CurrentNeighborhood Health Plan of Rhode IslandPolicy N/A

Non-Covered Diagnoses

Lists diagnosis codes identified as non-covered for Neighborhood Health Plan of Rhode Island; appears to be a mapping/mismatch report between 'Commercial' and 'INTEGRITY' code sets rather than a clinical policy with medical necessity criteria. Intended for billing/coding staff to identify diagnoses that should not be billed/are excluded.

Policy Summary

PayerNeighborhood Health Plan of Rhode Island

PolicyNon-Covered Diagnoses

Policy CodePolicy N/A

Change TypeNo material changes

Effective Date

Next Review Date

Key ActionDo not bill or submit claims with the diagnosis codes and code ranges listed as non-covered; verify the correct ICD-10 mappings with the payer before claim submission to avoid denials.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

~60distinct ICD-10 diagnosis codes or code ranges mentioned (approximate)

Commercial vs INTEGRITYcoding sources compared

Policy Summary & Scope

This document lists diagnosis codes identified as non-covered for Neighborhood Health Plan of Rhode Island and appears to be a mapping/mismatch report between two code sets labeled Commercial and INTEGRITY. It is intended for billing and coding staff to identify diagnoses and code ranges that the payer has marked as excluded or not covered rather than to provide clinical medical necessity criteria.

Quick Facts

PolicyNon-covered diagnoses list (diagnosis mapping issues)

StatusCURRENT

Approx. distinct ICD-10 diagnosis codes or code ranges mentioned~60

Coding sources comparedCommercial vs INTEGRITY

Non‑Covered Diagnosis Codes (ICD‑10)

Non-covered diagnosis codes / ranges (as listed)ICD-10Not Covered

N46.01 to N46.9	Disorders of male genitalia (listed as non-covered)
L70.0 to L70.9	Acne (appears as Commercial equivalent)
N52.9	Male erectile dysfunction, unspecified (listed)
L73.0	Follicular cyst of skin? (appears as Commercial equivalent)
N97.0 to N97.9	Female infertility codes (listed)
L8O	Possibly malformed code in source (L80?)
Z0.8	Other specified general examination (formatting in source inconsistent)
Z01.21	Encounter for pregnancy test and childbirth and childcare instruction (source mapping inconsistent)
Z01.20 to Z01.21	Encounter for other special examination of other specified body systems
Z02.1	Encounter for admission to residential institution (source shows blank Commercial mapping)

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Policy Summary

PayerNeighborhood Health Plan of Rhode Island

PolicyNon-Covered Diagnoses

Policy CodePolicy N/A

Change TypeNo material changes

Effective Date

Next Review Date

Key ActionDo not bill or submit claims with the diagnosis codes and code ranges listed as non-covered; verify the correct ICD-10 mappings with the payer before claim submission to avoid denials.

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.

Required Actions for Providers & Coding Staff

Billing Rule

Do not bill/submit encounters with listed non-covered diagnosis codes

Claims with the diagnosis codes and code ranges listed as 'Non-Covered Diagnoses' should be considered excluded/not covered and handled per payer denial/billing policy. The document shows multiple inconsistent mappings between 'Commercial' and 'INTEGRITY' code sets; validate the correct diagnosis code set before submission.

Handle per payer denial/billing policy
Validate which code set (Commercial vs INTEGRITY) applies before submitting claims

Documentation Required

Validate diagnosis code mapping

Because the source contains formatting errors and inconsistent mappings (typos such as 'L8O', 'ZO.8', missing Commercial mappings), providers and coding staff must verify the intended ICD-10 codes with the payer prior to claim submission to avoid denials.

Example malformed/typo codes or entries found in the source: 'L8O' (likely L80)
'ZO.8' and 'Z0O.8' formatting inconsistencies for Z0.8
Multiple entries with missing Commercial mappings (e.g., Z02.1, Z41.3, Z43.7, Z52.810–Z52.819)

OpenPayer

Non-Covered Diagnoses

Policy Summary & Scope

Non‑Covered Diagnosis Codes (ICD‑10)

Required Actions for Providers & Coding Staff

Defined Terms

Document Context & Limitations