ICD-10 transition has several impacts that many health plans and health care providers will not consider, unless they are doing a comprehensive assessment of all systems and processes.  If ICD-9 diagnosis coding (ICD-9 CM) and ICD-9 procedure codes are included in the workflow.

Systems that capture ICD-9 codes  in the workflow will need to be revised.  Payor specific EDI systems  also need to be reviewed and most likely remediated.  Supervisors and other staff that work on the Insurance Verification process will need to be re-trained for ICD-10 CM diagnosis coding and ICD-10 PCS procedure codes for inpatient care.  Standard operating procedures need to be re-examined.  Provider scheduling will also need to be reviewed for ICD-10 process changes.  Payor – provider testing will be required to ensure that the remediated systems and processes are working.

Similarly, the EDI transactions supporting this workflow are relevant.  The eligibility / benefits inquiry and response transactions (HIPAA x12 270 and 271) should be comprehended in this systems, process remediation and subsequent testing.

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