Nebraska Medicaid Program
ICD-10 Implementation Project
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The following Provider Bulletins have been published regarding ICD-10 Implementation.
Here are some suggested steps to prepare:
Reach out to your Clearinghouse or Trading Partner to request they coordinate a test run with Medicaid to ensure that your claims submission can be accepted after October 1, 2015.
Contact your billing and EHR software vendor to ensure your system is ICD-10 ready for the ICD-10 implementation.
Note: Nebraska Medicaid claims can be submitted for up to 6 months from the date of service.
ICD-9 will only be accepted for processing if the dates of service are before 10-1-2015.
ICD-10 will only be accepted for processing if the dates of service (“to” date or discharge date) are on or after 10-1-2015.
REVISED ICD-10 Electronic and Paper Claims Testing Plan
- Provider Bulletin 15-23 details changes to ICD-10 testing plan, including the addition of paper claims testing.
- While testing is not required, it is highly recommended to ensure accurate and prompt payment of Fee-For-Service claims after October 1, 2015
- For questions specific to the ICD-10 transition, contact the ICD-10 Team at: DHHS.ICD-10Implementation@nebraska.gov
- RECEIVE EMAILED UPDATES: Please subscribe above to this ICD-10 webpage to receive notice of updates as further information is available.
Information about the International Classification of Diseases, 10th Revision (ICD-10)
The United States Department of Health and Human Services requires that all HIPAA covered entities use ICD-10 codes beginning October 1, 2015. This date is an extension from the original deadlines of October 1, 2013, and October 1, 2014. The ICD-10 coding system will fully replace the current ICD-9 coding system and will have a substantial impact on the entire health care industry.
The ICD-10 final rule concurrently adopts the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) for diagnosis coding, and the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS) for inpatient hospital procedure coding. These code sets will replace the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) Volumes 1 and 2, and the International Classification of Diseases, Ninth Revision, Clinical Modification (CM) Volume 3 for diagnosis and procedure codes, respectively.
As a HIPAA covered entity, Nebraska Medicaid will be transitioning to ICD-10 for both electronic transactions and paper claims. Other affected forms and processes will be announced as decisions are made. We are currently in the process of remediating the Medicaid Management Information System (MMIS) to accept and process with ICD-10 codes beginning October 1, 2015, for dates of service on or after October 1, 2015.
Highlights of how claims will be impacted when ICD-10 is implemented October 1, 2015
Reimbursements will be impacted if ICD-10 is not implemented timely and accurately by providers.
Providers must submit claims with either ICD-9 or ICD-10 codes and matching ICD indicator depending on the date(s) of service:
Claims for dates of service prior to October 1, 2015, must be submitted with ICD-9 codes and an ICD-9 indicator, regardless of the date submitted.
Claims for dates of service on or after October 1, 2015, must be submitted with ICD-10 codes and an ICD-10 indicator.
Refer to Provider Bulletin 15-22 to determine which ICD code and matching indicator to use for claim types where the dates of service begin before but end after October 1, 2015.
Electronic and paper claims combining both ICD-9 and ICD-10 codes will be rejected, regardless of the date of service.
Nebraska Medicaid will not accept ICD-10 codes prior to the compliance date of October 1, 2015.
Dental Claims (paper and electronic 837D) will not require ICD-10 diagnosis codes. Claims will not be rejected if a valid diagnosis code(s) is submitted.
Electronic and paper claims will be processed using the same rules for diagnosis coding.
On or after 10-1-2015, Providers must use either ICD-9 or ICD-10 based on the date(s) of services claimed, regardless of the billing date.
Providers must submit claims within180 days (6 months) after the date of service.
Frequently Asked Questions (FAQs)
The Centers for Medicare & Medicaid (CMS) provides extensive information, facts sheets, tools, and resources for providers, vendors and payers for implementing ICD-10. We are providing select links to assist you with your ICD-10 efforts. For more information, visit the CMS website at www.cms.gov/icd10.
CMS’s Road to 10: The Small Physician Practice's Route to ICD-10.
Check out the ICD-10 Quick Start Guide for a 5 step checklist to help health care professionals get ready.
CMS ICD-10 Code Sets: The ICD-10-CM, ICD-10-PCS code sets and the ICD-10-CM official guidelines are available free of charge.
45 CFR Part 162, Final Rule : Governing legislation for implementing the ICD-10 code sets.
CMS Provider Resources: Resources to assist providers in the transition to ICD-10
CMS Vendor Resources: Resources to assist vendors in the transition to ICD-10
CMS 2014 ICD-10-CM and GEMs and CMS 2014 ICD-10 PCS and GEMs: GEMs are General Equivalence Mappings between ICD-10-CM and PCS and ICD-9-CM codes. They are designed to assist converting applications and systems from ICD-9 and ICD-10 codes and are updated annually.
Check out the Nebraska Health Information Management Association website at: http://www.nhima.org for some training opportunities in Nebraska.
Nebraska ICD-Collaborative is the website of Nebraska individuals and organizations working together to facilitate communication, collaboration and information sharing. It includes resources and events.