Affinity Health Plan

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  • ICD-10 Frequently Asked Questions

    1. What clearinghouse(s) does Affinity use?
    Affinity uses Emdeon as its claims clearinghouse.

    2. Will Affinity be implementing a "cross walk" solution for incoming claims?
    Affinity is not implementing any type of cross walk solution(i.e., where software will map ICD-9 codes to ICD-10 codes on submitted claims). Affinity will be unable to process any submitted claims that do not meet CMS' ICD-10 requirements as outlined above.

    3. How does ICD-10 impact Affinity's Medical Policies?
    Affinity is remediating all medical policies which contain ICD codes. In order to assist providers, Affinity has decided to share all of its remediated medical policies which contain a mapping of current ICD-9 diagnosis codes to ICD-10 diagnosis code(s). Policies may be found on the Affinity Provider Portal website.

    4. Are you modeling (or do you plan to model) the revenue impact of ICD-10?
    Affinity is conducting internal modeling exercises to examine the potential financial impacts of ICD-9 to ICD-10 mappings as they relate to APR-DRG and APG calculations.

    A key objective of Affinity's ICD-10 strategy is, wherever possible, to maintain benefit and financial neutrality. Affinity will not attempt to use the transition to ICD-10 as a vehicle for altering provider reimbursements at the expense of its providers.

    5. What should a provider do if its contract with Affinity contains ICD-9 codes?
    Affinity will be contacting providers whose agreements contain ICD codes. In the meantime, if you have any questions, please contact your Affinity provider relations representative.

    6. Does the change from ICD-9 to ICD-10 codes have any impact on CPT and HCPCS codes?
    No. CMS regulations governing the use of ICD-10 codes have no impact on CPT and HCPCS codes.

    7. Does Affinity expect its preauthorization procedures to change as a result of implementing ICD-10?
    No.

    8. How will Affinity handle authorization of services that occur on or after the ICD-10 compliance date of October 1, 2015?
    Affinity will follow its current process, which is to issue authorizations based on service date. Affinity will begin accepting ICD-10 codes for authorization and referral requests from September 1, 2015 for date of service on or after Oct. 1, 2015 and will not accept any ICD-9 authorization codes after Oct. 1, 2015. For additional details, please refer to our quick reference guide.

    9. How will Affinity handle inpatient authorizations for unknown discharge date at the time of authorization request?
    If the expected date of discharge is unknown and if the request is prior to 10/1/2015, we will require ICD-9 code set and if the request is on or after 10/1/2015, we will require ICD-10 code set.

    10. Will Affinity update ICD-9 or ICD-10 coding during concurrent review process?
    Affinity will NOT be updating ICD-9 or ICD-10 coding during concurrent review process. Authorizations requested with ICD-9 or ICD-10 codes will remain the same.

    11. What are Affinity’s Claims processing rules for ICD-10 code set?
    Affinity will adjudicate claims based on the CMS rules. Please refer to our ICD-10 compliance rules quick reference guide for more details.

    12. How will Affinity handle "run out" claims?
    "Run out" claims are those submitted to Affinity on or after 10/1/15 with a date of service/date of discharge prior to 10/1/15. "Run out" claims will be processed by Affinity but must continue to use the ICD-9 code set.

    13. Will Affinity Health Plan conduct ICD-10 testing with providers?
    Yes; however, Affinity is only testing with selected providers at this time and that testing is underway.

    14. Where can providers obtain details on how ICD-10 testing claims files should be set up and submitted to Emdeon?
    Please visit the Emdeon ICD-10 Submitter-Provider Quick Start Guide for instructions.

    15. How many test ICD-10 claims should providers submit?
    Affinity will contact selected providers to conduct testing, ICD-10 claim submission testing requirements will be discussed with selected providers.

    16. Does Affinity have any other testing requirements?
    Affinity will contact selected Providers to discuss specific ICD-10 testing requirements.

    17. What ICD-10 testing feedback will providers receive from Affinity?
    Affinity will contact selected providers to discuss ICD-10 testing feedback.

    18. What should providers do if they have additional questions?
    Affinity will periodically update the ICD-10 FAQs as new information becomes available, so providers should check back regularly. Additionally, providers can email questions to: ICD10_info@affinityplan.org