Recently, the Centers for Medicare and Medicaid Services issued clarification on specificity that indicated Medicare will relax specificity requirements for automated medical review or complex medical record review during the first 12 months after International Classification of Diseases, 10^th Revision (ICD-10) implementation. ForwardHealth does not perform automated medical review or complex medical record review; therefore, this concept does not apply to Medicaid.

Like Medicare, ForwardHealth will enforce the validity of ICD-10 diagnosis codes (i.e., the highest number of characters required by the code set) for all claim and prior authorization (PA) request submissions. As of October 1, 2015, if a stakeholder uses an ICD-10 diagnosis code that is not valid, ForwardHealth will deny the claim or return the PA request, and the claim or PA will need to be resubmitted with a valid ICD-10 code.