Medicaid Payers that require ICD-10 diagnostic codes

December 20, 2016

States that will reject dental claims that do not have ICD-10 diagnostic codes:
Alaska, Arizona, California, Illinois, Louisiana, Michigan, Minnesota, Nevada, Oklahoma, Pennsylvania, South Carolina, Texas, and Washington
Make sure you are sending claims on the newest ADA 2012 insurance form because this form has an area on it to include the diagnosis codes from ICD-10.
Some states are requiring this one county at a time so may not be state wide as of yet. The date that this has gone into effect is July, 31, 2016. The list does not include ACA or private payer plans that require ICD-10 codes.
On claim denials the payers will not state “lacking ICD-10 codes” they will deny with “incomplete information” or “request for more information” or “lack of diagnosis
This is not just isolated to Medicaid claims. Other payers are asking for the ICD-10 diagnostic codes when a medical necessity is required for the claim.