New York’s provided some helpful guidance for agencies submitting billing to eMedNY, just in time if you haven’t fully prepared yet.
A reminder that guidelines for the ICD-10 code changes in Therap are available in our ICD-10 Transition User Guide for Institutional Claims (outside of New York, you may want to use the similar ICD-10 Transition User Guide for Professional Claims).
Starting October 1, 2015, New York State Medicaid will begin accepting and processing claims using ICD-10 diagnosis and procedure codes.
Top 10 things all providers should know:
- Claims for Dates of Service on and after 10/1/2015 require valid ICD-10 Codes: Claims with ICD-9 codes for dates of services on and after October 1 will be rejected by pre-adjudication edits.
- While ICD-9 and ICD-10 codes are not allowed within the same claim, ICD-9 claims and ICD-10 claims can be sent in the same file.
- Providers currently submitting ICD-9 primary diagnosis code 7999 – “Other Unspecified Diagnosis” are recommended to use ICD-10 code R69 – “Illness, unspecified”.
- ePACES ICD Version radio button: Starting October 1, you must select which ICD code version is submitted on your claims. This field currently defaults to ICD-9. See the ePACES Claim Quick Ref+erence Guides for more information.
- “I’m a ______ provider type, does ICD-10 really impact me?” Review the FAQs to see how your NY Medicaid claims will need to be submitted.
- eMedNY will not publish an ICD-9 to ICD-10 crosswalk. Use the extensive resources at https://www.emedny.org/icd to explore ICD-10 coding and train your office.
- Electronic Claims Submitters: Make sure your software submits the appropriate Code List Qualifier designating either ICD-9 or ICD-10 diagnosis codes are on the claim. Principal diagnosis is required on all electronic claims.
- Providers using Vendors, Clearing Houses and Service Bureaus: Communicate with your vendors to understand what you may need to do in order to be ready on October 1 and coordinate testing in eMedNY’s Provider Test Environment.
- The Provider Testing Environment: Electronic claim submitters and vendors are able to test ICD-10 claim submissions and receive paper or PDF remittance advices from to eMedNY right now. Detailed instructions on testing can be found at https://www.emedny.org/Notice/ICD_10_7-8-14.pdf.
- If you have any questions about ICD-10, testing and claim submission, contact the eMedNY Call Center at 1 800-343-900
Reach out if you have any questions!