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HCL’s ICD 10 Transformation Solutions


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An improved classification of diseases in the diagnostic and the procedure codes is crucial for providing high-quality and effective patient care. The U.S. Department of Health and Human Services (HHS) has proposed that all healthcare organizations replace the current ICD-9-Clinical Modification codes with the ICD 10 codes. The transition to ICD 10 involves multiple challenges, such as substantial investments in ICD business and IT remediation, the development of more-effective models for deriving useful insights from ICD 10 data, an overhaul of existing systems to fit ICD 10 codes, and disruptions in important functional areas such as finance, claims and medical management, and benefits.

With vast experience and domain knowledge in healthcare and in the ICD space, HCL can help organizations address most challenges related to the transition to ICD 10. Our ICD 10 transformation framework is designed to mitigate the risks introduced by complex ICD 10 coding structures, align them to the principles of neutrality, and identify and deal with business and technical impacts of the transition.

Gain absolute consistency and alignment to the principles of neutrality while ensuring zero impact to business through HCL’s ICD 10 remediation solutions. To know more, read here:

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HCL’s ICD 10 Transformation Solutions

  1. 1. Copyright © 2014 HCL Technologies Limited | HCL – Healthcare Payer Solutions ICD Transformation
  2. 2. Copyright © 2014 HCL Technologies Limited | www.hcltech.com2 ICD -10  The US Department of Health and Human Services (HHS) has proposed a long-awaited regulation that will replace the ICD-9-Clinical Modification code sets to report healthcare diagnoses and procedures, with advanced ICD-10 code sets. The tentative date of compliance is 2014.  Transitioning to ICD-10 involves an overhaul of the current coding systems, and requires substantial investments in doing ICD Business & IT Remediation.  ICD-10 Transformation Services include (Impact Assessment, ICD Remediation, ICD Testing)  HCL has developed an end- to-end solution called as i-CRM: ICD Crosswalk and Reimbursement Mapping which helps in mapping, modeling and cross walk between ICD-9 and ICD-10 codes (vice versa).CMS defined GEMs guidelines provide 1-1 approximate maps for up to 77% of the ICD codes. HCL has built more than 200,000 clinical rules along with the GEMs guidelines so as to reduce the 23% of 1-many ICD-10 code mappings. With these rules the iCRM solution is able to deliver 1-1 mappings up to 94% vs. only 77% under GEMs.  HCL has developed an ICD Testing Tool iDPC: ICD Data Prepare & Compare for end-to-end and system testing to help payers address the challenges of benefit and financial neutrality testing as part of the ICD-10 conversion. iDPC identifies statistically valid test data from historical claims and provides ICD9 code coverage statistics at various levels e.g. Test Deck, Test Scenario with proper case mix. It also supports End to End Test Management from Data Generation, Case/Scenario Management to Test Run Management.  End to End ICD10 Transformation service to help payers adhere to compliance mandate and remediate claims processing systems  One-Stop-Shop Solution for doing end –end ICD-10 transformation services using Tools (i-CRM & iDPC) & Services  HCL’s ICD Framework integrate all 3 (Business, Technical, Operation) units, diminishes gaps and stabilizes the ICD Plan. MARKET NEED FEATURES BENEFITS
  3. 3. Copyright © 2014 HCL Technologies Limited | www.hcltech.com3 HCL’s ICD-10 Transformation Framework ICD-10 Services ICD-10 Service Components HCL Enablers ICD 10 PROGRAM GOVERNANCE People Testing Phase Assessment Business Impact Assessment Technology Impact Assessment Prizm® eXact Methodology arkMedes™ Process Policy & Process Changes PM Smart People Training / KM Remediation Solution Phase Historical Data Analysis / Reports Business Intelligence System Upgrade Mapping / Crosswalk iCRM Functional Testing Integration Testing Parallel Testing Regression Testing Neutrality Testing Trading Partner Testing iDPC Testing Phase Tech COE BI & DW Infrastructure Mainframe Java Domain & Testing COE FACETS/QNXT Medical and Clinical Automation/Perfor mance COE Configuration Setup Custom Accelerators System Integration Re-usable Artifacts Post - Remediation
  4. 4. Copyright © 2014 HCL Technologies Limited | www.hcltech.com4 HCL’s ICD Crosswalk and Mapping Tool SINGLE SOURCE OF TRUTH FOR CODE MAPPING Customizable and Robust Code Mapping rule engine Ensures Clinical integrity and Payment neutrality of codes Multi-Layered Code mapping Approach Unique Search capabilities Workflow driven and Privilege based access User friendly GUI Integrated batch and online solution Customizable reporting and dashboards Mapping Crosswalk Modeling iCRM
  5. 5. Copyright © 2014 HCL Technologies Limited | www.hcltech.com5 ICD-10 Testing: HCL Point of View  The ICD-10 program impacts virtually every business process and system within a health plan  Traditional testing models with an IT-centric focus will be inadequate to meet the challenges  Key objective is to maintain business operations successfully in the post ICD-10 environment.  Calls for a robust testing framework which addresses –  Financial neutrality, clinical equivalence, benefit neutrality  Test data creation specific to ICD-10 migration  Prioritized testing based on risk based approach both internally and with external partners  Multiple partners with varying compliance strategies and timelines
  6. 6. Copyright © 2014 HCL Technologies Limited | www.hcltech.com6 Core Testing ServicesEnabling Functions Tools Group FACETS CoE Healthcare Payer CoE IV&V Quality Process Group Accelerators ICRM IDPC TFIB XC Accelerator Reusable Test Assets Test Program Management and Governance Metrics & SLA Dashboard & Reporting Test Strategy Test Estimation Reviews & Audits Manage Change & Risk Supporting Test Services Test Data Mgmt Test Environment Mgmt External Partners Mgmt TFIB™ Enabled Test Management End to End Testing Framework Testing Type Test Planning Test Design Test Execution Functional Testing    System Integration Testing    E2E Testing    Financial Neutrality Testing    Benefit Neutrality Testing    Operational Stability Testing    External Trading Partner Testing   
  7. 7. Copyright © 2014 HCL Technologies Limited | www.hcltech.com7 For Questions, Please Contact:
  8. 8. Copyright © 2014 HCL Technologies Limited | www.hcltech.com8