Aetna, one of the nation's largest health insurers, believes it is ready for the ICD-10 changeover on October 1 but has processes in place to understand as quickly as possible if there are problems, says Stacie Watson, head of the payer’s ICD-10 program management office. She also discussed procedures that Aetna hsa put in place for contingencies.
The company continues to work on final checks and encourages providers—even if they think they are ready—to keep checking whether physicians and all pertinent staff are fully trained to properly code, all physicians have successfully completed a clinical documentation improvement program, all pertinent software is updated, and that everyone involved with the new code set has a list of the subset of codes most likely to be used in the organization.
It is important to remember that it will take time following the compliance date for both insurers and providers to know if there are ICD-10 problems festering. On October 1and likely several days later, providers will be coding and submitting ICD-9 claims for services rendered before the changeover date. Depending on how quickly providers generate claims, they also may be coding in ICD-10 on October 1for services rendered on that day.
In general, Medicare and many commercial insurers pay claims within two weeks of submission; Medicaid has a stated limit of 30 days to process that often is longer. So, whether the transition will be relatively smooth or a message won’t be known for a while. Two weeks, Watkins says, would be a good time to understand what’s going on.
Also See: Providers Share Final ICD-10 Checklist
Providers working with Aetna who do encounter denied claims, lower reimbursement than expected or other issues once ICD-10 goes live should follow the normal procedure when problems arise by calling the provider service center, where anyone answering the phone will be trained in ICD-10, as well as any other issue.
Aetna’s service center will be flagging and checking all ICD-10 calls to analyze for trends to assess if the insurer is having adjudication problems or other related issues. Watson suspects many other insurers have a similar plan. She cautions, however, that should insurers have problems that cause providers to call, they may not be able to answer all questions over the phone, depending on the issue and whether it has been resolved.
Providers may call a service center believing a problem lies with the insurer when the organization may be the one with the issue, Watson says. She advises before calling to check if disputed claims were indeed coded in ICD-10, that all pertinent software is updated, and that the clearinghouse received the claims and sent them to the insurer. If all these boxes are checked, that gives Aetna the information needed to look at the issue.
Watson also encourages providers to visit the Aetna ICD-10 website to access test results that can show various reasons why a claim may be denied, as well as a series of on-demand ICD-10 web seminars.
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