Preparing for ICD-10

Information for Web Portal and Clearinghouse customers

Bill HR4302 passes, ICD-10 implementation delayed until Oct 1, 2015

On April 1, President Obama signed into law a bill to delay the planned ICD-10 implementation until Oct. 1, 2015. Specifically, the bill prohibits CMS from enforcing a mandate to switch from ICD-9 to ICD-10 until Oct. 1, 2015. Details on implications to providers, health plans and technology companies in the health care industry are as yet unclear. Availity remains confident that we are prepared to accommodate any scenario that could unfold.

We are committed to helping you operate a healthy, thriving business—even in an industry constantly redefined by change. Because we have solid yet flexible contingency plans for ICD-10 and other programs, you and your business will have the support you need. We are committed to preserving the uninterrupted flow of your administrative, clinical and financial information exchange on our networks, to assure continuous cash flow to your business.

As a trusted intermediary between payers, providers and other industry partners, the decision to delay the ICD-10 implementation will cause businesses to rethink their plans. As we consult with payers about their strategies, we will advise you on potential impacts to testing, training and implementation as soon as possible.

Please watch our website’s ICD-10 pages and on-screen announcements within our software for updates as they happen.

Important notice to Revenue Cycle Management customers:

The information below pertains only to Web Portal and Advanced Clearinghouse customers. Certain ICD-10 policies and practices will differ for Revenue Cycle Management (formerly RealMed) customers. Visit our ICD-10 page for Revenue Cycle Management customers for more information. You may also contact your account manager, or call 1.877.927.8000.


What do I need to know about Availity’s readiness for ICD-10?

Availity is fully prepared to meet the Oct. 1, 2015 deadline.

What do I need to know about ICD-10?

On Oct. 1, 2015, the health care industry will begin using a revised and expanded version of the current set of codes used by physicians and other health care providers to classify and code diagnoses, symptoms and procedures. The ICD-10 revision includes more than 69,000 diagnostic codes, compared to the current set of 13,600.

Why is the switch to ICD-10 happening?

ICD-9 is 30 years old, it has outdated and obsolete terms, and is inconsistent with current medical practices. Also, the structure of ICD-9 limits the number of new codes that can be created, and many ICD-9 categories are full.  ICD-9 codes provide limited data about patients’ medical conditions and hospital inpatient procedures.

ICD-10 codes allow for greater specificity and exactness in describing a patient’s diagnosis and in classifying inpatient procedures. ICD-10 will accommodate newly developed diagnoses and procedures, innovations in technology and treatment, performance-based payment systems and provisions to enable more accurate billing. The new codes will also make the billing process more streamlined and efficient, allowing for enhanced fraud detection.

Are my Availity transactions affected by the ICD-10 mandate?

Yes. The mandate applies to the following HIPAA transactions processed by Availity’s Web Portal:

  • 837 professional and facility claim submission
  • 278 authorizations
  • Member liability estimates via patient cost estimator (formerly known as CareCost Estimator and currently known as CareCalc® for Florida Blue submitters.)
  • Patient care summaries (formerly known as CareProfile®)

Who is affected by the mandate?

All HIPAA-covered entities must use ICD-10 starting Oct. 1, 2015. This includes health care providers and health plans that do not deal with Medicare claims. Organizations that are not covered by HIPAA, but use ICD-9 codes should be aware that their coding may become obsolete if they do not transition to ICD-10. Workers’ Compensation and automobile insurance submitters are not required to submit ICD-10 codes unless required by state government.

What do providers need to do to make sure their organizations are ready to meet the mandate?

CMS recommends having a transition plan in place and making sure to document the steps being followed and the dates that milestones will be achieved to comply with ICD-10 requirements. Include vendor tasks in a plan and timeline, and make sure to communicate with your practice management system and/or electronic medical record vendors regularly about ICD-10. Also, providers should establish an emergency fund to cover unexpected costs, reduced productivity and possible reimbursement delays.

Will Availity be able to accept ICD-10 codes prior to Oct. 1, 2015 or accept ICD-9 codes after?

Availity is planning to support early use of ICD-10 between willing trading partners and is currently developing a process to do so. Our ability to accept ICD-9 codes after the mandate will be payer-specific, by exception, as information becomes available. Availity is also preparing to support various contingencies for the possibility of a delayed ICD-10 mandate or enforcement of the mandate by relaxing ICD-9 edits.

Where can providers learn more about the ICD-10 mandate and how to transition?

Clearinghouses were many providers’ first-line support during 5010 – identifying issues behind claim rejections and providing guidance on correcting claims – but won’t be able to provide that same level of support through ICD-10. While they can help, they can’t help you identify which ICD-10 codes to use based on your clinical documentation. Providers are encouraged to work with their payers and practice management system vendors for information about updates, payer readiness and other information.

How will Availity’s products be updated for ICD-10?

For the Availity Web Portal and Clearinghouses (both Basic and Advanced), ICD-10 codes have been added to our HIPAA code validation engine and will be effective on Oct. 1, 2015.

In addition to working closely with your payers and vendors, you may want to familiarize yourself with ICD-10 information available through the Centers for Medicare and Medicaid Services, professional associations and industry workgroups, such as the Workgroup for Electronic Data Interchange. And remember to take advantage of free training options for you and your staff, such as the ICD-10 Webinar Series available through the Availity Learning Center.

Does Availity have any additional ICD-10 resources?

Availity is offering our Web Portal customers an implementation solution through our business partner, Complete Practice Resources. The product, Ready10™, is a physician practice-focused ICD-10 implementation solution that delivers just about everything you will need to know or do to successfully manage your transition to ICD-10, and to ensure that your reimbursements flow as predictably as possible after the Oct. 1, 2015 mandate deadline.

Use Ready10 to:

  • Prepare your practice for success by monitoring key tasks and milestones;
  • Establish deadlines and accountability;
  • Conduct a thorough impact assessment;
  • Create budgets for estimated, allocated and actual costs, and much more.

Review quick product highlights or register for a demonstration of this product now to get started.


When will Availity begin testing ICD-10 transactions?

Availity currently supports a self-testing environment which allows submitters to send in ICD-10 transactions and test various scenarios. Most payers are still actively testing the functionality internally or between their systems and Availity’s, so the submitter responses in this environment will typically be limited to Availity responses. As the industry moves closer to the October 1, 2015 deadline, we anticipate payer participation will increase.

Will Availity support dual use of codes after implementation (concurrently based on date of service)?

Yes, we will have the ability to accept both ICD-9 and ICD-10 codes (regardless of date of service). However, ICD-9 and ICD-10 codes must be on separate claims. Regarding dual processing, per the mandate, we will accept both ICD-9 and ICD-10 codes based on the date of service.

If Availity is not ready on Oct. 1, 2015, can a provider revert to ICD-9?

Availity is prepared to meet the Oct. 1, 2015 deadline. In the event a specific payer is not ready and CMS allows an exception to the mandate, Availity will be capable of allowing ICD-9 claims for that payer.

Training, communication and support

As a user, how will I receive updates from Availity on ICD-10?

We encourage you to monitor this website and watch for timely email updates regarding our ICD-10 implementation. We will also be communicating with providers via Web Portal announcements, newsletters, webinars and training materials, market and deployment specialists and through our call center representatives.

Will Availity be offering training or information sessions on the transition?

Through the Availity Learning Center, you can get the latest news on the ICD-10 mandate, tips to help you transition, specialty-specific code training and more. The ICD-10 Webinar Series brings you industry leaders to deliver your essential ICD-10 information at little or no cost.

How will Availity communicate with vendors, clearinghouses and payers about the transition?

Partners should contact their appropriate relationship manager. For vendors, this is a representative with our Channel Relationship and Vendor Management teams. Payers should contact their representative with our Account Management team.

ICD-10 education from Availity

Through the Availity Learning Center, you can get the latest news on the ICD-10 mandate, tips to help you transition, information about working with health plans and vendors, and more. The ICD-10 Webinar Series is being offered through the Oct. 1, 2015 mandate, and brings you industry leaders to deliver essential ICD-10 information at little or no cost.

Go to the Availity Learning Center to register today! Live sessions are being added regularly, or view a recording at any time. Examples of recorded sessions available include:

  • Cracking the ICD-10 Codes for Chiropractors
  • ICD-10 Diagnosis Coding for Obstetrics
  • ICD-10 Diagnosis Coding for Mental, Behavioral and Neurodevelopmental Disorders
  • ICD-10 for ENT
  • Skin in the ICD-10 Game
  • ICD-10 Diagnosis Coding for Breast Reconstruction


ICD-10 industry resources