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Leading Blue Payer

Leading Blue Payer

Client

An independent license of the Blue Cross Blue Shield Association offering benefits and services to members through its array of indemnity and managed care products.

Business Problem

  • Comply with ICD-10 regulatory requirement
  • Impact to multiple Business and IT application workflows
  • Managing complex mapping scenarios with minimal impact
  • Identifying impacts to various medical policies
  • Maintaining clinical equivalence and payment neutrality for minimal ICD-10 transition impact
  • Maintaining Benefit neutrality and updating various business artifacts
  • Ensuring no impact to operational stability

 

Solution

 

HCL proposed its proprietary ICD-10 tool suite comprising of consulting frameworks, mapping tool, testing frameworks and testing tool. The highlights of solution provided by HCL include:

  • Experienced Medical coders and clinicians to perform mapping of complex scenarios
  • Creation of custom maps to achieve clinical equivalence
  • Medical Policy Remediation with the help of Domain experts and medical coders
  • DRG Shift analysis to address payment neutrality

 

Value Delivered

 

  • Provided the client with a clear understanding of ICD-10 code usage and complexity associated in the key medical policies for different functional areas
  • Created a repeatable process for code mapping and governance
  • Data analytical services using payer's historical claim data
  • A variety of assessment reports, from multiple perspectives, for the financial neutrality impact analysis
  • Consulting services for Neutrality-provider reimbursements, medical policy management and benefits management

 

HCL's Strength

 

  • Strong Domain knowledge in healthcare space
  • Already offering ICD-10 consulting services to large number of Payers
  • Dedicated ICD COE with 500+ SME's
  • Tools and Accelerators
  • Testing, Technology COEs

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