PAY­ERS

Modern Healthcare - - HEALTH IT -

Rel­a­tive calm also de­fined the at­mos­phere among sev­eral

in­sur­ers. “All is go­ing well,” said De­bra Cotter, the ICD-10 pro­ject di­rec­tor at High­mark in Pittsburgh. The Blue Cross and Blue Shield plan, which has 5.3 mil­lion mem­bers and pro­cessed 114 mil­lion claims last year, has been pre­par­ing for the switch to ICD-10 since 2010. It has tested sys­tems with providers over the past year, and then per­formed qual­ity checks at mid­night on ICD-10 day.

“We’re ex­cited to see the years and years and years of work ac­tu­ally in prac­tice,” Cotter said. “We have seen our first claims sub­mit­ted in ICD-10, and we have fi­nal­ized a cou­ple claims al­ready.”

But the new code set does not mean ICD-9 will be im­me­di­ately buried in its grave. For pa­tients who saw their doc­tor or were ad­mit­ted to a hos­pi­tal be­fore Oct. 1, those claims will still have to be sub­mit­ted in old code. Cotter said High­mark will be ready to jug­gle both code sets at the same time.

Dr. J. Mario Molina, pres­i­dent and CEO of Med­i­caid in­surer Molina Healthcare in Long Beach, Calif., com­pared the ICD-10 launch to Y2K, when Amer­i­cans braced them­selves for a tech­no­log­i­cal melt­down.

“We thought the world was go­ing to end, but ev­ery­thing went pretty smoothly,” Molina said. Molina’s busi­ness pro­cesses have been ready for ICD-10 for more than a year, and claims oper­a­tions at Molina have been sta­tus quo so far, he added.

At Se­cu­rity Health Plan, a smaller, 230,000-mem­ber payer owned by the Marsh­field (Wis.) Clinic, the im­pact of ICD-10 won’t be felt im­me­di­ately. Se­cu­rity re­ceived its first claims files the evening of Oct. 1 for ser­vices pro­vided ear­lier that day, said Sara Foem­mel, the plan’s claims oper­a­tions di­rec­tor.

Few hic­cups are ex­pected. “We’ve tested a tremen­dous amount with all of the providers,” Foem­mel said.

But in­sur­ers can’t rule out po­ten­tial de­lays in pay­ment if codes aren’t sub­mit­ted prop­erly.

“The de­lay would have to do with the provider re­cod­ing the claim and re­send­ing it to us,” said Robin May­hall, a spokes­woman for Blue Cross and Blue Shield of Louisiana. “I don’t think it would be any­thing too ex­ten­sive.”

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