1) ICD-10 implementation will impact prior authorization processes as providers will need to submit more specific diagnosis and procedure codes to insurance companies. 2) This may lead to delays in authorization approval as well as increased workload for providers to gather the necessary clinical details required by insurers. 3) Providers should train staff on ICD-10 code selection, review pre-authorization templates for additional required details, and consider outsourcing authorization services to help streamline the process.

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How ICD-10 Impacts
Prior Authorizations
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Once a patient is scheduled for appointment, insurance verification and authorization
is imperative to reduce claim denials and increase revenue. Pre-authorization is an
authorization that a health insurance or plan requires their beneficiaries to obtain before
receiving certain services. Obtaining proper pre-authorization will help providers ensure
prompt payment and reduce write-offs. As provider organizations are moving towards the ICD-
10 implementation programs, they need to pay more attention to their prior authorization
process. As cash flow disruptions are predicted for the coming ICD-10 transition, providers may
face serious loss for making even easily avoidable mistakes. Let’s take a detailed look into ICD-
10 impact on pre-authorization and how to address it.
Here are the major areas where providers face challenges to obtain prior approval under ICD-10.
 Diagnosis Code Submission – Submitting diagnosis codes with prior authorization
requests is crucial to obtain approval from the carrier. The increase in the number of
diagnosis codes in ICD-10 present a challenge to providers. They must use the most
specific codes for prior authorization requests.
 Procedural Code Submission – For timely approval of prior authorizations, the ICD-10
codes submitted should match the procedure codes requested. If the codes are mapped
incorrectly, it may lead to denials and non-payment.
 New Procedures – There may be new procedures that require prior authorizations with
ICD-10. This will increase the volume of pre-authorization submissions. Providers will
need to handle this efficiently.
 Authorization Delays – The information provided in the pre-authorization forms may
not be sufficient for carriers owing to the existing manual process. They will ask

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providers for additional information in order to approve the request. This will cause
delay in payment.
 Patient Care – The authorization delays and increase in the number of codes is likely to
impose excessive pressure on providers, who may find it very difficult to devote time to
patient care.
Prior authorization is an important part of the provider-payer-patient cycle and it requires a
streamlined approach to make this process more efficient with ICD-10. Here are some effective
solutions for that.
 The physician has to write a letter to the carrier for obtaining prior approval. This would
take weeks to months to obtain. This means, providers must complete all ICD-10
training and testing weeks before the implementation date.
 Physicians may have to change the way they document the pre-authorization request to
provide the granular details required by the new ICD-10 codes. They will have to know
the ICD-10 codes really well so that they can provide the required information to their
office staff preparing the pre-authorization letter. It is important to review all templates
and note where additional details will be required to provide appropriate
documentation.
 Provide training to the medical coding staff regarding how to choose the most
appropriate ICD-10 codes.
Consider obtaining support from reliable insurance verification and authorization services,
because this will help enhance efficiency with trained professionals assisting providers with
their pre-authorization requests to carriers, obtaining approval and filing appeals in case of
denials.