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).

From eMedNY:

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:

  1. 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.
  2. 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.
  3. Providers currently submitting ICD-9 primary diagnosis code 7999 – “Other Unspecified Diagnosis” are recommended to use ICD-10 code R69 – “Illness, unspecified”.
  4. 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.
  5. “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.
  6. 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.
  7. 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.
  8. 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.
  9. 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.
  10. 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!

– Stephen