How to Report Issues With ICD-10 Medicare Claims
All claims and other administrative transactions (such as eligibility, prior authorization and others) for dates of service on and after Oct. 1, 2015, must have an ICD-10 diagnosis code. All transactions with ICD-9 diagnosis codes will be rejected.
If you experience any problems in the processing of your Medicare claims or other Medicare administrative transactions, you may complete and submit an ICD-10 complaint form to the Centers for Medicare & Medicaid Services (CMS).
Please note: This is for Medicare only. Forms will be sent directly to the Centers for Medicare & Medicaid Services. Sending this email constitutes your authorization for the information to be supplied to CMS. The American Medical Association will not provide individual responses to each complaint.
Please complete and send an ICD-10 complaint form.
There are also other steps you can take to address the issues you are having.
- If the payer is Medicare:
- Check your Medicare Administrative Contractor (MAC) website for information on problems they are addressing and for a method of contact for ICD-10 issues.
- The complaint form will be sent to the CMS ICD-10 ombudsman.
- If the payer is Medicaid, check the state Medicaid website for information and method of contact.
- If the payer is a commercial payer, check their website for information and method of contact.
- If you are having issues with your practice management system or electronic health record (EHR), contact your vendor.
- If you are having issues with your billing vendor or clearinghouse, contact them.
- For advice on handling problems and to find out if other practices are experiencing similar issues, contact your state or specialty medical society.