- Q: Will Humana be accepting ICD-10 coded claims in advance of the compliance deadline?
A: No. Humana will not accept ICD-10 codes prior to the ICD-10 implementation date.
- Q: Has Humana defined the process for readmission claims within 30 days?
A: Yes. Humana will follow the current claims submission process.
- Q: What is Humana's plan for ICD-10 acceptance?
A: Humana will support both ICD-9 and ICD-10 coding formats for a period of time after the compliance date. However, Humana will accept only correctly formatted claims, both electronic and paper, which contain ICD-10 codes for service dates and discharge dates on or after the compliance date. Humana will accept ICD-9 codes for service dates or discharge dates prior to the compliance date for the contracted run-out period or timely filing requirements.
- Q: Does Humana anticipate claims-processing issues with the preparation for ICD-10?
A: No. Humana has invested in remediation of systems and processes to support ICD-10 requirements. Humana does not foresee issues with claim processing with the change to ICD-10. Testing will help mitigate such issues.
- Q: Can one claim be submitted for services that span the new CMS proposed compliance date of Oct. 1, 2015?
A: FOR OUTPATIENT SERVICES ONLY No. Per CMS, Humana will require claims with dates of service that extend past the compliance date to be split into separate claims. This means that all services that occur before the compliance date should use ICD-9 codes and should be billed separately from services with dates of service on or after the compliance date, which should contain only ICD-10 codes.
A: FOR INPATIENT SERVICE ONLY Yes. The date of discharge will determine which ICD code set should be used. For inpatient services, if the date of discharge is on or after the compliance date, the claim should be submitted using only ICD-10 codes. If the date of discharge is before the compliance date, ICD-9 codes should be used.
Humana will follow CMS or current state filing requirements.
- Q: How will Humana handle authorization of services that occur on or after the ICD-10 compliance date?
A: We will follow Humana’s current process, which is to issue authorizations based on request date.
- If an authorization is requested on or before the compliance date, and the date of service is on or after Oct. 1, 2015 providers should submit an ICD-10 code.
- If the authorization is requested after the compliance date, the ICD-10 code will be required.
- Humana will begin accepting ICD-10 codes for authorizations and referrals on July 1, 2015 and will not accept any ICD-9 authorization codes after Oct. 1, 2016.
- Q: What will the appeal process be for resubmission of ICD-9-based claims with ICD-10 codes during the transition period?
A: The appeal and resubmission process will be the same as the current process.
- Q: Will there be extensions given for timely filing during the ICD-10 transition time?
A: No. Humana does not anticipate the use of timely filing extensions at this time.
- Q: Will reporting formats change?
A: Yes. Reporting formats that include ICD-9 today will be remediated to reflect ICD-10 codes.
- Q: Will your remediation plans vary by product or platform?
A: No. ICD-10 will be applied through all products and platforms.
- Q: If I submit or process a transaction with an ICD-9 code for a date of service after the compliance date, will I be HIPAA-compliant?
A: No. The date of service determines the compliant code format to be used on a claim regardless of the date the claim is filed or submitted.
- Providers must submit claims before the compliance date with ICD-9 codes when the services were performed prior to the compliance date.
- Payers will process claims if received on or after the compliance date with ICD-9 codes when the services were performed prior to the compliance date. This situation is HIPAA-compliant.
- Q: Will you accept 837 batches with both ICD-9 and ICD-10 claims spanning the conversion deadline?
A: Yes. Humana will accept 837 batches containing both ICD-9 and ICD-10 claims as long as both codes are not contained on the same claim.
- Q: What are the plans for restrictions on the acceptance of the unspecified codes for ICD-10?
A: Humana will follow current CMS guidelines.
- Q: Would Humana agree to prospective experienced-based payments with retro adjustments (likely to happen at a future date) should your adjudication system fail?
A: No. Humana will not agree to experienced-based payments.
- Q: Are there companion guides to reflect ICD-10 changes?
A: Yes. Here is the link to our companion guides:
- Q: Will claims that don’t meet specifications be rejected at point of receipt or will a denial be issued?
A: They will be rejected at point of receipt.
- Q: Will the claim resubmission process change with ICD-10?
A: No. Provider resubmission processes will continue to follow current guidelines.
- Q: How will the transition from ICD-9 to ICD-10 work with eligibility transactions and subsequent episodes of care?
A: All eligibility transactions using a diagnosis code must be compliant with ICD-10 upon the compliance date.
- Q: Does Humana require/support interim billing?
A: No. Humana does not support interim billing.
- Q: What customer support and training will be provided to providers?
Humana publishes current ICD-10 information on its provider website:
Providers should continue to access the CMS website for the most current ICD-10 information: