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Provider Update: October 2, 2015

ICD-10 Code Conversion and Compliance

Effective October 1, 2015, the United States transitioned from the use of ICD-9 to ICD-10 as the code set for medical diagnoses.  All billing submitted for payment of Medicaid services provided on this date and beyond, must be associated with an ICD-10 diagnosis code in order to receive reimbursement for services rendered.   

MSU has closely monitored the transition and it appears that Case Management and Home Care providers are about 90% compliant in completing the mandatory conversion.  This was a remarkable effort given the relatively short timeframe allowed for the transition. 

The EVV provider submitted files to OHCA to be tested for compliance errors and coding but none were found.  Therefore, MSU is not anticipating large scale issues resulting from the conversion, although MSU staff is prepared to address issues that might surface.  If there are instances where a provider experiences related problems, please submit concerns through SMARTERMAIL at  Providers submitting issues should type, "ICD-10 issue" in the subject line of any email request for assistance related to the ICD-10 conversion.

The "Request for Physician Validation of Member Diagnosis Codes", forms that were completed during the conversion should be stored in the Members record.  It is not necessary to submit these to MSU at this time, although this will be subject to change when MSU has installed a new Waiver Management Information System. 

Service Plans (6g's) will begin to present with ICD-10 code only, beginning 11/01/15 (approximate date). 

New UCAT's generated on 10/01/15, and beyond will include ICD-10 code only for both the primary and secondary diagnosis code.  

If you have any questions regarding the information provided above, please feel free to contact us via SMARTERMAIL at

Thank you.   

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