Will MaineCare accept ICD-9 claims after October 1, 2014?
For all discharges and dates of service on or after October 1, 2014, diagnosis and procedure codes must be submitted using ICD-10 codes in order to receive reimbursement. Claims for discharges and dates of service prior to October 1, 2014 should be submitted using the ICD-9 codes.
Is MaineCare responsible for ensuring that providers are using appropriate ICD-10 codes?
No. Providers are responsible for submitting claims with correct ICD-10 codes.
Will MaineCare issue new policies based on ICD-10?
MaineCare is actively reviewing its policies to ensure that they reflect the updated ICD-10 codes. Any changes to policies will be published and communicated in the News and Updates.
Will MaineCare accept files with both ICD-9 and ICD-10 codes?
ICD codes are driven by date of service. If the date of service is prior to 10/01/14, ICD-9 codes should be used, but if the date of service is on or after 10/1/14, ICD-10 codes should be used. MaineCare is able to accept both ICD-9 and ICD-10 codes in the same file, as long as the claim is properly coded with ICD-9 codes for dates of service prior to 10/01/14, and ICD-10 codes for dates of service on or after 10/01/14.
Will MaineCare conduct testing?
Yes, MaineCare will be pilot testing for ICD-10. At this time, MaineCare has not yet determined which providers and entities it will test with. Updates will be provided as they become available.
When will partner testing begin with MaineCare?
Testing should begin during the 1st quarter of 2014 and be completed by the 3rd Quarter of 2014.
Who is impacted by the transition to ICD-10?
All entities covered under HIPAA must transition to ICD-10. This includes providers, payers, and clearinghouses. If you are unsure if you are covered under HIPAA, please check the CMS webpage regarding HIPAA covered entities.
Will providers need new provider agreements because of ICD-10?
No. Provider agreements do not contain procedure or diagnosis codes; therefore, no changes are necessary.
Do you have questions about ICD-10? An ICD-10 e-mail box is available specifically for your ICD-10 related questions.