Risk Readiness
Will Wellcare be able to accept electronic claims with ICD-9 and ICD-10 coding based on the dates of service and dates of discharge using Version 5010 transactions on Oct. 1, 2015?
Wellcare will be compliant with the CMS rule for ICD-10 readiness beginning Oct. 1, 2015.
How will Wellcare evaluate provider readiness for Oct. 1, 2015?
Wellcare uses an external testing process, which involves having providers answer questions and signing off to determine readiness.
What is Wellcare's risk mitigation plan for accepting electronic claims?
Wellcare will be compliant with the CMS rule for ICD-10 readiness beginning Oct. 1, 2015. In the unforeseen event that electronic claims cannot be accepted beginning Oct. 1, 2015, Wellcare will accept paper claims.
Does Wellcare plan to complete an impact assessment to determine how the migration from ICD-9 to ICD-10 might impact business?
Yes, an internal impact assessment has been completed.
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Will Wellcare be able to complete coordination of benefit processes and exchange claims with partners including Medicare and others on Oct. 1, 2015?
Coordination of benefit claims payment will be handled in the same manner whether the claim is an ICD-9 claim or an ICD-10 claim.
Is Wellcare willing to build in contract language that addresses revenue variance impacts for both the provider and payer? How will Wellcare measure these?
Wellcare plans to monitor the impact of this change very closely, looking for variation against historical payments. Wellcare is not building language into contracts for payment variance, in part due to the complexity in measuring the ICD-10 impact. Should variation exist that is greater than anticipated, either party has the option to open a negotiation through the normal contract provisions.
Will Wellcare re-contract due to the ICD-10 transition?
Wellcare will maintain the existing provider contract agreements and use the General Equivalence Mappings (GEMs) crosswalk mapping as a baseline for the identification and transitional usage of all applicable ICD-10 code sets. Please visit the CMS website for further guidance and information about GEMs mapping.
Offering no-cost or low-cost billing software to providers has been recognized as a risk mitigation strategy for provider non-compliance. Does Wellcare plan to pursue this strategy?
No, Wellcare does not plan to pursue this strategy at this time.
Does ICD-10 contain an exemption for small providers and hospitals?
All HIPAA-covered entities are required to convert to ICD-10 for dates of service no earlier than Oct. 15, 2015, regardless of the entity's size.
