ICD-10 Claim Submission Alternatives
The Centers for Medicare & Medicaid Service (CMS) has issued a MLN Matters® article for provider claims submission alternatives related to International Classification of Diseases (ICD)-10 system problems. Providers that are unable to complete the necessary systems changes or are having issues with billing software, vendor(s), or clearinghouse(s), may use the following alternatives.
• Free billing software;
• Provider internet portals;
• Direct Data Entry (DDE); and
• Paper claims.
The article provides details on how providers can use each alternative method for claim submission.
FREE BILLING SOFTWARE
Providers may download the free billing software that the A/B Medicare Administrative Contractors (MACs) offer on their web pages. The software has been updated to support ICD-10 codes and requires either a Network Service Vendor (NSV) or dial-up or both to transmit claims. The software download is free, but there may be fees associated with submitting claims through an NSV or dial-up. The MAC web pages also provide information about NSVs.
PROVIDER INTERNET PORTALS
Internet portals are only available for ICD-10 compliant professional claims and can be used by providers that bill an institutional claim, which include home health and hospice agencies.
Home health and hospice providers are permitted to submit claims electronically via DDE screens. DDE requires a connectivity service provided by an external company to establish the connection.
In limited situations, CMS will permit providers to submit paper claims during the ICD-10 transition.
To find more information on submitting paper claims, visit http://www.cms.gov/Medicare/Billing/ElectronicBillingEDITrans/ASCAWaiver.html on the CMS website. To submit paper claims, you must meet the requirements to qualify for a waiver of the Administrative Simplification Compliance Act (ASCA) provisions.