0 presentation to: providers, trading partners & billing firms presented by: sheldia...
DESCRIPTION
2 Topics for Discussion DCH ICD-10 Post Go-Live Open Forum: Questions and AnswersTRANSCRIPT
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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
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MissionWe will provide Georgians with access to
affordable, quality health care through effective planning, purchasing and oversight.
We are dedicated to A Healthy Georgia.
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Topics for Discussion
• DCH ICD-10 Post Go-Live• Open Forum: Questions and Answers
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DCH ICD-10 Post Go-Live
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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
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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.
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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 [email protected] 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.
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Open Forum: Questions & Answers
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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.
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Resources
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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
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Contact Us
• HP Call Center– 770-325-9600 or 1-800-766-4456.
• We welcome your questions and comments at– [email protected]
• This presentation will be posted within two business days to http://dch.georgia.gov/icd-10-events
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Thank You