Jawood Hipaa 5010 Solution (3)


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Jawood Hipaa 5010 Solution (3)

  1. 1. 888-822-5984 [email_address] www.jawood.com
  2. 2. 4010A1 – 5010 5010conversion@jawood.com  888.822.5984  www.jawood.com
  3. 3. 5010conversion@jawood.com  888.822.5984  www.jawood.com GARTNER COST STUDY “ HIPAA systems implementation costs form the majority of costs associated with the HIPAA Version 5010 proposed rule. The following table summarizes the cost categories and an estimate of each category as a percentage of total costs incurred. The major cost item is the TESTING COSTS – these costs on average are estimated to account for 60% to 70% of the total costs that will be incurred.” - Gartner* *Gartner. Version 5010 Regulatory Impact Analysis – Supplement. September 2008 Cost Category Percentage of Total Costs (Providers) Percentage of Total Costs (Health Plans) Hardware Procurement 0% 0% Software Costs 15% 10% Transmission Costs 0% 0% New Data Collection 0% 0% Customized Software Development 5% 2.5% Testing Costs 60% 70% Training Costs 5% 2.5% Transition Costs 15% 15% Total 100 % 100% Testing Costs 60% 70%
  4. 4. 4010A1 – 5010 5010conversion@jawood.com  888.822.5984  www.jawood.com Questions <ul><li>What are the impacts to your enterprise in support of HIPAA 5010 Implementation? </li></ul><ul><li>Have you considered ALL the projects spanning the 5010 go-live date and those requiring HIPAA transaction input? ICD-10! </li></ul><ul><li>Will your existing test beds based on HIPAA transactions for Benchmark, Release Management, QA Validation, UAT be converted? </li></ul>
  5. 5. Let the Jawood Solution funnel out your Data Conversion Requirements all while saving you 50% in cost over 5010 DATA REQUIREMENTS / SCOPE 5010conversion@jawood.com  888.822.5984  www.jawood.com <ul><li>Tools </li></ul><ul><li>Processes </li></ul><ul><li>Resources </li></ul>
  6. 6. 4010A1 – 5010 5010conversion@jawood.com  888.822.5984  www.jawood.com Questions <ul><li>What is the volume of EACH transaction within your enterprise that will need to be converted? 10,000? 100,000? More? </li></ul><ul><li>How will you provide quality in test data creation to mitigate enterprise risk? </li></ul><ul><li>How much will the conversion cost? </li></ul>
  7. 7. 5010 TEST DATA COSTS 5010conversion@jawood.com  888.822.5984  www.jawood.com 5010 Data Conversion Cost Test Coverage / Risk Mitigation 100 Risk Jawood Solution Manual Save up to 60% 0 Costs for Manual Claim Conversion Time: 1 claim = 30 minutes Cost: 1 claim = $ 22.00 1,000 claims = $ 22,000.00 10,000 claims = $ 220,000.00 100,000 claims = $ 2,200,000.00 Savings with the Jawood Solution The greater the risk mitigation / the greater the test coverage – THE GREATER THE SAVINGS / THE LOWER THE RISK!
  8. 8. RISK MITIGATION 5010conversion@jawood.com  888.822.5984  www.jawood.com <ul><li>To minimize risk, the volume of claims, membership records and inquiries required to meet the acceptable mitigation levels: </li></ul><ul><ul><li>100% of high dollar claims </li></ul></ul><ul><ul><li>100% of high volume transactions </li></ul></ul><ul><ul><li>100% of special claims where errors become media worthy (HIT, HOT, PT, Chiro) </li></ul></ul><ul><ul><li>Highly visible accounts or encounter/ non-reimbursable accounts </li></ul></ul><ul><li>Historically, organizations have assumed high levels of risk due to the cost of finding and creating the right amount of test data to properly test conversion type projects. </li></ul><ul><ul><li>Small number of transactions created </li></ul></ul><ul><ul><li>Transactions created did not test high risk areas </li></ul></ul><ul><ul><li>Validation flawed, human intervention required </li></ul></ul>
  9. 9. VALUE PROPOSITION 5010conversion@jawood.com  888.822.5984  www.jawood.com <ul><li>By utilizing Jawood’s Products and Services your plan can: </li></ul><ul><ul><li>Lower Project Costs </li></ul></ul><ul><ul><ul><li>Reduce time to develop test data to meet all test types and project expectations </li></ul></ul></ul><ul><ul><ul><li>Reduce project staff due to Jawood expertise (PM, DM, SA, PA, Test Specialist) </li></ul></ul></ul><ul><ul><ul><li>Reduce project costs using offshore blended model </li></ul></ul></ul><ul><ul><ul><li>Additional savings with shared test strategies and tool load with other Blue Plans </li></ul></ul></ul><ul><ul><ul><li>Reduce project lags due to test support in the early stages versus identification in UAT </li></ul></ul></ul><ul><ul><li>Improve risk mitigation, meet audit expectations </li></ul></ul><ul><ul><li>Improve provider/account satisfaction scores </li></ul></ul><ul><ul><li>Reduce post implementation errors and recoveries </li></ul></ul><ul><ul><li>Meet key Business Objectives thru extensive test support </li></ul></ul><ul><ul><ul><li>Verification: Payout, First Pass Rate, TPA/Provider/Clearinghouse, System Performance </li></ul></ul></ul>
  10. 10. JAWOOD TOOL SET <ul><li>Tools </li></ul><ul><li>Felix@4010-5010: </li></ul><ul><ul><li>Easy to use, high volume 4010A1-5010 converter testing mapping, field expansion, new code sets, and non compliance. </li></ul></ul><ul><li>Felix@ANSI-Claim-Generator: </li></ul><ul><ul><li>Fully functional, highly customizable ANSI X12 837 Claims Test data generator that caters to all business and technical scenarios. </li></ul></ul><ul><li>Felix@Payer-Testing-Platform: </li></ul><ul><ul><li>On multiple cycles of execution, for any size IT projects, you will be able to analyze, trend, report, and store data in any file format. </li></ul></ul><ul><li>[email_address] </li></ul><ul><ul><li>Based on claims identification (diagnosis, procedure, provider, etc), filter incoming data and track the success of building the perfect test file to meet enterprise risk mitigation. </li></ul></ul>5010conversion@jawood.com  888.822.5984  www.jawood.com
  11. 11. TOOL ASSESSMENT <ul><li>Automatic conversion to: </li></ul><ul><ul><li>Test all new field boundaries </li></ul></ul><ul><ul><li>Test all new / revised code sets </li></ul></ul><ul><ul><li>Force non-compliance </li></ul></ul><ul><li>Generation of multiple 5010 test claims based on a single 4010A1 </li></ul><ul><li>Full comparison and storage of multiple test cycles to demonstrate progress </li></ul><ul><li>Ease of setting default values for all new data fields </li></ul><ul><li>Capability to complete conversions real-time or batch for files in excess of 5,000 </li></ul>5010conversion@jawood.com  888.822.5984  www.jawood.com
  12. 12. 5010conversion@jawood.com  888.822.5984  www.jawood.com FELIX@4010-5010 PREVIEW
  13. 13. 5010conversion@jawood.com  888.822.5984  www.jawood.com <ul><li>[email_address] </li></ul><ul><ul><ul><li>Load criteria for identifying claims needed to mitigate risk of 5010 project </li></ul></ul></ul><ul><ul><ul><li>Build the criteria once within corporate and push to the remaining claim systems area to ensure common risk mitigation </li></ul></ul></ul><ul><ul><ul><li>Each site will pull production claims and send thru the tool until all matches have been found. </li></ul></ul></ul><ul><ul><ul><li>Extensive reports will report on progress after each successive run. </li></ul></ul></ul>4010A1 – 5010 : JAWOOD Enterprise Tool Deployment 400,000 claims Claim Locator / Extractor Based on Test Grid Loaded 4010A1 10,000 claims 4010A1 Jawood / Felix: Tool Set
  14. 14. 5010conversion@jawood.com  888.822.5984  www.jawood.com <ul><li>[email_address] </li></ul><ul><ul><ul><li>Define 5010 Companion Guide using the Felix@4010-5010 tool at the corporate level. </li></ul></ul></ul><ul><ul><ul><li>Define the Global values at the Corporate level </li></ul></ul></ul><ul><ul><ul><li>Define the User Preferences to meet the overall corporate test objectives at the corporate level </li></ul></ul></ul><ul><ul><ul><li>Copy the tool at each location with a decision to either allow minor changes or to force control at the corporate level </li></ul></ul></ul><ul><ul><ul><li>Ensures consistent risk mitigation </li></ul></ul></ul><ul><ul><ul><li>Applies to all HIPAA transactions </li></ul></ul></ul><ul><ul><ul><li>Automated compares of each load of the tool to document the gaps which would require resolution to meet the goal of a common companion guide for the enterprise per transaction. </li></ul></ul></ul>4010A1 – 5010 : JAWOOD Enterprise Tool Deployment Global Defaults Based on Companion Guide / Plan Setup User Pref: 1 Straight Conversion User Pref: 2 Test Field Boundaries User Pref: 3 Test Code Variations User Pref: 4 Test Non-Compliance Jawood / Felix : Tool Set
  15. 15. 5010conversion@jawood.com  888.822.5984  www.jawood.com 4010A1 – 5010 : JAWOOD AUTOMATED TEST CLAIM CREATION Global Defaults Based on Companion Guide / Plan Setup User Pref: 1 Straight Conversion User Pref: 2 Test Field Boundaries User Pref: 3 Test Code Variations User Pref: 4 Test Non-Compliance File: 1 10,000 Claims 400,000 claims Claim Locator / Extractor Based on Test Grid Loaded 4010A1 10,000 claims 4010A1 5010 File: 2 10,000 Claims 5010 File: 3 10,000 Claims 5010 File: 4 10,000 Claims 5010 Jawood / Felix : Tool Set Jawood / Felix: Tool Set
  16. 16. 5010 PROJECT OPTIONS 5010conversion@jawood.com  888.822.5984  www.jawood.com <ul><li>Supply all test resources </li></ul><ul><li>Project / Test Team Leads </li></ul><ul><li>Test Analysts, Test Specialists </li></ul><ul><li>  </li></ul><ul><li>Supply all test tools </li></ul><ul><li>Jawood Claim Locator / Extractor </li></ul>
  17. 17. SCHEDULE YOUR ASSESSMENT REVIEW TODAY!!! See a Jawood Representative for more details! Blaine Mallat, VP 248-833-8000 [email_address] www.jawood.com