UHC ICD-10 Edits

I’m getting inundated with ICD updates from the payers and clearinghouses now that 10/1 is getting near. I thought I would share some of these from time to time.

UNITEDHEALTHCARE SYSTEM NOTIFICATION

 Date:  8/6/2015

ICD-10 Code Edits Applied By UnitedHealthcare

Oct. 1, 2015 is the compliance date for the transition to ICD-10 coding to replace ICD-9. These codes are used by physicians and health care professionals to record and identify diagnoses and procedures for claims payments. ICD-10 affects diagnosis and inpatient procedure coding only. It does not affect current procedural terminology (CPT) coding for outpatient procedures.

ICD-10 edits currently in place are shown in the grid below, subject to change prior to Oct 1. Please refer to the Enhanced Claim Edits section of UnitedHealthcareOnline.com for the complete list of edits applied by UnitedHealthcare.

Based on ANSI X12 TR3 compliance regulations, WEDI SNIP Types indicated are enhanced at a pre-adjudication level during HIPAA validation. This enables UnitedHealthcare claim submitters to identify and correct rejected information prior to the claim’s acceptance into our adjudication system for processing.

 

We encourage providers to check claim submission reports on a regular basis and in a timely manner. They can view tracking your electronic claims to learn more about electronic reports and rejections. The UnitedHealthcare ICD-10 website contains many tools and resources to assist submitters with the transition to ICD-10. Our newest is the Physician ICD-10 Coding Practice Tool that allows providers to practice selecting ICD-10 codes for various clinical scenarios across 35 medical specialties.

If you have any questions, please contact Electronic Data Interchange (EDI) Support:

 

UnitedHealthcare Commercial UnitedHealthcare Medicare SolutionsUnitedHealthcare West	EDI transaction support form  or 800-842-1109
UnitedHealthcare Community Plan	EDI transaction support form or ac_edi_ops@uhc.com or 800-210-8315
UnitedHealthcare Oxford	ediproviderassistance@oxhp.com or 800-599-4334

 

*Exceptions:  Harvard Pilgrim (04271), Medica HealthCare Plans (78857), Preferred Care Partners (65088), The Alliance (88461) and TRICARE West (99726)

 

Thank you,

UnitedHealthcare