CurrentNeighborhood Health Plan of Rhode IslandPolicy N/A

Non-covered diagnoses list (coding crosswalks)

This document lists diagnoses that are considered non-covered for Neighborhood Health Plan of Rhode Island and shows mappings/crosswalks between 'Commercial' and 'INTEGRITY' coding values; it affects billing/coding staff and claims processors applying coverage rules.

Policy Summary

PayerNeighborhood Health Plan of Rhode Island

PolicyNon-covered diagnoses list (coding crosswalks)

Policy CodePolicy N/A

Change TypeNo material change

Effective Date

Next Review Date

Key ActionRefer to the listed ICD-10 diagnosis codes and use the provided Commercial and INTEGRITY mappings when processing coverage decisions and claims.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

~40diagnosis code mappings or entries provided

2document chunks parsed

multipleentries include empty/unmapped values

Non-covered Diagnoses

Non-covered diagnoses

Non-covered diagnosis entries and their mappings:

N46.01 - N46.9 (Non-covered) — Commercial crosswalk: L70.0 - L70.9; INTEGRITY crosswalk: N46.01 - N46.9

N52.9 (Non-covered) — Commercial crosswalk: L73.0; INTEGRITY crosswalk: N52.9

N97.0 - N97.9 (Non-covered) — Commercial crosswalk: L80; INTEGRITY crosswalk: N52.9

Z00.8 (Non-covered) — Commercial crosswalk: N52.9; INTEGRITY crosswalk: N97.0 - N97.9

Z01.20 (Non-covered) — Commercial crosswalk: N52.9; INTEGRITY crosswalk: Z00.8

Policy Summary

PayerNeighborhood Health Plan of Rhode Island

PolicyNon-covered diagnoses list (coding crosswalks)

Policy CodePolicy N/A

Change TypeNo material change

Effective Date

Next Review Date

Key ActionRefer to the listed ICD-10 diagnosis codes and use the provided Commercial and INTEGRITY mappings when processing coverage decisions and claims.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Code Lists and Mappings

Mapped non-covered diagnosis codesICD-10Not Covered

N46.01-N46.9	Non-covered; Commercial maps to L70.0-L70.9; INTEGRITY maps to N46.01-N46.9
N52.9	Non-covered; Commercial maps to L73.0; INTEGRITY maps to N52.9
N97.0-N97.9	Non-covered; Commercial maps to L80; INTEGRITY maps to N52.9
Z00.8	Non-covered; Commercial maps to N52.9; INTEGRITY maps to N97.0-N97.9
Z01.20	Non-covered; Commercial maps to N52.9; INTEGRITY maps to Z00.8
Z01.21	Non-covered; Commercial maps to Z00.8; INTEGRITY maps to Z01.20-Z01.21
Z02.1	Non-covered; Commercial maps to Z01.20; INTEGRITY maps to Z01.3
Z02.3	Non-covered; Commercial maps to Z01.21; INTEGRITY maps to Z02.1
Z02.71	Non-covered; Commercial maps to Z02.1; INTEGRITY maps to Z02.71-Z02.79
Z02.79	Non-covered; Commercial maps to Z02.3; INTEGRITY maps to Z02.89

1–10 of 18

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Additional non-covered or incompletely mapped codesICD-10Not Covered

Z33.3	Non-covered; Commercial maps to Z52.819; INTEGRITY maps to Z91.1
Z41.1	Non-covered; Commercial maps to Z98.810; INTEGRITY maps to Z98.810
Z41.3	Non-covered; Commercial mapping blank in document
Z43.7	Non-covered; mapping entries blank in document
Z52.810-Z52.819	Non-covered; mapping entries blank in document
Z98.810	Non-covered; mapping entries blank in document

Billing & Provider Guidance

Denial Risk

Non-covered diagnosis mappings — denial risk

These diagnosis codes are designated non-covered. Billing with Commercial vs INTEGRITY diagnosis mappings shown below may result in claim denials if submitted under a covered indication. Verify the member's plan and use the correct diagnosis code set for Neighborhood Health Plan of Rhode Island. If a mapping is blank or unmapped, confirm the correct code before submitting to avoid denial risk.

Non-covered diagnosis mappings listed below are authoritative for denial decisions — do not substitute without payer confirmation.
When a Commercial ↔ INTEGRITY crosswalk is blank or shows '.' the entry is unmapped: providers MUST verify coding and update the claim to an appropriate supported diagnosis.
If you receive a denial related to an unmapped/blank diagnosis, resubmit with corrected diagnosis after verifying member eligibility and medical record documentation.

Billing Rule

Unmapped or blank entries — provider actions

Several entries in the source mapping are missing Commercial or INTEGRITY equivalents (shown as '.' or blank). Providers should verify coding against the latest ICD-10 code set and payer-specific code lists. Recommended actions are listed below.

Verify all diagnoses before claim submission when the mapping shows '.' or is blank (examples: Z41.3, Z43.7, Z52.810–Z52.819, Z98.810 in the source).
If a mapping is blank, investigate whether an updated crosswalk exists with Neighborhood Health Plan of Rhode Island or submit an appeal with supporting documentation if service was medically necessary.
Update claims promptly with the corrected diagnosis code and include relevant clinical documentation to reduce denial/appeal turnaround time.

Term Mappings & Internal Codes

Commercial / INTEGRITY mappings

Definition'Commercial' and 'INTEGRITY' are the two internal mapping categories used in this document to show equivalent or related ICD-10 diagnosis codes across systems; each non-covered diagnosis is listed with its Commercial and INTEGRITY mapped values.

Interpretation — directionalityEach line shows the non-covered ICD-10 code or range first, then 'Commercial =' and 'INTEGRITY =' to indicate the mapped code(s) in each category (e.g., 'Z31.0 to Z31.42, Commercial = Z31.0; INTEGRITY = Z31.41 to Z31.42').

Examples — complete mappingsN46.01 to N46.9: Commercial = L70.0 to L70.9; INTEGRITY = N46.01 to N46.9. (Chunk 0)

Examples — mixed mappingsZ31.81 to Z31.9: Commercial = Z52.813; INTEGRITY = Z52.810 to Z52.819. (Chunk 0)

Incomplete / blank mappingsSome entries have missing Commercial or INTEGRITY values (e.g., Z41.3, Z43.7, Z52.810–Z52.819, Z98.810 show blank mappings in the source). (Chunk 1)