For healthcare providers and trading partners utilizing electronic X12 837 transactions for claim submissions to NCTracks, a critical update accompanying the ICD-10 transition on October 1st is the mandatory inclusion of the correct ICD Qualifier within the Health Care Information Codes Segment. This qualifier is essential as it specifies whether the submitted claim pertains to services rendered before October 1st (ICD-9 codes) or on or after October 1st (ICD-10 codes).
It’s important to understand that while a single claim can only use either ICD-9 or ICD-10 codes exclusively, a batch of claims sent to NCTracks can contain a mix of both ICD-9 and ICD-10 coded claims. The ICD Qualifier acts as the key differentiator for NCTracks to correctly process these claims.
The insertion of the ICD Qualifier into the 837 transaction can be managed either by your practice management software or by the trading partner responsible for submitting claims to NCTracks. Therefore, providers must ascertain where this qualifier is being implemented in their 837 transactions and verify its accuracy. If there’s any uncertainty regarding the ICD Qualifier in your 837 transactions, reaching out to your trading partner is crucial. It’s important to note that the NCTracks Contact Center cannot provide assistance for claims with missing or, crucially, an incorrect diagnosis code qualifier. Addressing a Diagnosis Code Qualifier Is Incorrect issue is the responsibility of the provider and their trading partner/software.
To aid in ensuring accuracy, NCTracks provides a comprehensive X12 List of ICD Qualifiers available on the NCTracks Provider Portal. You can find this valuable resource on both the Trading Partner Information page and the ICD-10 page. This list meticulously details the loop and segment(s) within the 837 transaction used to specify the ICD Qualifier, along with the precise qualifier values required for each claim type (837 D/I/P). Notably, there are distinct ICD Qualifiers (9 and 10) for each claim type and each diagnosis type (and procedure code for 837I claims). These ICD Qualifiers are uniformly adopted across all payers accepting the 837 transaction. Providers and trading partners familiar with the 837 transaction format should utilize this list to guarantee their claims are coded correctly, thus preventing claim denials due to an incorrect diagnosis code qualifier. Remember, claims flagged with an incorrect diagnosis code qualifier will be rejected.
It’s worth reiterating that these qualifiers are specifically for electronic batch claims and do not apply to claims directly entered into the NCTracks Provider Portal. For portal claims, the system simplifies the process with a radio button interface, allowing users to directly select whether ICD-9 or ICD-10 codes are being used for each individual claim. This eliminates the need to manually manage qualifiers within the portal interface.
