At DMBA, we follow ICD-10 processing guidelines established by the Centers for Disease Control for “header codes” and “codes valid for HIPAA transactions.” Based on these guidelines, we must deny claims that use header codes. While these unspecified codes may be valid for billing HIPAA transactions, they don’t meet the appropriate level of specificity for supporting medical necessity.
After last year’s implementation of ICD-10, DMBA offered a one-year courtesy grace period, allowing payment for claims billed with unspecified codes. Starting April 1, 2017, we will begin denying claims that do not meet the appropriate level of specificity. We will return these claims with a request for more information. To avoid delayed payments, please make sure clinical documentation is adequately detailed so that appropriate ICD-10 codes are billed.
For more information about ICD-10 standards, visit the following websites:
If you have any questions or wish to request a report of unspecified codes that we’ve received on your claims, please call Healthcare Systems at 801-578-5600 and choose options 1, 3, and 5 in the phone menu. Or email us at firstname.lastname@example.org.