The ICD Qualifier: For Batch Claims Only

For providers and trading partners who file their claims to NCTracks as electronic X12 837 transactions, there is an important change with the advent of ICD-10 on October 1. The Health Care Information Codes Segment must contain the appropriate ICD Qualifier. The ICD Qualifier designates whether the claim being submitted is for services rendered prior to October 1 (using ICD-9 codes) or on or after October 1 (using ICD-10 codes.)

A claim may use ICD-9 codes or ICD-10 codes, but not both. A batch of claims submitted to NCTracks may include both ICD-9 and ICD-10 claims.

The ICD Qualifier may be inserted into the 837 transaction by either the practice management software or the trading partner submitting the claims to NCTracks. It is important for providers to understand at what point the ICD Qualifier is being inserted into the 837 transaction and confirm that it is accurate. Providers who are uncertain regarding the ICD Qualifier on their 837 transactions should contact their trading partner. The NCTracks Contact Center cannot assist with claims that have a missing or incorrect ICD Qualifier.

The X12 List of ICD Qualifiers can be found on the NCTracks Provider Portal, both on the Trading Partner Information page and the ICD-10 page. The list specifies - by claim type (837 D/I/P) - the loop and segment(s) used to designate the ICD Qualifier, as well as the value of the ICD Qualifier that should be used. There is a unique ICD Qualifier (9 and 10) for each claim type and each type of diagnosis (and procedure code for 837I claims.) The same ICD Qualifiers are being used by all payers that accept the 837 transaction. Providers and trading partners familiar with the 837 transaction should be able to use the list to ensure their claims are properly coded. Improperly coded claims will be denied.

Not for Portal Claims

Qualifiers don’t apply to providers who key their claims into the NCTracks Provider Portal. Each portal claim will have a radio button to select ICD-9 or ICD-10.