In the ICD-10 Consortium social network this week, health plans posted questions regarding processing ICD-10 claims that have date of service  periods that span the mandated timeline as well as an outreach to other health plans regarding the pros and cons of receiving an ICD-10 claim, mapping it to an ICD-9 to adjudicate it.  Also, ICD-10 is expected to impact auto adjudication rates for plans.

No World Borders maintains several social media groups that enable payors and providers to discuss ways to overcome challenges, innovate and share best practices including electronic medical records, HIPAA mandates such as ICD-10 and their impacts, Medicare Advantage, and Accountable Care Organizations.

To view these questions, post your own answers or view the answers of other health plans and providers click the links below.

Authorizations that span the compliance date?

I am curious how payers are documenting their requirements for business and/or system changes around Claims and Authorizations. Auths…

Mapping back to ICD-9 from ICD-10

“Hello, any Blue plans out there considering using down mapping, or backward mapping to handle institutional claims? Essentially backward map from I10 to I9 in order to price DRG based claims?”

Note: while we are posting this discussion regarding “down mapping” or “step down” to ICD-9 we do not recommend the approach. Some payors are going to have to do this as an emergency scenario because of time and budget constraints but it introduces other issues – NWB

Auto adjudication rates

How are Blue plans baselining their auto adjudication rate? What tools/products/policies used in order increase Auto adjudication rate?…

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