ICD-10 Implementation: Have You Begun to Reach Out to Your Clearinghouse and Payers?

In preparing for ICD-10 implementation, it is imperative that you start to form relationships with your clearinghouse and payers.

Some of the key areas of discussion should be:

Payers and Clearinghouse 

  • Establish a key contact for the ICD-10 implementation process and set up monthly meetings and/or conference calls to discuss their current status and any questions or issues you may have.
  • Determine where they currently are in ICD-10 transition and what their testing timelines and testing requirements are.
  • For hospitals specifically – review current contracts that have carve outs for enhanced reimbursement and determine if the contracts need to be updated. 
  • Determine if there will there be any new policies/procedures (i.e., prior authorizations/referrals based on ICD-9 diagnosis and procedure codes) that you need to be made aware of.
  • Determine what their process for delays in payments or incorrect denials be handled and if there will be a dedicated contact or department to resolve those issues.



Maureen Doherty is a Health Care Services Group Consultant providing coding, billing and insurance claims processing services to a variety of multi-specialty practices.

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