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

August 2015

ICD-10 Transition & Paper Claims Submission

As you are aware, Harvard Pilgrim will be moving from ICD-9 diagnosis and procedure codes to the significantly more extensive ICD-10 code sets on the October 1, 2015 compliance date mandated by the Centers for Medicare and Medicaid (CMS).
With this transition approaching, we would like to remind providers who use paper claims to submit the applicable ICD indicator on the claim form to identify the version of ICD codes being reported: ICD-9 or ICD-10. When submitting the CMS-1500 form for professional services or the UB-04 form for technical services, use the indicator “9” for ICD-9 codes and the indicator “0” for ICD-10 codes. If you are submitting the ADA J-400 form for dental services, the indicator “B” denotes an ICD-9 code and “AB” denotes an ICD-10 code. For more information, please see the Paper Claims section of our Provider Manual.

We encourage all our providers to file electronic claims, which offer ease of use and result in fewer errors. For information on electronic claims filing, please see the Electronic Claims section of our Provider Manual.

ICD-10 FAQ for providers

To answer common questions about the transition to ICD-10 codes, Harvard Pilgrim has developed an an FAQ for providers. The FAQ covers several topics associated with submitting claims, such as: how Harvard Pilgrim will approach claims adjudication, how providers should submit inpatient and outpatient claims that span the ICD-10 implementation date, etc. It also includes sections on implementation; notifications, referrals, and authorizations; and provider self-testing.

More information

For more information and additional resources, please refer to the Preparations for ICD-10 page on Harvard Pilgrim’s provider website. If you have any further questions, contact the Harvard Pilgrim EDI Team at EDI_Team@harvardpilgrim.org or 800-708-4414 (select option 1, then press 3).

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Eric H. Schultz,
President and Chief Executive Officer

Robert Farias,
Vice President, Network Services

Annmarie Dadoly,

Joseph O'Riordan,

Kristin Edmonston,
Production Coordinator