Baltimore, MD (September 15, 2015) – Maryland Medicaid is prepared to accept ICD-10 diagnosis and procedure codes on October 1, 2015 in accordance with federal requirements for payers.

 

The Maryland Department of Health and Mental Hygiene (DHMH) anticipates that, if providers follow appropriate billing instructions, claims will not be denied because of diagnosis-based changes. Because of system constraints, Medicaid will convert the ICD-10 codes submitted on claims into ICD-9 codes using a “cross walk.” This process will be seamless for providers, because the conversion will be completed by Medicaid.

 

“Our Medicaid program has been conducting end-to-end testing for ICD-10 since March 2015, with preliminary tests completed as early as September 2014,” said DHMH Deputy Secretary for Health Care Financing Shannon McMahon. “We have tested with 616 professional providers, 256 provider groups, 35 facilities or hospital providers, and all 8 managed care organizations, as well as with several clearinghouses that represent these and many more providers in the state of Maryland.”  

 

More than 90 percent of tested claims have passed; of those that were denied, only a handful of them were for lack of ICD-10 specificity reasons. The remaining denials were because of issues unrelated to diagnosis edits, such as recipient eligibility, date of service, and procedure code edits.

 

All prior authorizations for professional services paid by fee for service Medicaid must be renewed on October 1, 2015 using the new ICD-10 codes. All prior authorization requests for hospital inpatient services must be submitted based on the date of discharge.

 

If providers that anticipate a professional service prior authorization that spans across the implementation date must submit another prior authorization for the span October 1, 2015, and onwards using ICD-10 codes.

 

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