ICD-10 Payers not ready??

As a friend said to me “this is my surprised face“.

I have been telling providers for several months, there will be a group of  insurance payers that will not be ready for the conversion.  Modern Health Care published an article outlining the state Medicaid programs that are not ready for ICD-10.  CMS has authorized the use of a software crosswalk to convert ICD-10 back to ICD-9.

This process will be used by more payers than just these four Medicaid programs.  There will still be a number of payers that were not ready for ICD-10 and will use a crosswalk conversion process to convert back to ICD-9 and pay claims.  This means you will have to be diligent in monitoring denials because there will be crosswalk mistakes that cause an inappropriate ICD-9 code to be assigned to the claim resulting in rejection.

ICD-10 is here and the insurance payers that were not ready for ICD-10 have not published that information on their websites.  In my discussion with two clearinghouses at the beginning of September, they had not been told specifically by any payer that their software would not be ready for ICD-10 conversion. The carrier will accept claims from the clearinghouse in the ICD-10 format and then use internal software to convert back to ICD-9.

I have advised practices to start calling their smaller payers to verify if they will be ready for ICD-10 or would they be using a crosswalk. If you have confirmation by a payer they will be using a crosswalk to convert ICD-10 back to ICD-9, please let us know so we can continue to update this process and communicate with providers. It is crucial for businesses to know if the carrier is using a crosswalk to convert ICD-10 back to ICD-9 so they can monitor denials for errors that might be related to this conversion.