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Project Vision

On Jan. 16, 2009, the Department of Health & Human Services (HHS) published a rule adopting ICD-10-CM and ICD-10-PCS to replace ICD-9-CM for everyone covered by the Health Insurance Portability and Accountability Act (HIPAA), with an effective implementation date of Oct. 1, 2013. 

On Sept. 5, 2012, HHS published a rule adopting a revised effective implementation date of Oct. 1, 2014. 

In April 2014, the U.S. Senate voted and President Obama passed a bill: Protecting Access to Medicare Act of 2014, which preserves the pay rate for doctors treating Medicare patients and pushes back the compliance deadline for ICD-10 from Oct. 1, 2014, to no earlier than Oct. 1, 2015.

In light of the announced delay, WellCare Health Plans will still move ahead with its ICD-10 enterprise project and maintaining existing project timeline and milestones. We intend to continue with our internal system readiness activities and move forward with external testing with select entities. 

Fortunately, our planning and mitigation approach from the project's inception puts WellCare in a position to continue our strategy while remaining responsive to this and any other changes. 

WellCare will align its implementation to coincide with the updated mandate. General Equivalency Maps (GEMs) will be used along with WellCare custom clinical and coding mappings to address gaps in GEMs when transitioning.

Health care providers are encouraged to confirm that all vendors, clearinghouses, in-house or practice management systems and billing services are prepared to support them and comply with the ICD-10 transition deadline.

WellCare recommends that health care providers seek specific ICD-10 training offered by societies and professional organizations. Providers can also use the Centers for Medicare & Medicaid Services (CMS) website for ICD-10 resources and training materials.


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Last Updated On: 9/23/2015