The Edifecs ICD-10 solution helps health plans mitigate risk at every stage of their transition using an end-to-end approach that spans analysis, mapping, testing and translation.

Challenge

The migration from ICD-9 to ICD-10 codes is among the most extensive conversion projects healthcare organizations have undertaken. With adoption now set for October 1, 2015, health plans are focusing more than ever on the risks of the transition and how to ensure continuity for all aspects of their business. Because the vast majority of IT systems will be affected, this is no small endeavor.

Achieving financial and operational neutrality, and maintaining provider relationships, medical policy enforcement and care management programs are top priorities for payers. Financial risks have plans concerned. Early pilot testing with external providers has shown unexpected variances in DRG-based payments. In some cases these vary between 10 and 30 percent from projections, representing millions of dollars of risks. Also, many health plans have not kept up with recommended project schedules, especially for testing, and that poses still more uncertainty.

About the Edifecs ICD-10 Solution

The Edifecs ICD-10 solution is an integrated, end-to-end approach. It helps health plans transition to ICD-10 by highlighting and mitigating risks at each stage of the process. It accelerates timelines to achieve neutrality and business continuity on October 1, 2015 and beyond.

Benefits

  • Identifies which ICD-9 codes and MS-DRGs in historical data create the most financial or other risk to an organization.
  • Supports remediation efforts for high-risk codes by developing code maps that leverage medical ontology concepts beyond the general equivalency maps (GEMs).
  • Streamlines the development of ICD-10 test data and analysis of results for business readiness.
  • Provides a collaborative testing environment and framework for payers and trading partners to understand the real risk of ICD-10 claims and manage for this.
  • Maintains business continuity for systems not remediated in time by supporting ICD-10 data conversion or translation of full HIPAA files in a production environment.

 

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We find significant value in having an integrated suite of products that work together to deliver end-to-end support for our ICD-10 project life cycle.

Ian Gordon

BCBS NC

ICD-10 INSIGHTS



PRESS

Aug 19, 2013

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