Blue Cross Ready for National Medical Coding System Transition

Sept. 30, 2015

On Oct. 1, when the national medical coding system transitions from the International Classification of Disease (ICD) codes set known as ICD-9 to ICD-10 for diagnosis and hospital inpatient procedure coding, Blue Cross and Blue Shield of Louisiana will be ready to give authorizations and accept/process claims from providers who comply with the new coding system.  

The Centers for Medicare and Medicaid Services (CMS) has mandated the transition for all Health Insurance Portability and Accountability Act or HIPAA-covered entities, which requires substantial changes to the business processes and systems for all health insurers, clearinghouses, physicians and hospitals. The transition from ICD-9 to ICD-10, the most significant medical coding change in three decades, increases diagnosis codes from approximately 14,000 to 68,000 and inpatient procedure codes from approximately 4,000 to 87,000.

Blue Cross has been updating its business processes and systems over the past four years to comply with the federal mandate. “Blue Cross has worked diligently to be fully compliant and ready for the mandated medical coding change,” says Allison Young, the company’s senior vice president of benefits administration. Young says Blue Cross completed a company-wide impact assessment to ensure all business process and system changes are in place, conducted extensive internal testing and provided employee training to ensure readiness and avoid disruptions in claims processing and payments.

Over the past three years, Blue Cross educated the Louisiana provider community and created awareness among physicians, clinics and hospitals about the importance of being ICD-10-compliant to avoid disruptions in payments.  The company offered education through seminars, webinars, letters, newsletters and updates on its website. Blue Cross also deployed a testing portal where providers can practice coding clinical narratives across 39 specialties based on ICD-10 guidelines, and conducted transactional end-to-end testing with providers.

“In order to be compliant with the federal ICD-10 mandate, Blue Cross will not accept or pay claims with old codes (ICD-9) for dates of service on or after Oct. 1, 2015,” says Sabrina Heltz, senior vice president of medical economics and chief analytic officer.  Heltz says if a claim with dates of service on or after Oct. 1 is submitted with ICD-9 codes, Blue Cross will send the claim back to the provider and request it be re-submitted with the appropriate ICD-10 codes.

“Unfortunately, this could result in delayed payments to our providers, which is why we have worked so hard to help them prepare,” says Heltz.

All entities impacted by the transition from ICD-9 to ICD-10 have had to plan for and make major changes to their business operations.  To be ready, all health insurers, clearinghouses, physicians and hospitals had to update their systems and train their staff to be ICD-10-compliant.

When the nation’s medical systems switch to ICD-10, the country will have more specific, detailed and universal coding for diagnoses and hospital procedures. This will help the healthcare system gather more national data on healthcare services and trends, more effectively prevent fraud, waste and abuse, compile more specific data on medical treatments and pay for services more effectively.

About Blue Cross and Blue Shield of Louisiana
Founded in New Orleans in 1934, Blue Cross and Blue Shield of Louisiana is a tax-paying nonprofit health insurer. We are a private company, mutually owned by our policyholders, with an independent Louisiana Board of Directors and no shareholders. We are an independent licensee of the Blue Cross and Blue Shield Association.

Blue Cross and Blue Shield of Louisiana is committed to improving the health and lives of all Louisianians. With our subsidiaries, HMO Louisiana and Southern National Life, we provide group and individual health insurance plans, life and disability insurance, group voluntary products and administrative services to one out of four Louisiana residents. We’re the only Louisiana insurer that offers plans in every parish. We also provide every customer with comprehensive wellness education, programs and services to help them live healthier lives. Headquartered in Baton Rouge, we have eight regional offices to serve our customers around the state.

Blue Cross and Blue Shield of Louisiana is dedicated to transforming the healthcare industry in Louisiana into one that delivers high-quality health outcomes for our customers with top-notch service at more affordable costs. Our reputation for exceptional service and prompt payments, as well as the hard work of our 200+ in-house doctors, nurses, pharmacists, social workers and dietitians, keeps both customer and provider satisfaction high. Surveys by the Louisiana State Medical Society and the Louisiana Hospital Association consistently rank Blue Cross the best company providers do business with.

Blue Cross is deeply committed to the communities we serve. We invest both time and money in the health and wellbeing of Louisiana children by supporting more than 200 charitable organizations. We invite and encourage all Louisianians to visit our website or talk to us on social media through our online hub.