Administrative
Simplification

Momentum is building as the healthcare industry presses forward with a number of mandates such as ICD-10 and CORE Operating Rules.

This infrastructure provides an essential foundation necessary for efficient exchange of administrative, financial and clinical information.

Compliance2

Data Exchange3

AHIMA4

When we take a look at where we are today as a country and where we're going, this is our chance to say we've built infrastructure for health IT on the front lines; we've built infrastructure around information exchange.

Karen DeSalvo, MD, MPH, MSc
National Coordinator for Health Information Technology
Source: FierceHealthIT

Implement validation and coding standards to support interoperability

Comply with mandates such as ICD-10 and CORE Operating Rules

Test internally to ensure benefits, then test externally to ensure preparedness and neutrality

Enable end-to-end visibility, ensuring compliance

Improve clinical documentation and train coders on ICD-10

Ensure system readiness to accept and process ICD-10 codes

Test externally with payers to ensure both preparedness and financial neutrality

Enable end-to-end visibility, ensuring compliance

Key Implementation Capabilities

Prepare for Mandate
Implement Mandate

Impact Assessment

Analyze risk associated with reimbursement and benefits.  Access processes, people and technology. Scope the effort and identify risks to be tracked. Run “what if” models.

Learn how Impact Analytics can help.

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Manage Remediation

Initiate the project by cross-walking code sets, upgrading systems and addressing gaps in process, technology, training, rules for code validation and translation.

Learn how Edifecs Code Management can help.

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Protocol Enablement

Create specifications, mapping and routing to receive new or changed messages. Rules for code validation and translation.

Learn how Edifecs Smart Trading can help.

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Content Governance

Create policy and plans to manage data especially master data. Ensure process is compliant with the regulations and policy.

Learn how Edifecs Smart Trading can help.

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Process Control

Create, orchestrate and modify processes, in the appropriate order, and develop controls to detect variances and ensure service levels.

Learn how Edifecs Operating Rules can help.

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Internal/External Testing

Train staff and partners in policy and process. Adhere to change management processes. Test system. Report coverage.

Learn how Edifecs Enterprise Testing can help.

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End to End Visibility

Implement last mile process and performance metrics including trend and error reporting. Ensure data is archived according to process controls and data governance.

Learn how Edifecs Smart Trading can help.

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Administrative Simplification Maturity Model

How successful have you been in attaining pervasive adoption of compliance initiatives, fully realizing cost savings and improving service?

Our experts can help.

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  • CS

    Case Study

    From Complexity to Clarity

    When the road ahead is fraught with challenges, it’s best to use a trusted guide. The nation’s largest publicly operated health plan had a problem: how to maintain service levels and adjudications rates while migrating to a new claims and benefit administration system.

    View Case Study

  • CS

    Case Study

    Thorough Testing is Central to Success for ICD-10 and Beyond

    Learn how BCBS Massachusetts was able to reduce resources needed to create test data by 50% and improve test coverage.

    View Case Study

  • CS

    Case Study

    Massachusetts Health Data Consortium Success Story

    Payers and providers have long resisted sharing sensitive information. That makes the groundbreaking partnership between the Massachusetts Health Data Consortium, Massachusetts eHealth Data Collaborative and Edifecs all the more significant.

    View Case Study

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2. Health plans are mandated to comply with operating rules or else they face significant penalties
Source: CMS


1, 3. Healthcare data exchange continues to see double digit growth
Source: CAQH 2014 Index


4. Journal of AHIMA Source: AHIMA