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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

May 2015

Harvard Pilgrim’s Preparations for ICD-10 Transition

As you know, ICD-10 code sets will be replacing ICD-9 this fall. Harvard Pilgrim has completed systems work, and will be ready to implement ICD-10 diagnosis and procedure codes by the October 1, 2015 compliance date set by the Centers for Medicare and Medicaid (CMS). We are also currently updating our medical and payment policies to include ICD-10 coding, and will be posting the updated policies on a rolling basis throughout the spring and early summer.

The expanded ICD-10 code set includes significantly more codes than ICD-9, allowing for much more specific and extensive reporting. 

Self-testing options

Providers may choose to conduct ICD-10 self-testing to gain important knowledge about operational readiness for ICD-10 and identify any improvements that may be needed. Two forms of self-testing are available.

First, ICD-10 validation self-testing can ensure that claims can be correctly submitted with ICD-10 codes. This form of testing uses the Edifecs Ramp Management application, supports processing of ICD-9 and ICD-10 claims, and allows providers to submit 837 claim files. Upon successful completion of Ramp testing, you will receive a pass/fail notification. This is not an end-to-end test of claims and, therefore, you will not receive a claim acknowledgement or 835 electronic remittance advice.

Second, following successful Ramp testing, Harvard Pilgrim will also support end-to-end self-testing that supports processing of ICD-9 and ICD-10 claims and allows providers to submit claim files through their existing provider test connection with Harvard Pilgrim. For more details on end-to-end testing, please refer to this FAQ.

To get started with any self-testing, complete the Harvard Pilgrim ICD-10 Test Enrollment Form and submit it via secure email to EDI_Team@harvardpilgrim.org or fax it to 866-884-3844. Then submit your claims to the provider test system.

More information available

Harvard Pilgrim’s ICD-10 page for providers offers up-to-date information regarding the transition, including answers to frequently asked questions, links to key ICD-10 resources, and updated 837 professional and institutional claims companion guides, which include additional information on testing and set-up of claims related electronic transactions.

For any questions regarding the transition to ICD-10, email EDI_Team@harvardpilgrim.org or call 800-708-4414, select option 1, then press 3.

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Eric H. Schultz,
President and Chief Executive Officer

Richard Weisblatt PhD,
Senior Vice President, Provider Network

Annmarie Dadoly,

Joseph O'Riordan,

Kristin Edmonston,
Production Coordinator