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Provider Update: February 4, 2015

ICD-10 Code Conversion

The preliminary phase for the Medicaid Services Unit and Contracted Providers to transition from ICD-9 to ICD-10 begins August 1, 2015. During this phase providers should convert current Member ICD-9 diagnosis codes to the appropriate ICD-10 code for billing and medical eligibly purposes prior to the October 1, 2015 conversion date. The process of engaging the conversion will differ depending upon the type of service that the Provider offers.

Electronic Visit Verification System Users:

Providers (ADvantage and SPPC) who currently bill for services through the Electronic Visit Verification system (EVV), will be enabled to update Member profile records within the application with the appropriate ICD-10 code effective August 1. EVV system users will have training available that will provide a general review of the ICD-10 changes, recommended workflow, and functionality. The training includes a 40 minute recorded presentation along with Power Point slides that can be printed and disseminated for use.

Functional features offered to EVV users to assist with conversion include an ICD-10 conversion tool that has been incorporated into the software application, reporting to track converted/unconverted records, and an alerting component that will identify unconverted ICD-9-codes. Users will receive recommended workflow protocols that will help chart progress and readiness for the August 1 date.

The EVV system will be set to properly reconcile claims that cross over the 10/1 date that will need to be split into two claims. One claim that includes dates of service prior to 10/1 and reports ICD 9 codes and one claim that includes dates of service on and after 10/1 and reports ICD 10 codes. Billing rules have been added to the system to ensure the correct code is attached to the claim based on the defined ICD 10 rules. Additionally, formats have been updated to accept ICD 10 codes including electronic transactions and paper claims. All exports and import fields have been updated to accept ICD 10 codes and perform code validations. The EVV Provider will coordinate opportunities for ICD-10 testing with OHCA in advance of Oct 1.

Deployment of the training materials and protocols for EVV system users will commence August 3, 2015, although the system will be live for conversion August 1. The EVV Provider will continue to host the "Weekly Provider Call", to address pending issues during the

Services not Covered by EVV:

It is anticipated that Providers not covered by EVV have a predetermined approach to converting Member records when necessary to include ICD-10-code updates for billing purposes that is consistent with internal business processes.

For your information:

Any ICD-10 codes submitted on a claim prior to the federally mandated implementation date will be denied as an invalid code. Only ICD-9 codes will be accepted until the federally mandated implementation date. OHCA will not accept ICD-9 codes with dates of service on or after the federally mandated compliance date, currently set for 10/01/2015. Claims submitted after that date, but with dates of service prior to that date, must contain the applicable ICD-9 codes.

Providers in need of additional supports in preparation for the October 1 implementation date may wish to review the following:

  • YouTube "ICD-10 Coding Basics" 26 minute video

  • CMS ICD 10 page

  • As many are probably already aware, there are free on line conversion tools available, such as

Please submit questions regarding ICD-10, to the ICD-10 team at

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