Pursuant to Bulletin No. 15-07 dated September 21, 2015, Acting Insurance Commissioner Richard J. Badolato mandated that all New Jersey health insurance companies; hospital service corporations; medical service corporations; health service corporations; health maintenance organizations; and organized delivery systems use ICD-10 codes for billing for services pursuant to the Protecting Access to Medicare Act of 2014, § 212 (H.R. 4302, P.L. 113-93) and 45 C.F.R. § 162.1002(c). Transition from ICD-9 to ICD-10 is required, pursuant to federal law, on or before October 1, 2015.

Badolato warns that transition from ICD Code 9 to 10 cannot delay claims processing or payment. Claims not paid properly will trigger the mandated “prompt pay” interest payment for so-called clean claims not paid consistent with N.J.S.A. 17B:30-13.1 and CMS regulations, and will subject the payor to enforcement action by the Department.

Questions concerning the Department’s directive can be addressed to Cynthia Borrelli at Bressler, Amery & Ross, P.C.


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