Most NCTracks PAs Do NOT Require Split for ICD-10 Transition

We have good news. You will not need to split Medicaid prior approvals (PAs) over the ICD-10 transition date of October 1 in the same way you will need to split claims. We regret any confusion from previous postings and we are delighted this will be easier than previously reported.

Medicaid PAs that span October 1 do not need to be split. If you have an approved PA request with a begin date before October 1 and an end date on or after October 1, no action is required. It is possible for a claim to be submitted after October 1 with an ICD-10 code and the PA to be approved with an ICD-9 code.

The ICD-10 transition won’t affect PAs because the diagnosis codes on PAs aren’t used to adjudicate claims. Instead, PAs are used by clinicians to see if the service to be provided is appropriate for the diagnosis.

Therefore, most PAs that span October 1 do not need to be split. However, the claim submitted for services rendered on or after October 1 must use ICD-10 codes.

All PA requests submitted to NCTracks on or after October 1 should use ICD-10 codes. Retroactive requests for PA for dates of service before October 1 should use ICD-9 codes.

Exceptions: The exceptions are the Sickle Cell and EHDI (Early Hearing Detection and Intervention) programs under the N.C. Division of Public Health. PA requests for Sickle Cell and EDHI services cannot span the October 1 implementation date. Providers must obtain a new PA for Sickle Cell and EDHI services rendered on or after October 1. (NCTracks will automatically end date existing PAs for Sickle Cell and EDHI that extend beyond September 30.)

Review of Claims

With claims, when the date of service begins before the October 1 implementation of ICD-10 and ends afterwards, you must split them into two separate claims. A single claim cannot contain both ICD-9 and ICD-10 codes. For services rendered before October 1, submit one claim using ICD-9 codes. For services rendered on October 1 and afterwards, submit a second claim using ICD-10 codes. This will only be required for situations in which the dates of service span the October 1 implementation date.

The exception is hospital inpatient claims. Inpatient claims with DRG pricing cannot be split. Instead, use the ICD code based on the discharge date. If the discharge date is September 30 or earlier, then hospitals will submit the claim with ICD-9 codes. If the discharge date is October 1 or later, submit the claim with ICD-10 codes.

NCTracks won’t accept ICD-9 codes for claims with dates of service starting October 1 or later, per policy from the Centers for Medicare and Medicaid Services (CMS).