Nebraska Medicaid Program
ICD-10 Implementation Project
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Nebraska Medicaid is ready to accept and process ICD-10 codes effective October 1, 2015.
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.
The following Provider Bulletins have been published regarding ICD-10 Implementation.
Recently published Provider Bulletins:
The following provider bulletins were published between June and November 2015:
Previously published Provider Bulletins:
- 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. The ICD-10 coding system will fully replace the ICD-9 coding system and 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 has transitioned to ICD-10 for both electronic transactions and paper claims effective October 1, 2015. The Medicaid Management Information System (MMIS) has been remediated to accept and process with ICD-10 codes effective 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.
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.
Providers and Trading Partners should now use 10/01/15 as the ICD-10 test implementation date on all paper and electronic ICD-10 test claims.
Provider Bulletin 15-23 details updates to the 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.
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. Roadto10.org is your one-stop source for all things ICD-10. This site is for the small physician practice. This interactive site includes FAQs, Specialty References, Template Library and more.
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.