HCL ICD 10 Transition Services:Helping You Leverage Regulatory Compliance for a Competitive Advantage

The direct impact of ICD code change on the application level may not be big but the ongoing implications of this change will be massive considering its indirect impact affecting complete Financials, Adjudication and Payments, Disease management, Benefit management and other applications & workflows. Therefore, ICD 10 related change should be considered more than just a tactical IT exercise.

HCL Technologies’ fully integrated solution suite and transformation framework makes ICD 10 transition smooth and efficient today while helping you leverage its business impact for long term strategic advantage.

• HCL has multiple well tested frameworks, which have been utilized to create iCRF – these include PMSmart™ (for Program Governance), ArkMedes™ (for Knowledge Management), iDPC™ (for Testing), Prizm® (for Impact Assessment).

• iCRF utilizes HCL’s iCRM (HCL’s integrated Mapping, Modeling, Crosswalk) tool.

• iCRF is supported by a detailed step-by-step workflow and a rich repository of templates, artifacts and best practices.

• iCRF is enabled via automation and has multiple levels of in-built dashboards, trackers and status reports which are role and track based.

• iCRF is supported by HCL Payer Academy to train and certify practitioners

iCRF: An Integrated e2e ICD 10 Transformation Framework

iCRMAt the core of iCRF is HCL’s industry leading crosswalk, mapping & analytics tool – iCRM.

COE

Business Intelligence & Data Warehouse

Enterprise Transformation Services

Infrastructure

Mainframe

Jave

MicrosoftIntegration

DomainHealthcare Payer SME

Medical & Clinical

BA & BPR

Program Governance Knowledge Management

People

Training

Policy & Process

Changes

People Process

TestingTesting Phase

Solution Phase

Crosswalk System Upgrade

Field Expansion

New System

Integration Business Integration Integration

Assessment PhaseRemediation Approach Preparation

Technology Impact Assessment Business Impact Assessment

PM Smart arkMedes™ IDPC Framework eXact Methodology Prizm®

Production & Roll Out

Roll Out Phase

iCRM

Technology

Developed by a team of physicians, clinicians, medical coders, technology experts & health insurance industry veterans HCL’s iCRM is an end to end ICD transformation tool & offers several differentiators like:

Bilateral Mapping: HCL’s bilateral mapping functionality includes mappings which were not covered by GEMs. These mappings are over and above GEMs and have been created both for forward and backward mapping.

Historical Data Analysis: i-CRM is designed to analyze and identify the ICD-9 codes that have one to- one, one-to-many and No match to the corresponding ICD-10 codes. This analysis would help determine the specificity of the mapping and the effect it will have on reimbursement.

HCL Rules: HCL’s five levels of rules edits for both forward and backward mapping will enable Payers to narrow down from multiple to minimum possible choices and ultimately choose a single code from ICD-10 (forward mapping) and ICD-9(backward mapping) without losing the clinical integrity of the claim.

Crosswalk for Live claims: i-CRM has the capability to convert incoming live claims (via the EDI gateway) incase the Payer plans to process all ICD-10 based claims with ICD-9 based adjudication systems. This feature will maximize the Auto Adjudication.

Reimbursement Mapping: CMS created Reimbursement Mappings in an attempt to identify the best mapping option for reimbursement purposes. The reimbursement mappings focus only on backward mapping i.e. ICD-10 to ICD-9. I-CRM leverages these mappings to help payers do a 1:1 map in backward mapping.

Financial Neutrality: DRG’s play a vital role in determining pricing in a claim. i-CRM helps determine which ICD codes have potential DRG shifts in the historic claims. Thus helps Payers do an analysis on how they can achieve financial neutrality.

HCL’s iCRM provides features to analyze data, configure rules, and automate the mapping from ICD- 9 to ICD-10 codes. iCRM will help Payers address all crosswalk requirements at an enterprise level. HCL also offers various services around the tool with technical and domain capabilities to expedite the process of implementing ICD-10 at an enterprise level.

iCRM is developed as a web based tool that can be integrated with any application or system in the Payer portfolio. It addresses all types of integration and data handling with respect to real-time, batch and user queries.

HCL’s Other Services for ICD 10 TransformationICD Remediation ServicesHCL established its ICD-10 CoE in 2009 to assist Payer and Provider organizations in achieving a smooth transition to ICD-10. The ICD-10 CoE has a dedicated pool of roughly 500+ HCL resources made up of senior representatives with strong healthcare domain expertise, including practicing physicians, nurses, medical coders, clinical analysts, domain analysts, business consultants, solution architects, and technical experts

The ICD-10 specialists from HCL help mitigate the risks posed by the complex coding change, align to the principles of Neutrality and ensure that benefits and member out of pocket payments are dealt with accurately with the highest level of automation through a tested approach:

Business Remediation Services (Mapping Competency Center)To ensure successful remediation of business artifacts, HCL has established ‘Mapping Competency Centre’, a tested approach, which will serve as a translation backbone and help successfully remediate all the business artifacts (medical policies, provider contracts and benefits).

Mapping Competency Centre helps to consolidate and prioritize business artifacts for remediation, do the mapping, conversion and outcome analysis for ICD codes and will perform multiple iterations (HCL prescribes 3 iterations), the outcome of which will recommend map revisions.

For efficient execution of Mapping Competency Centre, HCL has set-up a well-defined Governance Framework, comprising standard operating process, decision/accountability frameworks and compliance monitoring mechanisms.

Technical Advisory ServicesHCL’s technical advisory services helps healthcare organizations to plan the entire remediation cycle with minimal impact on day-to-day business operations. The execution approach will begin with Assessment and Planning Phase followed by a Proof of Concept for remediation. These are finally followed by review and finalization approach of overall remediation plan and a complete remediation phase. All of these phases are supported by various tools and accelerators designed specifically to assist in remediation process.

ICD-10 Testing ServicesThe change to the ICD-10 code sets will require updates to multiple systems and applications within a payer. Hence, testing will certainly need to include end-to-end, cross-functional, regression, internal and external components. ICD-10 would also require analytics for validating results of the test transactions, and impact to business process of those results. In particular, if crosswalks are involved, there will be a need to analyze the results in much greater detail. Testing will need to be well thought out and planned for in advance of the updates to reimbursement, utilization, underwriting and many other operational processes.

In this scenario, planning a test strategy at the earliest opportunity, coordinating both internally and externally and leveraging efficient and comprehensive testing methodologies ensures a low-risk, high-quality output from testing. In addition, organizations should explore the many tools available to help with testing needs, which can ultimately reduce time and cost for these projects. HCL’s iData Prepare iData Compare tool allows payer’s to import a significant number of historical ICD-9 claims (e.g. two years) and convert them to ICD-10 claims (see diagram).

iDataPrepare

iCompare

Hello, I’m from HCL! We work behind the scenes, helping our customers to shift paradigms and start revolutions. We use digital engineering to build superhuman capabilities. We make sure that the rate of progress far exceeds the price. And right now, 90,000 of us bright sparks are busy developing solutions for 500 customers in 31 countries across the world. How can I help you?

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HCL’sEmployeesFirstisanewandradicalmanagementphilosophywhichwillcatchonwiththeworldsoonerorlater

DardenSchoolofBusinesshasdoneacasestudyontheimpactcreatedbyHCLthroughits“EmployeesFirstCustomersSecond”practice

Rankedastheworld’sMostInnovativeCompanyforitsworkforcepractices

WorldBlulistsHCLasoneofthe44MostDemocraticWorkplacesintheWorld

ExclusivereportonEFCSrecognizesthatthisphilosophyempowersHCL’sfrontlineemployeestomakedecisionsandtakeactionsforthebenefitofcustomers

HarvardBusinessSchoolteachesaboutHCLasacasestudyonbusinesstransformationhighlightingtheEmployeesFirstinitiative

Employees First, Customers Second isnowabookpublishedbyHarvardPress.Admiredbymanyglobalthoughtleaders-TomPeters,TonyHsieh,GaryHamel,JudyMcGrath,RamCharan,VictorK.Fung

HCL’sEmployeesFirstand‘democratization’ofmanagementconceptcould‘bringaboutacorporaterenaissance’

OneofBritain’sTopEmployersforthe4thConsecutiveYear

tHe WorLD is NotiCiNg SOMETHING UNIqUE ABOUT HCL

it is EMPLOYEES FIRST

Hello, I’m from HCL!Weworkbehindthescenes,helpingourcustomerstoshiftparadigmsandstartrevolutions.Weusedigitalengineeringtobuildsuperhumancapabilities.Wemakesurethattherateofprogressfarexceedsthe price. And right now, 77,000 of us bright sparks are busy developing solutions for 500 customers in29countriesacrosstheworld.How can I help you?

www.hcltech.com

BestEmployerinIndia–HewittStudy2009

The World is Noticing Something Unique about HCL

The‘EmployeesFirst’philosophyatHCL,thefirstsucharticulationintheITIndustry,isatthecoreofoureffortstoprovideouremployeeswithaworkenvironmentandculturethattheycantakepridein.

HCL’sEmployeesFirstisanewandradicalmanagementphilosophywhichwillcatchonwiththeworldsoonerorlater

DardenSchoolofBusinesshasdoneacasestudyontheimpactcreatedbyHCLthroughits“EmployeesFirstCustomersSecond”practice

Rankedastheworld’sMostInnovativeCompanyforitsworkforcepractices

WorldBlulistsHCLasoneofthe44MostDemocraticWorkplacesintheWorld

ExclusivereportonEFCSrecognizesthatthisphilosophyempowersHCL’sfrontlineemployeestomakedecisionsandtakeactionsforthebenefitofcustomers

HarvardBusinessSchoolteachesaboutHCLasacasestudyonbusinesstransformationhighlightingtheEmployeesFirstinitiative

Employees First, Customers Second isnowabookpublishedbyHarvardPress.Admiredbymanyglobalthoughtleaders-TomPeters,TonyHsieh,GaryHamel,JudyMcGrath,RamCharan,VictorK.Fung

HCL’sEmployeesFirstand‘democratization’ofmanagementconceptcould‘bringaboutacorporaterenaissance’

OneofBritain’sTopEmployersforthe4thConsecutiveYear

tHe WorLD is NotiCiNg SOMETHING UNIqUE ABOUT HCL

it is EMPLOYEES FIRST

Hello, I’m from HCL!Weworkbehindthescenes,helpingourcustomerstoshiftparadigmsandstartrevolutions.Weusedigitalengineeringtobuildsuperhumancapabilities.Wemakesurethattherateofprogressfarexceedsthe price. And right now, 77,000 of us bright sparks are busy developing solutions for 500 customers in29countriesacrosstheworld.How can I help you?

www.hcltech.com

BestEmployerinIndia–HewittStudy2009

HCL’s Employees First is a new and radical management philosophy which will catch on with the world sooner or later

Harvard Business School teaches about HCL as a case study on business transformation high-lighting the Employees First initiative

Best Employer in India – Hewitt Study 2009

Employees First, Customers Second is now a book published by Harvard Press. Admired by many global thought leaders - Tom Peters, Tony Hsieh, Gary Hamel, Judy McGrath, Ram Charan, Victor K. Fung

One of Britain’s Top Employers for the 4th Consecutive Year

HCL’s Employees First and ‘democratization’ of management concept could ‘bring about a corporate renaissance’

Darden School of Business has done a case study on the impact created by HCL through its “Employees First Customers Second” practice

Ranked as the world’s Most Innovative Company for its workforce practices

WorldBlu lists HCL as one of the 44 Most Democratic Workplaces in the World

Exclusive report on EFCS recognizes that this philosophy empowers HCL’s frontline employees to make decisions and take actions for the benefit of customers

The ‘Employees First’ philosophy at HCL, the first such articulation in the IT Industry, is at the core of our efforts to provide our employees with a work environment and culture that they can take pride in.

It is Employees First

For more information please visit: http://www.hcltech.com/lifescience-healthcare/payers or email: contact.lsh@hcl.com

HCL’s recommends ICD-10 remediation testing as follows• Payers should analyze their own historical data to understand the ICD-9 distributions with respect

to ICD-9 codes usage per provider, contribution to pay out per ICD-9 code, distribution of codes in the 23% of ICD-9 codes mapping 1 to many ICD-10 codes, etc.

• Use the analysis reports to identify the right set of claims with high priority ICD-9 and 10 codes to test, since it would be difficult to test all codes

• Prepare the test environment for executing the tests on end-to-end processes

• Compare the outcomes of EOBs and ERAs to ensure that benefits and provider reimbursements are identical for the same claim with ICD-9 and equivalent ICD-10 codes

HCL’s unique approach and its toolsets are equipped with the intelligence to analyze historical data and be able to cull out a statistically valid dataset. This approach helps to test all applications in sequence to ensure that the maps developed with various factors like clinical equivalence and financial neutrality are intact.