Healthcare Solutions | ICD-10 Solution

The migration from the ICD-9 to ICD-10 codes will likely be one of the most extensive conversion projects healthcare organizations will undertake, and it is fraught with risk.  The vast majority of IT systems and many healthcare policies will be affected.

The scope of this change presents significant risks to organizations seeking to achieve financial neutrality and to avoid undermining provider relationships. It also presents risks to key functions such as medical policy enforcement and disease management.

Edifecs ICD-10 solution helps healthplans achieve neutrality in the transition to ICD-10 by understanding and mitigating ICD-10 risks at each stage of their migration. The solution allows an organization to:

• Identify which ICD-9 codes and MS-DRGs in historical data create financial or other risk.
• Efficiently develop code maps to support remediation efforts for high-risk codes.
• Streamline the development of ICD-10 test data and analysis of ICD-10 test results.
• Translate codes between ICD-9 and ICD-10 for conversion of historical data or to serve as a contingency plan if full remediation is not completed on time.

The foundation of Edifecs’ ICD-10 solution is an integrated product suite that supports all major phases of an ICD-10 implementation. This end-to-end ICD-10 solution allows for a strategic approach to ICD-10 migration that compresses timelines while reducing staffing needs.

Edifecs provides products and services that support each phase of an ICD-10 project. The products can be used as an integrated suite or deployed independently.

Edifecs ICD-10 Impact Analytics

Edifecs ICD-10 Impact Analytics automates the identification and graphic visualization of relationships between ICD-9 codes in historical claims data and corresponding ICD-10 codes. It also provides a visual representation of DRG assignments and financial risks by groups, codes, and providers.

Edifecs ICD-10 Code Management 

Edifecs ICD-10 Code Management is a medical ontology-based code management system that uses the underlying clinical definitions of ICD-9 and ICD-10 codes to model and generate code maps. This approach simplifies and improves the accuracy of mapping between the code sets. Use of customized business rules automates complex mapping logic.

Edifecs ICD-10 Testing

Edifecs ICD-10 Testing automates test scenario development and generation of large volumes of ICD-10 test data. It also provides an enterprise-wide repository to support sharing and reuse of ICD-10 test data and automatically identifies the variances between expected and actual results. This ICD-10 compliance testing solution supports internal and ICD-10 external testing.

Edifecs ICD-10 Code Translation

Edifecs ICD-10 Code Translation is a scalable, high-performance translation engine that enables ICD code translation and end-to-end visibility into all transactional activity, based on code maps and business rules published from Edifecs Code Management or other code management software.

Edifecs ICD-10 Consulting Services

Edifecs ICD-10 Consulting Services provides clinical consultants to aid in ICD-10 remediation as well as expert support for Edifecs products and services related to the use of Edifecs products.