ICD-10 Readiness
ICD-10 Readiness

ICD-10 has launched—and Availity remains committed to your successful transition

On October 1, 2015, the health care industry implemented a revised and expanded version set of codes used by physicians and other health care providers to classify and code diagnoses, symptoms, and procedures. The previous set had 13,600 codes, and the ICD-10 revision now includes more than 69,000 diagnostic codes, which enable greater specificity and exactness.

The change likely affected many of your everyday workflows, transactions you submit to health plans through Availity, your reimbursements, and many other aspects of your business. Availity will continue to help you navigate this change so you can operate a healthy, thriving business—with ICD-10 and beyond.

What do I need to know about Availity’s readiness for ICD-10?
Availity is fully compliant with ICD-10.

What do I need to know about ICD-10?
On Oct. 1, 2015, the health care industry began using a revised and expanded version of the ICD-9 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 was the switch to ICD-10 necessary?
ICD-9 is 30 years old, has outdated and obsolete terms, and is inconsistent with current medical practices.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 in describing a patient’s diagnosis and in classifying inpatient procedures. ICD-10 accommodates 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 and RCM solutions:

  • 270 eligibility transaction
  • 278 authorization
  • 837 professional and facility claim submission
  • 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 as of 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.

Where can providers learn more about the ICD-10 mandate?
Clearinghouses were many providers’ first-line support during 5010 – identifying issues behind claim rejections and providing guidance on correcting. While they can help to some extent with ICD-10, 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 were Availity’s products updated for ICD-10?
For the Availity Web Portal and Clearinghouses (both Basic and Advanced), ICD-10 codes were added to our HIPAA code validation engine and are effective as of Oct. 1, 2015.

Can Availity crosswalk ICD-9 codes to ICD-10, or the reverse?
No, Availity will not be offering any crosswalk services. We will have edits that are applied based on payer readiness to accept these codes and the ability to look up ICD-10 codes within our system.

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.