Company Name

Affinity uses Emdeon as its claims clearinghouse.

Affinity is not implementing any type of cross walk solution(i.e., where software will map ICD-9 codes to ICD-10 codes on submitted claims). Affinity will be unable to process any submitted claims that do not meet CMS' ICD-10 requirements as outlined above.

Affinity is remediating all medical policies which contain ICD codes. In order to assist providers, Affinity has decided to share all of its remediated medical policies which contain a mapping of current ICD-9 diagnosis codes to ICD-10 diagnosis code(s). Policies may be found on the Provider Portal.

Affinity is conducting internal modeling exercises to examine the potential financial impacts of ICD-9 to ICD-10 mappings as they relate to APR-DRG and APG calculations.

A key objective of Affinity's ICD-10 strategy is, wherever possible, to maintain benefit and financial neutrality. Affinity will not attempt to use the transition to ICD-10 as a vehicle for altering provider reimbursements at the expense of its providers.

Affinity will be contacting providers whose agreements contain ICD codes. In the meantime, if you have any questions, please contact your Affinity provider relations representative.

No. CMS regulations governing the use of ICD-10 codes have no impact on CPT and HCPCS codes.

No

Affinity will follow its current process, which is to issue authorizations based on service date. Affinity will begin accepting ICD-10 codes for authorization and referral requests from September 1, 2015 for date of service on or after Oct. 1, 2015 and will not accept any ICD-9 authorization codes after Oct. 1, 2015. For additional details, please refer to our quick reference guide.

If the expected date of discharge is unknown and if the request is prior to 10/1/2015, we will require ICD-9 code set and if the request is on or after 10/1/2015, we will require ICD-10 code set.

Affinity will NOT be updating ICD-9 or ICD-10 coding during concurrent review process. Authorizations requested with ICD-9 or ICD-10 codes will remain the same.

Affinity will adjudicate claims based on the CMS rules. Please refer to our ICD-10 compliance rules quick reference guide for more details.

"Run out" claims are those submitted to Affinity on or after 10/1/15 with a date of service/date of discharge prior to 10/1/15. "Run out" claims will be processed by Affinity but must continue to use the ICD-9 code set.

Yes; however, Affinity is only testing with selected providers at this time and that testing is underway.

Please visit the Emdeon ICD-10 Submitter-Provider Quick Start Guide for instructions.

Affinity will contact selected providers to conduct testing, ICD-10 claim submission testing requirements will be discussed with selected providers.

Affinity will contact selected Providers to discuss specific ICD-10 testing requirements.

Affinity will contact selected providers to discuss ICD-10 testing feedback.

Affinity will periodically update the ICD-10 FAQs as new information becomes available, so providers should check back regularly. Additionally, providers can email questions to ICD10_info@affinityplan.org