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

November 2015

ICD-10 Reminder and Provider Support


ICD-10 implementation is now well underway, and Harvard Pilgrim has a reminder for providers submitting paper claims. Please be sure to provide 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 FAQ for providers. The FAQ covers several topics associated with submitting claims, such as: how Harvard Pilgrim will approach claims adjudication, and how providers should submit inpatient and outpatient claims that span the ICD-10 implementation date.

More information
Harvard Pilgrim has been offering weekly call-in forums where providers and office staff have the opportunity to ask ICD-10 questions or discuss issues with Harvard Pilgrim staff. Forums will continue to be conducted from 8:30 a.m. to 9:30 a.m. on Thursdays through Dec. 3 — excluding Thanksgiving. No registration is required; simply call 888-687-4838 and enter participant code 19050791#.

For further questions regarding electronic transactions and ICD-10, contact the Harvard Pilgrim EDI Team at EDI_Team@harvardpilgrim.org or 800-708-4414 (select option 1, then press 3). For claims issues, please contact the Provider Service Center at 800-708-4414 or your Provider Relations Consultant.

For more information and additional resources, please refer to the Preparations for ICD-10 page on Harvard Pilgrim’s provider website.

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