ICD-10 FAQs
- What is Health Net's program approach to implement ICD-10?
-
Health Net will be compliant by the ICD-10 implementation date of October 1, 2015. A cross-functional team of Health Net subject-matter experts is working on testing requirements for systems and business processes under a program approach. Health Net will enhance core enterprise systems to directly utilize ICD-10 data
for processing.
- What is Health Net's primary strategy for ICD-9 and ICD-10 claims processing after the ICD-10 implementation date?
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Health Net will process ICD-10 claims based on, including, but not limited to, Centers for Medicare and Medicaid Services (CMS) guidelines, regulations, dates of service, and discharge dates. This translates to Health Net accepting ICD-10 claims with dates of service and discharge dates on and after October 1, 2015, and ICD-9 claims received after October 1, 2015, with dates of service and discharge dates prior to
October 1, 2015.
- Is Health Net planning to accept ICD-9 after the compliance date?
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Health Net will only accept claims with ICD-9 codes received after October 1, 2015, with dates of service and discharge dates prior to October 1, 2015, according to the HIPAA ICD-10 final
rule mandate.
- Is Health Net planning to accept ICD-10 before the compliance date?
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No. Health Net will only accept ICD-10 claims with dates of service and discharge dates on and after
October 1, 2015.
- How long will Health Net provide support for both ICD-9 and ICD-10?
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Health Net will remain compliant with existing Provider Participation Agreement (PPA) language, and state, federal and regulatory requirements related to claims
processing timelines.
- What are Health Net's processing guidelines for paper claims on and after October 1, 2015?
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The use of these ICD-10 code sets is not predicated on how the claim is submitted. Paper claims will be subject to the same rules as electronic claims, in accordance with
CMS guidelines.
- Does Health Net have plans to update its medical policies to be consistent with ICD-10 prior to the implementation
date? -
Health Net will update all medical policies in accordance with ICD-10 coding, as needed, and communicate these changes to providers prior to the ICD-10 implementation date of
October 1, 2015.
- Will Health Net require or support interim billing?
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Providers with inpatient members admitted prior to October 1, 2015, and discharged after October 1, 2015, need to submit the final interim bill using
ICD-10 codes.
- What if a bill is received with mixed ICD-9 and ICD-10 codes?
-
Health Net will not accept claims with mixed ICD-9 and
ICD-10 coding.
- How does Health Net intend to handle prior authorizations surrounding the transition date?
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ICD-9 codes must be used for authorizations with dates of service prior to October 1, 2015. ICD-10 codes must be used for authorizations with dates of service on or after
October 1, 2015.
- When does Health Net intend to begin and complete testing for ICD-10?
-
Health Net has planned external testing for Q3 2015. Health Net will conduct regular testing with providers who submit encounters directly to Health Net, repricing vendors and clearinghouses. Health Net is not planning to test on an individual provider level unless the provider submits encounter data. Health Net encourages each provider to work with his or her clearinghouse to ensure the ability to send and receive data with the clearinghouse prior to the ICD-10
implementation date.
- What resources are available for providers who need assistance with ICD-10 implementation?
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Health Net encourages providers to work with their claims vendors to prepare for
ICD-10 implementation. The Workgroup for Electronic Data Interchange (WEDI) offers an online resource directory which lists vendors that offer products and services available to assist providers in preparing
for ICD-10. The CMS website offers resources for providers on the implementation for ICD-10.
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