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ICD-10

Shouldn't your comprehensive approach to ICD-10 readiness have value long after the transition?

Edifecs believes the pathway to compliance should include simplifying administrative tasks, creating reusable assets from your test data, and generating operational savings by scaling adoption across the entire enterprise. Not only do our ICD-10 solutions identify financial impact, they create a robust internal test bed and a platform for external testing with key trading partners. Our analytics and professional services are the foundation for post transition risk mitigation planning and offer strategic insight into lines of business.

Product Spotlight

  • Impact Analytics

    Your organization needs insight into the new codes alongside the probable financial impact upon your organization. Edifecs’ Impact Analytics automates the identification and visualization of the relationships between ICD-9 codes in historical claims data and their potential ICD-10 code matches. Organizations can then quickly analyze and compare financial impacts using General Equivalency Maps for MS-DRG outcomes based on historical ICD-9-coded claims and the possible resulting ICD-10 scenarios.

  • Test Management

    Test Management reduces overall cost of testing, increases test coverage and enhances visibility to results using the client’s production workflow. Large scale automation, volume data generation, and the de-identification of data sets are key features of the Test Management platform. By leveraging the client’s own de-identified test data, a test bed is created that lays the foundation for external testing.

  • Code Management

    Creating accurate crosswalks between ICD-9 and code sets is critical to Edifecs Code Management quickly creates, versions and publishes customized bi-directional mappings between the code sets. Code Management permits analysts to rapidly develop high-quality custom maps through relevant references including GEMS and coding guidelines. Code Management tracks user assignments and mapping status using our flexible rules platform.

Capabilities

No matter where you are in the ICD-10 compliance timeline, Edifecs has the tools and capabilities to support you.

Understanding financial impact is key to a successful ICD-10 transition

Get started by understanding the financial impact by claim, DRG and by paid amount. Edifecs Impact analytics automates the identification and visualization of relationships between historical ICD-9 claims and their potential ICD-10 matches, allowing you to quickly analyze and compare financial impacts of MS-DRG outcomes.

  • Understanding root causes for DRG shifts is important. Consider the impact of coding guideline changes, granularity of ICD-10 codes, combination codes and comorbid condition changes
  • Identify and measure DRG shifts. Determine the associated effects on reimbursement
  • To address risk, prioritize high volume and high impact areas and begin addressing these first. Collaborate with trading partners to improve predictability of reimbursement

Edifecs has been the de facto standard in claims EDI for nearly two decades

As we build a best of breed EDI product portfolio, Edifecs also attracted a high performing consultants to our team. Our high skilled ICD-10 experts can augment your team and our AHIMA certified trainers, medical and project management staff can lend a land too. How can we help you?

  • Edifecs offers ICD-10 advisory services for payers, providers and states. We have numerous marquee references and a wide portfolio of services to assist you
  • Mapping services experts can build and test functional maps between ICD-9 and ICD-10 code sets
  • Edifecs also offers policy and benefit management services. We can help with policy remediation and benefits conversion

Testing is a vital component of mitigating ICD-10 risk

Edifecs has solutions and consulting services to meet all of your internal and external testing needs. For nearly two decades, Edifecs has helped payers, providers and states perform internal and end-to-end testing. Let us show you how.

  • Has a neutral third party evaluated the work you’ve done for ICD-10? Edifecs Health Check Services uses a proven methodology to that lends an impartial eye to your risk mitigation plans
  • Test Management helps you evaluate internal systems, workflows as well as the outcomes you achieve - ensuring their adoption is consistent with expectations all across your enterprise
  • Providers, payers and states can come together on Collaborative Testing’s neutral, Web-based platform to exchange ICD-10 claims outside of their respective organizations and thoroughly understand the impact on coding and claims processing

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