0 Presentation to: Providers, Trading Partners & Billing Firms Presented by: Sheldia Evans-Maddox Department of Community Health (DCH) Medical Assistance Plans Division October 15, 2015 ICD-10 Go-Live: ICD-10 Issues, Resolutions, and Experience

1 Mission We will provide Georgians with access to affordable, quality health care through effective planning, purchasing and oversight. We are dedicated to A Healthy Georgia.

2 Topics for Discussion DCH ICD-10 Post Go-Live Open Forum: Questions and Answers

3 DCH ICD-10 Post Go-Live

4 Claims Statistics Total Claims Submitted: 151,145 Total Claims Paid: 104,163 /68.9 % Total Claims Denied: 46,595 / 30.8% Here are the most frequently posted diagnosis related edits/errors that caused the denials: ST ICD-10 DIAGNOSIS CODE IS NOT SPECIFIC ND ICD-10 DIAGNOSIS CODE IS NOT SPECIFIC RD ICD-10 DIAGNOSIS CODE IS NOT SPECIFIC 4040 PRIMARY DIAGNOSIS CODE NOT ON FILE TH ICD-10 DIAGNOSIS CODE IS NOT SPECIFIC

5 Post Go-Live Findings Non-specified codes. Edits are set to deny claims that are billed with a non-specified code. The exception to the billing rule is inpatient (COS 010), Outpatient (COS 070), Swing-bed (COS 080), Hospital Based Rural Health Clinic (COS 541) and Nursing Home (COS 110/160) claims. A list of unspecified codes were added to the web portal under the Provider Notices link. EDI files are failing. The EDI files are not passing EDI compliance checks and therefore the claim is not making it into the system for processing. –ICD-9 qualifiers/diagnosis codes where billed with DOS on claims on or after 10/1/15. –ICD 10 qualifiers/diagnosis codes where billed with DOS on claims before 10/1/15 –ICD-9 qualifiers with ICD-10 diagnosis codes Updated provider communications entitled “ ICD 10 Post Go Live Banner” was posted on October 9 th. Go to: under Provider Messages link.

6 Triage Team DCH and HP has created a team of dedicated resources that will assist in identifying issues and issue resolution. If your organization have an issue specific to ICD-10 after October 1, 2015, please contact DCH at or HP via the web portal contact us feature at or by calling the call center at or

7 Open Forum: Questions & Answers

8 Questions and Comments Use the WebEx Q&A Feature On the right middle portion of the screen, you should see a hand. Click the hand if you have a question so that your line can be opened. Once you have received a response to your question, please click the hand again (lower your hand) so that the next person’s line can be opened. You may also type in any question as well.

9 Resources

10 ICD-10 Resources DCH Resources – DCH Dedicated ICD-10 Website – DCH Website for ICD-10 Webinars/Downloads – DCH ICD-10 Education Outreach and Resources – ICD-10: A Four-Part Series (Video)

11 Contact Us HP Call Center – or We welcome your questions and comments at This presentation will be posted within two business days to

12 Thank You