Nebraska Medicaid Program
ICD-10 Implementation Project
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- Nebraska Medicaid is following the same timeline adopted by the Centers for Medicare & Medicaid (CMS) for the transition of the CMS 1500 health insurance paper claim form. The transition timeline for moving from the current 08/05 version to the 02/12 version is as follows:
- Effective January 6, 2014, Nebraska Medicaid will begin receiving and processing paper claims submitted on the revised CMS 1500 claim form (version 02/12).
- Effective January 6 through March 31, 2014, Nebraska Medicaid will have a dual use and processing period during which we will continue to receive and process paper claims submitted on the old CMS 1500 claim form (version 08/05).
- Effective April 1, 2014, Nebraska Medicaid will receive and process paper claims submitted only on the revised CMS 1500 claim form (version 02/12).
- Note that on or after April 1, 2014, any claims received utilizing the older versions of the CMS 1500 claim form will be returned to the provider. See the Provider Bulletin #13-75: http://dhhs.ne.gov/medicaid/Documents/pb1375.pdf for additional information.
- Do not use ICD-10 diagnosis codes prior to the October 1, 2014.
- ICD-10 diagnosis codes can be used effective October 1, 2014, but only for dates of service on or after October 1, 2014.
- If ICD-10 codes are submitted before October 1, 2014, the claims will be denied.
Information about the International Classification of Diseases, 10th Revision
The United States Department of Health and Human Services requires that all HIPAA covered entities use ICD-10 codes beginning October 1, 2014. This date is an extension from the original deadline of October 1, 2013. 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, 2014, for dates of service on or after October 1, 2014.
Highlights of how claims will be impacted when ICD-10 is implemented on October 1, 2014
Reimbursements will be impacted if ICD-10 is not implemented timely and accurately by providers.
Providers must use either ICD-9 or ICD-10 depending on the date(s) of service:
Claims for dates of service prior to October 1, 2014, must be submitted with ICD-9 codes, regardless of the date submitted
When the dates of service span the implementation date, for example, the discharge date and/or through date is on or after October 1, 2014, the claim should contain only ICD-10 codes.
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, 2014
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 10-1-2014, 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.
To assist in delivery of information, a dedicated email address has been created for questions and answers specific to the ICD-10 transition. This email address is: DHHS.ICD-10Implementation@Nebraska.gov
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 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 2013 ICD-10-CM and GEMs and CMS 2013 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.
The CMS ICD-10 Planning Check List on the CMS website outlines the critical steps for providers to follow to accomplish implementation of ICD-10 codes.
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.