Provider Update: August 27, 2015
By September 30, 2015 all ADvantage Providers should have completed the transition from
using ICD-9 diagnosis code to ICD-10. If a valid and appropriate ICD-10 code is not applied to
billing records for Members by October 1, 2015, payment for ADvantage and SPPC billed
services will be denied by OHCA.
MSU is monitoring the overall progress of ICD-10 conversions on a Member level through the
EVV system. It appears that as of August 26, 2015, approximately 30% of the Provider
Community has at least engaged the conversion process. There are several agencies that
have either completed or are near the completion of the conversion. There may be instances
where MSU staff will contact a Provider should it appear that there is an issue with the
conversion, or otherwise to offer assistance as needed.
It is important to note that the conversion to ICD-10 will mostly impact provider payments, but
there is also an effort underway to update all Member records on the part of MSU as it relates
to the Members eligibility for services. The purpose of this bulletin update is to delineate and
discuss what work is occurring by both the Provider and MSU.
What are providers doing? :
On July 30, 2015 the MSU distributed a bulletin outlining steps for Providers to launch the
conversion process. Since that time the EVV system has been activated such that providers
were enabled to complete the conversion process for Case Management and Home Care
services. All other providers should have begun the conversion based upon their
predetermined internal business practices.
The following lists FAQ’s regarding the EVV conversion process:
A. The provider agency will still enter the diagnosis code on the Santrax system on the
same client screen currently used. There will be an additional ICD-10 code to enter.
Q. What do I need to do first?
A. Run the Santrax “ICD 10 Transition Report”. This report will show you the ICD-9 and
ICD-10 codes for all Members served by your agency. Members that come on board or
are recertified during the transition period will require dual coding. Running the
Transition Report frequently will allow your agency to monitor your progress towards
meeting the October 1, 2015 deadline. To run the report, select the Reports tab on your
Santrax home page. The ICD 10 Transition Report is available under the “Clients”
Q. How do I know what the appropriate ICD-10 code is?
A. Use the conversion tool available at http://www.icd10data.com/Convert
Q. How do I change a Member’s code on Santrax?
A. Access the Member/client screen on Santrax, select the Diagnosis field, then click
the plus sign in the upper right-hand corner to add the ICD-10 code.
Santrax also provides a link to the conversion tool at http://www.icd10data.com/Convert
Q. When do the codes need to be changed?
A. Begin to change the codes now. October 1, 2015 is the official date OHCA will begin
using the ICD-10 codes. However, both codes may be entered on Santrax at this time,
and the system logic will not apply the ICD-10 code to claims until October 1, 2015. If
the codes are not changed by October 1, 2015, your claims will deny with OHCA.
Q. How many codes need to be entered?
A. For Members receiving ADvantage and SPPC services, only one primary and one
secondary diagnosis code needs to be entered. The EVV system requires the user to
indicate whether or not the code is primary or secondary. In reviewing the data it
appears in some instances only a secondary diagnosis code was entered. Please verify
that in every case a primary code is entered.
Q. Who do I contact if I have questions?
A. You may direct questions to Sandata Customer Care, 1-844-289-4246, or a
dedicated email at firstname.lastname@example.org. You may also send emails to MSU at
email@example.com using a SmarterMail account.
Q. Will the EVV system appropriately apply the ICD-9 to claims invoiced prior to 10/1
and ICD-10 on or succeeding this date?
A. Yes. The system has been programmed to apply the code appropriately to all billing.
Q. What if there is no one-to-one match for the Members ICD-9 codes?
A. The preliminary results of the conversion suggests that in most cases there is a oneto-
one cross-over. When necessary, please follow ADvantage policy regarding the
verification of diagnosis codes.
317:35-17-14. Case Management services
(a) Case management services involve ongoing assessment, service planning and implementation,
service monitoring and evaluation, Member advocacy, and discharge planning.
(1) Within one working day of receipt of an ADvantage referral from the ADvantage Administration (AA),
the case management supervisor assigns a case manager to the Member. The case manager makes a
home visit to review the ADvantage program (its purpose, philosophy, and the roles and responsibilities of
the Member, service provider, case manager, and OKDHS in the program), review, update and complete
the UCAT assessment, discuss service needs and ADvantage service providers. The Case Manager
notifies in writing the Member's UCAT identified primary physician that the Member has been determined
eligible to receive ADvantage services. The notification is via a preprinted form that contains the
Member's signed permission to release this health information and requests physician's office verification
of primary and secondary diagnoses and diagnoses code obtained from the UCAT.
Providers should use the form below to complete the ICD-code verification process.
What is MSU doing? :
MSU is in the process of updating Member records so that the correct ICD-code-10 will be
associated with Member records. Once completed, Providers will begin to see the converted
code transmitted on the 6G. Because MSU must convert all Member records, Providers
should not expect to receive a 6G that identifies the Members updated diagnosis prior to
converting Member records for the October 1, 2015 date. Providers should proceed with
updating the diagnosis code for billing purposes before the October 1, 2015 date. The 6G will
only provide the ICD- 10 code after this date.
Additionally, MSU LTC nurses are currently entering an appropriate ICD-9 and ICD-10 to
UCAT’s as assessments are being completed. Until October 1, 2015 you will only see a
Primary code (ICD -9 and ICD-10) included on the UCAT. Post October 1, 2015 the UCAT will
include the Primary and Secondary ICD-10 diagnosis code.
MSU will use the diagnosis code that the Provider submits for billing purposes and has been
validated in accordance with 317:35-17-14.(a)(1), to reconcile future disparities between what
is identified in the MSU source system and what has been documented by the Provider as the
Members Primary and Secondary diagnosis codes.
Providers who have not yet begun the process of converting Member diagnosis codes
are urged to proceed immediately, as billing records that do not reflect an appropriate
ICD-10 code beginning October 1, 2015 are expected to fail.
If you have any questions regarding the information provided above, please feel free to contact
us via Smarter Mail at:firstname.lastname@example.org