Gain absolute consistency and alignmentto the principles of neutrality while ensuring zero impact to business through remediation.
The shift to ICD-10 will represent a complex, time-consuming and expensive compliance challenge, one that is more complex than HIPAA remediation and more pervasive than Y2K. The ICD-10 conversion touches nearly every operational and information technology process and will dramatically influence data collection and financial reporting strategies throughout the industry. ICD-10 impacts the health plan’s day to day operations with a direct impact in critical functions such as financials, claims, medical management, benefits, etc.
HCL with its expertise and in depth knowledge of ICD-10 conversion can help health plans in addressing most of the imminent challenges with a well-defined ICD-10 transformation framework. HCL’s ICD framework is designed to mitigate the risks posed by the complex coding change while ensuring the alignment to the principles of neutrality. The framework, enabled by our proprietary tools and accelerators, also ensures that all business and technical impacts are identified and dealt with accurately.
HCL’s ICD-10 Transformation Framework
The transformation framework covers the entire life cycle from assessment through remediation to post-remediation support using HCL’s proprietary tools and accelerators. It integrates people, process and technology to ensure an on-time, high quality, predictable delivery experience.
Key services offered as part of the ICD-10 transformation include:
Assessment Services: Business and Technical Impact Assessment using HCL’s Prizm® framework and eXact Methodology Key Enabler: Prizm™, an HCL proprietary tool, helps in holistic assessment of the ICD impact on a health plans systems by processing data gathered from various sources and providing decisive intelligence to the management.
Remediation Services: Includes Code Analysis and Mapping, Policy Remediation and Application Remediation Key Enabler: HCL’s proprietary tool iCRM (ICD Crosswalk and Reimbursement Mapping) helps in mapping ,modeling and cross walk between ICD-9 and ICD-10 codes (vice versa).
Post-Remediation Services: End-to-end Testing Services including Test Planning, Data preparation, Text execution and Management. Key Enabler: The ICD testing services are enabled using HCL tool iDPC (ICD Data Prepare & Compare) to help payers address the challenges of benefit and financial neutrality testing as part of the ICD-10 conversion.
HCL also provides a Partner Collaboration Portal to assess the readiness of all of the payer’s business partners to accept ICD-10 transactions. The portal dashboard shows the readiness status of individual partners and helps to tracks communications between the payer and partner.
All of the above services are delivered by HCL’s team of Domain Experts, Technology Experts, Testing CoEs and a robust Program Management and Governance Model.
The key differentiators which HCL provides to its customers are:
Accurate mapping leveraging HCL’s 200,000+ proprietary clinical rules and bilateral maps
Integration with groupers and pricer to ensure financial neutrality
Historical Data Analysis which enables prioritization of ICD codes for risk based testing
EDI integration and test data generation facilitating end-to-end testing
Business Partner readiness assessment framework to enable and track ICD-10 compliance of the partners
Pre-defined test scenarios and a structured testing methodology, ensuring optimum test coverage
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