asked questions and information on our What?s Up Wednesday monthly teleconference.