Payer software vendor and claims clearinghouse TriZetto Provider Solutions has seen a small uptick in insurers rejecting providers’ ICD-10 claims as the new code set enters its third week.

Overall, however, the changeover appears to be going well, says Paul Kaiser, senior vice president of the provider business unit for the Denver-based company.

Another TriZetto official at the MGMA conference earlier this month said that the company saw 10,000 denials as a result of ICD-10 during the first 12 days of the new code set, but the vendor later clarified that the number included other types of denials beyond ICD-10.

Kaiser attributes the rise in ICD-10 denials—meaning the claims were returned to the sender for corrections—to the magnitude and complexity of the coding change as providers learn on a payer-by-payer basis how to do ICD-10. But the denials, he believes, are “just a bubble” that will decrease over the next few months. The number one reason for rejecting claims has been because ICD-9 claims were not valid for the date of service entered, or the ICD-10 claims were not valid the date of service entered.

In the first week of ICD-10, only about 30-35 percent of claims coming into TriZetto were ICD-10; last week the figure hit 67 percent. Only now are claims volumes significantly ramping up as providers had many moving pieces to put in place after October 1 and exercised a lot of caution by holding claims and double-checking them before submission, Kaiser says. Accuracy rates should start increasing soon, he adds.

In the start of the third week of ICD-10, some providers are just starting to submit their first batches of claims in the new code format. By mid-to-late November, TriZetto expects virtually all claims received will be ICD-10.

One clear trend that TriZetto has seen is that when vendors or others provide ICD-10 guidance to providers, they adopt it quickly and get better at working the new code set. What the industry is waiting for however, is enough remittance advice to start going back to providers so they can assess how ICD-10 will affect their payments. For now, TriZetto does not have enough statistically relevant trends on remittance and that could take another two or three weeks, Kaiser says.

Kaiser believes the industry was in large part prepared for ICD-10, rejection rates are at reasonable levels and he is cautiously optimistic it will stay that way.

Register or login for access to this item and much more

All Digital Insurance content is archived after seven days.

Community members receive:
  • All recent and archived articles
  • Conference offers and updates
  • A full menu of enewsletter options
  • Web seminars, white papers, ebooks

Don't have an account? Register for Free Unlimited Access