Frequently Asked Questions Regarding ICD-10 and Services Requiring Prior Authorization
Posted on September 23, 2015
How will the payer handle recurring patient (chemo, physical therapy, etc.) authorization? Specifically, will new authorizations be needed for recurring appointments post 10/1/15?
If the provider has an existing authorization that spans past 10/1/15, that authorization will remain valid until the end date. New authorizations requested on or after 10/1 will require an ICD-10 code. Please note, however, that claims with dates of service 10/01/15 or later must be submitted with a valid ICD-10 code.
How will HNE handle authorization for inpatient and observation patient stays spanning 10/1/15? Will authorizations need to be reprocessed in ICD-10 post-discharge?
Same answer as above. If discharge is 10/1 or after, an IC-10 code will be required on the claim.
How will pre-authorizations be handled for patients scheduled for 10/1/15 or later?
An ICD-10 code will be required to enter the authorization for any pre-service requests with a DOS on or after 10/1.
Will HNE have edits in their system to prevent providers from getting an authorization using an ICD-9 code when ICD-10 code is needed?
HNE’s authorization application issues a warning to users entering an ICD-9 code with a date of service on or after 10/1/2015. The requestor will be asked to provide an ICD-10 code for services to be provided on or after 10/1.
How will retro-authorizations be handled, e.g., request for an authorization after 10/1/15 for a service prior to 10/1/15?
HNE does not accept retro-authorizations.
