Humana does not anticipate problems with claims processing or delays in payments when ICD-10 requirements take effect, if claims are properly coded based on the latest Centers for Medicare & Medicaid Services (CMS) guidelines. Code editing based on a diagnosis/procedure will apply per the current adjudication process.
Humana has invested in remediation of systems and processes to support ICD-10 requirements, as well as testing in advance of the implementation. ICD-10 will be applied through all products and platforms. Here are some important things to keep in mind about ICD-10:
- Claims that do not contain ICD-10 diagnosis and inpatient procedure codes for services provided on or after the implementation date will not be processed. They will be considered noncompliant with the Health Insurance Portability and Accountability Act (HIPAA). According to CMS, there will be a limited 12-month grace period for Part B Original Medicare claims during which CMS will not deny Part B claims based solely on the specificity of the ICD-10 diagnosis code so long as the provider used a valid code from the correct family. Valid ICD-10 codes will be required on all claims beginning Oct. 1, 2015, and claims may be reviewed or denied for reasons other than the specificity of the ICD-10 code. Humana will follow a similar policy. You can view applicable CMS guidance at http://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD-10-guidance.pdf.
- For outpatient services, ICD-10 codes will be required for dates of service on or after the implementation date. For inpatient services, ICD-10 codes will be required if the date of discharge is on or after the implementation date.
- With the exception of claims that contain an ICD-10 code in the correct family, for the first 12 months after the Oct. 1, 2015, implementation date, claims that don’t meet specifications will be rejected at the point of receipt.
- Humana will accept 837 batches with ICD-9 and ICD-10 claims as long as both codes are not contained on a single claim and are submitted according to CMS guidelines.
- Humana does not anticipate the use of timely filing extensions during the ICD-10 transition.
- ICD-10 codes will not be accepted before the implementation date. Please note that claims with dates of service before the implementation date, but submitted after the implementation date, must use ICD-9 codes.
- The claim resubmission process will not change with ICD-10
For more information about ICD-10 implementation at Humana, please see our frequently asked questions, as well as our ICD-10 training page.
You may email questions about ICD-10 to ICD10Inquiries@humana.com