Frequently Asked Questions About ICD-10
The U.S. Department of Health and Human Services (HHS) issued a rule on July 31, 2014, finalizing Oct. 1, 2015, as the compliance date for health care providers, health plans and health care clearinghouses to transition to ICD-10.
Sharp HealthCare began accepting ICD-10 codes on Oct. 1, 2015.
If you are a non-Sharp-affiliated provider and would like to learn more about our ICD-10 implementation, please review the frequently asked questions and helpful learning resources below.
ICD-10 learning resources.
What are the benefits of the ICD code transition?
One result of changing to the ICD-10 code system is that we have more details about the services our customers receive, generating better data on procedure and diagnosis trends.
Are there be any changes to authorization or medical necessity approval processes?
No. There are no changes to our utilization management guidelines or processes for medical necessity approval as a result of ICD-10 implementation.
What is Sharp's approach for authorizations?
Referral or authorization for a date of service or admission will only accept ICD-10 codes.
Sharp HealthCare will only accept one code type on a referral or authorization based on date of submission of the referral. If service is authorized in ICD-9 and claim date of service is after Oct. 1, 2015, please bill with ICD-10.
How can I contact Sharp's ICD-10 Readiness Team?
If you have any additional questions, please send us an email.
How will health care professionals be informed of Sharp's progress?
We will continue to communicate updates regarding our progress to health care professionals and hospitals through:
- Fax broadcast (News to Know)
- Sharp Community Medical Group office manager meetings
For more information, contact your health care professional service representative, or send us an email.
What ICD-10 learning resources are available for health care professionals?
You can find internal training documents available at the following websites:
Where are the ICD-10 modules located?
The online modules are located in the CME Portal, not HealthStream or SharpNET. To access the CME Portal, please log in now. You will need to log in to access the modules.
How do I access the ICD-10 training?
First, log in to the CME Portal. Then, select Online from the left menu. Finally, select your specialty from the available list so that you are viewing content that is relevant to you.
How do I find out if I already have a CME Portal account?
If you are unsure if you have an account, first check any email addresses you think you may have used to create your account. You should have received an email from email@example.com that contains your login information.
Otherwise, call the Technical Assistance Center (TAC) at 858-627-5000 and request that they search the CME Portal for your account. If you have an account, TAC can send you an email with your login information. If you do not have an account, TAC can help create one for you.
How can I get my CME Portal account login information?
Please call TAC at 858-627-5000 and request your login information. TAC is available 24 hours a day, 7 days a week.
Why do you need my email to create an account?
The email you provide is your unique identifier and it is how the CME Portal communicates with you. You can provide any email you wish, but CME recommends it is one you check regularly. The CME Portal allows you to send yourself login information, transcripts and other account information. The CME Department does not communicate with you via the CME Portal unless absolutely necessary.
I am trying to view my ICD-10 modules and the screen is blank. What now?
Physicians and clinicians who are eligible to view the modules have been designated as "Sharp providers." If you are getting a blank screen, your CME Portal account may not be properly designated as a "Sharp provider." Contact TAC at 858-627-5000 and request that they update your account accordingly. Doing so will make the modules visible in your account. You may need to log out and log back in to see the change.
Can I earn AMA PRA Category 1 Credits(s)™ for these modules?
No. Due to contractual obligations, no CME credit is available for these modules.
I do not see my specialty. Which one do I choose?
Information that may be helpful to you may be available under General Overview, Family Medicine/Other or Internal Medicine. You may need to launch a given module and review the table of contents for more specific information. If you need additional information, please contact the CME Department at 858-499-4560. Staff is available Monday through Friday, from 8 am to 5 pm.
What is Sharp's approach regarding claim processing?
We will continue to accept electronic and paper claims coded in ICD-9 until the compliance date based on the date of service or discharge. Please be sure you understand how the following claim types will be processed:
- ICD-10 coded claims: Claims submitted with dates of-service or discharge on or after Oct. 1, 2015, will be accepted with ICD-10 codes.
- Mixed coded claims: Claims coded with ICD-9 and ICD-10 on the same claim will not be accepted.
- Claims containing services before and after the compliance date: These claims require the health care professionals to split the claim so all ICD-9 codes remain on one claim with dates of service prior to the new compliance date and all ICD-10 codes on the claims with dates of service on or after the new compliance date.
- Inpatient hospital claims: There is an exception for these claims. These claims should be coded based on the discharge date. Use ICD-9 code if the discharge date is before Oct. 1, 2015. Use ICD-10 code if the discharge date is on or after Oct. 1, 2015.
It is the providers' responsibility to be ready by the mandated date. Failure to follow the government mandated compliance date will result in claims being rejected, as claims cannot be adjudicated if they contain codes not effective for the date of service.
Does Sharp accept the revised CMS 1500 paper claim form?
Yes, Sharp accepts the revised CMS 1500 health insurance claim form (version 2/12). The newest version of the form includes the following information to increase functionality:
- Indicators for differentiating between ICD-9-CM and ICD-10-CM1 diagnosis codes
- Expansion of the number of possible diagnosis codes to 12
- Qualifiers to Identify the following provider roles (on Item 17):
Will Sharp accept unspecified codes?
When sufficient clinical Information isn't known or available about a particular health condition to assign a more specific code, it's acceptable to report the appropriate "unspecified" code (i.e., a diagnosis of pneumonia has been determined, but not the specified type).
Are there any new claim reject codes for ICD-10?
No. We did not add or change any claim reject codes for ICD-10.
How is Sharp using the general equivalency mappings (GEMs)?
We used the GEMs as a guideline to build our diagnosis and procedure ICD-9 to ICD-10 translation maps. Certified coders and medical directors were engaged to review the GEMs to ensure agreement on the mapping, and to be sure all codes were included. These maps were used to update clinical policies, support client reporting, operating procedures and benefit plans including client specific plans.
Electronic Claim Submission
We strongly encourage you to submit your claims electronically, as it can help you save time and money, and can improve claim processing accuracy. Using one of Sharp HealthCare's electronic data interchange (EDI) options allows you to send, view and track claims with Sharp HealthCare — no faxing, printing or mailing.
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