1

Presentation to: Providers, Trading Partners & Billing Firms

Presented by: Sheldia Evans-Maddox

Department of Community Health (DCH) Medical Assistance Plans Division

October 15, 2015

ICD-10 Go-Live: ICD-10 Issues, Resolutions, and Experience

2

MissionWe will provide Georgians with access to

affordable, quality health care through effective planning, purchasing and oversight.

We are dedicated to A Healthy Georgia.

3

Topics for Discussion

• DCH ICD-10 Post Go-Live• Open Forum: Questions and Answers

4

DCH ICD-10 Post Go-Live

5

Claims Statistics

Total Claims Submitted: 151,145Total Claims Paid: 104,163 /68.9 %Total Claims Denied: 46,595 / 30.8%

Here are the most frequently posted diagnosis related edits/errors that caused the denials:• 4280 1ST ICD-10 DIAGNOSIS CODE IS NOT SPECIFIC • 4281 2ND ICD-10 DIAGNOSIS CODE IS NOT SPECIFIC • 4282 3RD ICD-10 DIAGNOSIS CODE IS NOT SPECIFIC • 4040 PRIMARY DIAGNOSIS CODE NOT ON FILE • 4283 4TH ICD-10 DIAGNOSIS CODE IS NOT SPECIFIC

6

Post Go-Live Findings

• Non-specified codes. Edits are set to deny claims that are billed with a non-specified code. The exception to the billing rule is inpatient (COS 010), Outpatient (COS 070), Swing-bed (COS 080), Hospital Based Rural Health Clinic (COS 541) and Nursing Home (COS 110/160) claims. A list of unspecified codes were added to the web portal under the Provider Notices link.

• EDI files are failing. The EDI files are not passing EDI compliance checks and therefore the claim is not making it into the system for processing.– ICD-9 qualifiers/diagnosis codes where billed with DOS on claims on or after

10/1/15.– ICD 10 qualifiers/diagnosis codes where billed with DOS on claims before 10/1/15– ICD-9 qualifiers with ICD-10 diagnosis codes

• Updated provider communications entitled “ ICD 10 Post Go Live Banner” was posted on October 9th. Go to: https://www.mmis.georgia.gov/portal/ under Provider Messages link.

7

Triage Team

DCH and HP has created a team of dedicated resources that will assist in identifying issues and issue resolution. If your organization have an issue specific to ICD-10 after October 1, 2015, please contact DCH at icd10project@dch.ga.gov or HP via the web portal contact us feature at https://www.mmis.georgia.gov/portal or by calling the call center at 770-325-9600 or 1-800-766-4456.

8

Open Forum: Questions & Answers

9

Questions and Comments

Use the WebEx Q&A Feature

• On the right middle portion of the screen, you should see a hand. Click the hand if you have a question so that your line can be opened. Once you have received a response to your question, please click the hand again (lower your hand) so that the next person’s line can be opened.

• You may also type in any question as well.

10

Resources

11

ICD-10 Resources

• DCH Resources– DCH Dedicated ICD-10 Website

http://dch.georgia.gov/icd-10

– DCH Website for ICD-10 Webinars/Downloadshttp://dch.georgia.gov/icd-10-events

– DCH ICD-10 Education Outreach and Resourceshttp://dch.georgia.gov/icd-10-educational-outreach-and-resources

– ICD-10: A Four-Part Series (Video)http://dch.georgia.gov/sorh-publications-and-presentations

12

Contact Us

• HP Call Center– 770-325-9600 or 1-800-766-4456.

• We welcome your questions and comments at– icd10project@dch.ga.gov

• This presentation will be posted within two business days to http://dch.georgia.gov/icd-10-events

13

Thank You