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ICD-10 Claims Submission Alternatives

For FROM dates of service (on professional and supplier claims) or dates of discharge/through dates (on institutional claims) on or after October 1, 2015, entities covered under the Health Insurance Portability and Accountability Act (HIPAA) are required to use the International Classification of Diseases, 10th Edition (ICD-10) code sets adopted under HIPAA.

If you will not be able to complete the necessary systems changes to submit claims with ICD-10 codes by October 1, 2015, or find that you are unable to submit claims on or after October 1, 2015, due to issues with your billing software, vendor or clearinghouse, the following claims submission alternatives are available.

Please note that these claims submission alternatives REQUIRE THE USE OF ICD-10 code sets for FROM dates of service (on professional and supplier claims) or dates of discharge/through dates (on institutional claims) on or after October 1, 2015.

Free Billing Software

You may download the free billing software that CMS offers via the Common Electronic Data Interchange (CEDI) website at www.ngscedi.comexternal website. The software has been updated to support ICD-10 codes and requires Network Service Vendor (NSV) connectivity in order to transmit Medicare DME claims to CEDI. The software download is free, but there may be fees associated with submitting claims through an NSV. The list of approved Network Service Vendors and an NSV Frequently Asked Questions document is available on the CEDI website at http://www.ngscedi.com/nsvexternal website.

It is also necessary to have a CEDI Trading Partner/Submitter ID to use the free billing software to submit claims to CEDI.

The CEDI enrollment forms are available on the CEDI website at http://www.ngscedi.com/forms/formsindex.htmexternal website. Forms should be submitted to CEDI as soon as possible, but no later than 09/15/15, to allow CEDI time to process your request and for any testing you might want to do prior to the 10/01/15 ICD-10 mandate. You will also need to allow for any additional time to sign up and establish connectivity to CEDI through the Network Service Vendor you choose.

This billing software only works for submitting Fee-for-Service claims to Medicare. It is intended to provide submitters with an ICD-10 compliant claims submission format; it does not provide coding assistance.

Please note that submitting electronic claims to Medicare using the free billing software does not change the requirement for ICD-10 compliant claims to be submitted for FROM dates of service on or after October 1, 2015. Any claims containing ICD-9 codes for FROM dates of service on or after October 1, 2015, will be rejected by Medicare.

Paper Claims

In limited situations, you may submit paper claims with ICD-10 codes to Medicare. To find more information on when you may submit paper claims, visit http://www.cms.gov/Medicare/Billing/ElectronicBillingEDITrans/ASCAWaiver.htmlexternal website on the CMS website. Please note that to submit paper claims, a provider must meet the requirements to qualify for a waiver of the Administrative Simplification Compliance Act (ASCA) provisions.

Practitioners (physicians and non-physicians) and suppliers use Form CMS-1500 to bill MACs and DME MACs. You can order Form CMS-1500 from printing companies, office supply stores, and the U.S. Government Printing Office (GPO), U.S. Government Bookstore. U.S. Government Bookstore orders can be placed by calling (866) 512-1800 or visiting http://bookstore.gpo.gov/agency/346external website on the GPO website.

Institutional providers use Form CMS-1450, also known as the UB-04, to bill MACs. You can order UB-04 claim forms from the National Uniform Billing Committee (NUBC) at http://www.nubc.orgexternal website on the NUBC website.

Also see our Submitting a Claim webpage for more information about submitting paper claims.

Please note that submitting paper claims to Medicare, even if approved for an ASCA waiver, does not change the requirement for ICD-10 compliant claims to be submitted for FROM dates of service (on professional and supplier claims) or dates of discharge/through dates (on institutional claims) on or after October 1, 2015. Any paper claims containing ICD-9 codes for FROM dates of service (on professional and supplier claims) or dates of discharge/through dates (on institutional claims) on or after October 1, 2015 will be returned as unprocessable by Medicare.

Please submit a request for an ASCA waiver by September 1, 2015, to ensure a response by October 1, 2015.

If you have questions, please contact our Customer Service department.

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