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September 28, 2015
ICD-10 basics and implementation dates

ICD-10 implementation deadline in the AlphaMCS system is October 1, 2015. All claims filed for date of service October 1, 2015 and after must be filed with an appropriate ICD-10 diagnosis. This includes inpatient claims spanning the September 30, 2015 to October 1, 2015 date range with a discharge after October 1, 2015. All claims for services through September 30, 2015 will continue to require an ICD-9 diagnosis.
 
ICD-10 format testing
If your organization is interested in participating in Smoky's ICD-10 testing and you have not already done so, please send an email request to ICD10@smokymountaincenter.com. Use "Interest in Testing" as the subject line and include the following information in the body:
 
* Provider name
* AlphaMCS ID
* Claims system and/or clearinghouse
* Contact information (name, phone, email address) for the person representing your organization
 
Smoky will contact you to proceed with testing. Your organization will then follow the steps outlined below.
  1. Create an 837 claims file that contains representative ICD-10 and ICD-9 codes. Please limit the number of claims in your file to a maximum of 12.
  2. Claims should use October 1, 2014, as the presumed implementation date for ICD-10. It should be expected that claims filed with an ICD-9 diagnosis after this date will deny. (Please note: October 1, 2014, is not the actual ICD-10 implementation date but is the operational date in the AlphaMCS test system.)
  3. Email the encrypted file to ICD10@smokymountaincenter.com. For HIPAA Security purposes, the email must be encrypted.
  4. Send a password to access the file in a separate email to ICD10@smokymountaincenter.com
  5. On receipt of your file, you will receive an email acknowledgement. Please allow a minimum of five business days for processing time.
  6. Smoky will send confirmation after the file has been processed and format testing results are available. Format testing verifies that the data filed conforms to the expected data requirements. Providers should expect a pass or fail result based on whether the claims filed conform. The format testing will not actually process the claim to either a denial or approval and payment.
For general questions regarding ICD-10, please consult the Smoky website. Thank you for your consideration and assistance in testing for ICD-10 readiness.
 
ICD-10 particulars: SARS, claims, records and reports
 
AlphaCM has configured the appropriate data tables and fields to allow for up to 10 characters in the Diagnosis Field within AlphaMCS.
 
Service Authorization Request (SAR)/Authorizations
  1. Current authorizations do not need to be updated to be in compliance with ICD-10 implementation.
  2. AlphaMCS will not validate SARs against ICD-10. SARs will continue to be managed using DSM-5 diagnostic definitions. With the implementation of ICD-10, the system will point users to the same DSM-5 dropdown for selection, but the display will be a cross-reference to ICD-10 diagnosis codes (currently a crosswalk to ICD-9 diagnoses). An asterisk will continue to show for ICD-10 diagnosis.  
Claims
  1. Claims must reflect ICD-9 diagnosis for dates of service (including discharge of inpatient stays) through September 30, 2015.
  2. Claims must reflect ICD-10 diagnosis for dates of services (including discharge of inpatient stays) that occur October 1, 2015 or after.
  3. As claims are received and processed through the AlphaMCS system, the diagnosis is automatically added to the patient record.
  4. Providers who submit 837 claims files containing both ICD-9 and ICD-10 diagnoses must use the ICD qualifier (see details below).
  5. Diagnoses must be in compliance with correct ICD formats and must be consistent with the appropriate diagnosis arrays in the service matrix specific to each benefit plan. 
Records
  1. AlphaMCS is the administrative health record for Smoky.
  2. Providers remain responsible for ensuring their medical record documentation, including any electronic medical records, remain in compliance with the Records Management Documentation Manual (RMDM).
  3. Providers should not submit a Consumer Update Request (CUR) to update a consumer's diagnosis from ICD-9 to ICD-10 format. Updates will occur as claims are submitted into the Alpha system with ICD-10 diagnoses.
  4. Smoky Care Coordination staff will ensure all annual Individual Services Plan (ISP) documents refer to the appropriate and valid diagnostic codes for each consumer.
  5. Not all DSM-5 descriptions have a one-to-one match with a specific ICD-10 code. If a record has one too many crosswalks, the care coordinator or staff person will confer with a clinically-licensed supervisor to determine the clinically-appropriate ICD-10 code to use.
ICD Qualifiers
 
ICD-10 goes into effect October 1, 2015. At that time, providers must begin including ICD qualifiers on 837 submissions. These qualifiers specify which diagnosis codes (ICD-9 or ICD-10) are on the actual claim. The ICD qualifier must be used when you use both ICD-9 and ICD-10 claims on an 837 file. Failing to use these qualifiers may result in a denial. A list of ICD qualifiers is available on the NCTracks website.
 
Crosswalk Tool for ICD-9 to ICD-10
 
Please visit the ICD-10 Data website as another online resource.
 
Need Further Assistance?
 
A repository of ICD-10 resources and information is available on the Claims page of the Smoky website. The repository is a helpful tool for staff, providers and others interested in implementation.


  
ICD-10 questions, concerns, or files for testing, please email
 
For Claims questions, you may contact your assigned claims specialist via direct phone extension or email. If you do not know your assigned specialist, please contact via the general email or extension:
About provider email alerts
  
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Smoky Mountain LME/MCO | 200 Ridgefield Court, Suite 206 | Asheville, NC 28806
Visit the Smoky website for more about: Authorizations and care management | Billing and claims 
Smoky Mountain LME/MCO manages publicly funded services for mental health, substance use and intellectual/developmental disabilities in Alexander, Alleghany, Ashe, Avery, Buncombe, Caldwell, Cherokee, Clay, Graham, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Polk, Rutherford, Swain, Transylvania, Watauga, Wilkes and Yancey counties in North Carolina. For immediate help or information about services, call 1-800-849-6127, 24 hours a day  (TTY: Relay NC 711). Visit us at www.smokymountaincenter.com.