ICD-10 Frequently Asked Questions

General Questions

Who do I contact at BCBSNE about ICD-10?

Please send an email to ICD10@nebraskablue.com and a member of the ICD-10 Team will contact you.

 

Does BCBSNE have an email list that I can subscribe to for ICD-10 updates?

Not at this time. The primary means of communicating the latest ICD-10 information will be via our ICD-10 page and our Update newsletters.

 

Does BCBSNE provide ICD-10 training?

No, but we encourage you to visit www.cms.gov/icd10 for ICD-10 resources. We also encourage you to visit our ICD-10 page as upcoming readiness events are listed as we learn of them.

 

When is the ICD-10 implementation date?

The U.S. Department of Health and Human Services (HHS)/Centers for Medicare and Medicaid (CMS) is in the process of setting the implementation date for ICD-10. As of the time of this writing, the proposed implementation date was October 1, 2015. Please refer to www.cms.gov/icd10 for the final official word on implementation.

 

Will BCBSNE be ready for ICD-10 by the implementation date?

Yes.

 

For claims with dates of service prior to the ICD-10 implementation date, will BCBSNE accept ICD-10 codes?

No.

 

For claims with dates of service on or after the ICD-10 implementation date, will BCBSNE accept ICD-9 codes?

No.

Will BCBSNE accept claims with ICD-9 codes past the ICD-10 implementation date?

Yes, but only if the dates of service listed on the claims occur prior to the implementation date.

 

After ICD-10 implementation, will BCBSNE accept “unspecified” ICD-10 codes?

If an unspecified code is appropriate per the coding guidelines, then it will be considered.

 

How will BCBSNE handle claims with services that span the implementation date?

For outpatient services, ICD-10 codes will be required for dates of service on or after the implementation date. Professional claims must be split between dates of service that occur before the implementation date and dates of service on or after the implementation date.

The code set used on institutional claims will be based on the date of discharge. For inpatient services, ICD-10 codes will be required for dates of discharge that occur on or after the implementation date.

Will BCBSNE tell me what ICD-10 codes I should use?

No. All coding should follow industry-standard coding guidelines based on clinical documentation.

 

Testing

When will BCBSNE begin ICD-10 testing?

BCBSNE began ICD-10 testing in fall 2013 and plans to continue to offer testing until further notice.

 

What kind of ICD-10 testing will BCBSNE conduct?

We offer end-to-end ICD-10 testing based on the provider’s and/or clearinghouse’s needs. Specifics are determined upon contacting us at ICD10@nebraskablue.com.

 

Is BCBSNE limiting the number of test partners?

Not at this time. We are open to testing with all BCBSNE providers and any other entities doing business with BCBSNE.

 

How much does it cost to test with BCBSNE?

Testing is free. No additional cost is required.

 

I want to test with BCBSNE. Where do I start?

Contact our ICD-10 Team via email at ICD10@nebraskablue.com.

 

Is there a limit to the number of test claims I can submit?

Yes. We will take a maximum of ten (10) dually coded test claims from each provider. If your organization consists of multiple lines of business (for example, a hospital and a clinic), it is possible that we could accommodate additional test claims.

 

What exactly does “dually coded test claims” mean?

Dually coding test claims involves starting with ten ICD-9 claims and then recoding them in ICD-10. Each claim “pair” should contain the same patient, same diagnoses, same procedures, same date of service, etc. – just different ICD code versions.

For example: 10 dually coded test claims = 10 ICD-9 coded claims + 10 ICD-10 coded claims.

Can I submit a test claim that contains both ICD-9 and ICD-10 codes?

No. Test claims must contain either ICD-9 codes exclusively or ICD-10 codes exclusively.

 

Can I submit an electronic test file that contains both ICD-9 claims and ICD-10 claims?

Yes.

 

Does BCBSNE determine the testing scenarios and/or what codes I can test with?

No. Diagnosis codes, procedure codes, and testing scenarios are at the provider’s discretion. We suggest using codes that are important to your organization and/or are commonly used.

 

Is BCBSNE testing with electronic claims?

Yes. You must contact the ICD-10 Team at ICD10@nebraskablue.com before submitting any test claims. Please coordinate with your clearinghouse for specific submission instructions. See our current list of clearinghouses partners on our ICD-10 page. If your clearinghouse is not yet on this list, please let us know.

 

Is BCBSNE testing with paper claims?

Yes. If your organization exclusively or frequently submits paper claims, we encourage you to test via paper submission. We will accept paper claims via secure email or fax after initial contact has taken place.

 

My organization uses PC-ACE to submit claims – can I test this way?

Yes. To receive submission details for PC-ACE, contact the ICD-10 Team at ICD10@nebraskablue.com before submitting any test claims.

 

Can I test now and then test again later, closer to the implementation date?

Until further notice, we are open to testing; however, second-round testing in 2015 may not be offered due to project timelines.

 

What kind of test results will BCBSNE provide?

We will initially provide a spreadsheet report with detailed test findings, as well as a brief summary of results. For electronically-submitted 837I and 837P test claims, we will also supply the submitter with the 999, CCR, and TA1 as applicable.

 

We will provide an Electronic Remittance Advice (ERA)/835 by request only. This electronic report will be delivered separately and at a later date than the other test reports because of required scheduling coordination with a BCBSNE vendor.

 

Can I submit a test claim where BCBSNE is the secondary payer?

We do not recommend this, as price comparisons during testing could be skewed when another payer is involved.

 

Can I submit test claims with mock/fake data?

No, test claims must contain real BCBSNE member ID data.