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Healthcare
Case Study




                      A Blue Cross Blue Shield Plan
                      ICD-10 Mapping Simplification & Business Rule Transition with
                      Infosys iTransform™ Product




             www.infosyspublicservices.com
Business Situation
                                         By October 1, 2014, healthcare organizations covered by the Health
                                         Insurance Portability and Accountability Act (HIPAA) are required to use
                                         the International Classification of Diseases - 10 (ICD-10) for all business
                                         transactions that contain any diagnosis or procedures information. The
                                         transition exercise is a complex process. Realizing success with the

        The Client                       ICD-10 transition requires healthcare organizations to adopt a solution
                                         that can help them gain business agility, lower the transition risk, reduce
                                         cost and effort, and innovate for market differentiation.

                                         As part of the ICD-10 migration program, the client wanted to create
                                         ICD-9 to 10 custom maps by overriding the CMS General Equivalence
                                         Mappings (GEMs), which could help them convert their existing
                                         ICD-9 based business rules and clinical policies to clinically equivalent
         A BlueCross BlueShield Plan,    ICD-10 codes. The client also sought a solution that would not only
                                         simplify the mapping complexities but also help maintain the maps
         part of a family of companies
                                         created in a common repository for enterprise-wide use and easy
         that finances and delivers      reference across their business units. The client engaged Infosys Public
         health care services and long   Services (Infosys) to incorporate its proprietary iTransform™ product
         term care insurance.            into its healthcare management portfolio to ensure a clinically accurate
                                         transition of the existing ICD-9 based business rules to ICD-10.



                                         Infosys Solution
                                         Infosys worked with the client from a very early stage to determine their
                                         transition approach, strategy and challenges. To define the right solution,
                                         Infosys conducted proper due-diligence through proof-of-concepts
                                         and workshops involving the program leaderships and end-users. This
                                         helped Infosys articulate the product fit and customization required to
                                         best suit the business needs, automate the code translation exercise, and
                                         address all crosswalk requirements at the enterprise level seamlessly.
                                         Along with the product implementation, Infosys also helped the client
                                         with necessary training and support to ensure a hassle free transition with
                                         least disruption to business continuity.

                                         Infosys iTransform™ product components implemented for ICD-10
                                         transition helped the client with the following capabilities:

                                            •	 iTransform™ Code Helper, a comprehensive knowledge repository
                                               of ICD-10 codes, helped end-users in easy understanding of the
                                               detailed and diversified new coding system. The component
                                               provided accurate knowledge of each character definition of
                                               the ICD-10 codes, its increased granularity, laterality, specificity,
                                               associated coding guidelines etc., which were pre-requisites for
                                               defining the correct ICD-10 mapping.

                                            •	 iTransform™ Mapping+ component was leveraged to evaluate
                                               the CMS GEMs and override these to establish necessary business
                                               specific custom maps. The direction agnostic and group mapping
                                               functionality of the product helped business users in determining
                                               the right ICD-10 codes for clinically appropriate translation of the
                                               business rules. The robust rules engine contributed significantly in
                                               automating the mapping process. The code management feature
                                               further eased the maintenance of the mapped code sets.



2 | Infosys Public Services
Implementing Infosys’ iTransform™ product and services for ICD-10 mapping delivered several
key business benefits to the client:



        Accurate mapping
1       Well-defined framework, robust rules engine, ability to analyze
        and override GEMs and tight governance process helped
        develop clinically accurate ICD-9 to 10 mapping and vice-versa




        Reduced coder training effort and increased proficiency
2       Through easy-to-use, self-learning training component




        Reduction in project cycle time and fast-track compliance
3       Through automated one-shot conversion of a range of ICD-9
        codes in the business rules to clinically equivalent ICD-10 codes




                                                                           Infosys Public Services | 3
About Infosys Public Services
Infosys Public Services is a U.S. based subsidiary of Infosys (NASDAQ: INFY),
a global business consulting & technology services company.
Infosys Public Services helps Healthcare & Public sector clients to
transform, innovate and optimize their organizations to build tomorrow’s
enterprise. We blend 30 years of commercial best practices with
innovative industry solutions, best-of-breed partner content and proven
execution to deliver measurable business value with predictability.

For more information, contact askus@infosyspublicservices.com                                                                                          www.infosyspublicservices.com
© 2012 Infosys Public Services, Plano, Texas, USA. Infosys Public Services believes the information in this publication is accurate as of its publication date; such information is subject to change
without notice. Infosys Public Services acknowledges the proprietary rights of the trademarks and product names of other companies mentioned in this document.

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Case Study - ICD 10 Compliance Blue Cross Blue Shield Plan

  • 1. Healthcare Case Study A Blue Cross Blue Shield Plan ICD-10 Mapping Simplification & Business Rule Transition with Infosys iTransform™ Product www.infosyspublicservices.com
  • 2. Business Situation By October 1, 2014, healthcare organizations covered by the Health Insurance Portability and Accountability Act (HIPAA) are required to use the International Classification of Diseases - 10 (ICD-10) for all business transactions that contain any diagnosis or procedures information. The transition exercise is a complex process. Realizing success with the The Client ICD-10 transition requires healthcare organizations to adopt a solution that can help them gain business agility, lower the transition risk, reduce cost and effort, and innovate for market differentiation. As part of the ICD-10 migration program, the client wanted to create ICD-9 to 10 custom maps by overriding the CMS General Equivalence Mappings (GEMs), which could help them convert their existing ICD-9 based business rules and clinical policies to clinically equivalent A BlueCross BlueShield Plan, ICD-10 codes. The client also sought a solution that would not only simplify the mapping complexities but also help maintain the maps part of a family of companies created in a common repository for enterprise-wide use and easy that finances and delivers reference across their business units. The client engaged Infosys Public health care services and long Services (Infosys) to incorporate its proprietary iTransform™ product term care insurance. into its healthcare management portfolio to ensure a clinically accurate transition of the existing ICD-9 based business rules to ICD-10. Infosys Solution Infosys worked with the client from a very early stage to determine their transition approach, strategy and challenges. To define the right solution, Infosys conducted proper due-diligence through proof-of-concepts and workshops involving the program leaderships and end-users. This helped Infosys articulate the product fit and customization required to best suit the business needs, automate the code translation exercise, and address all crosswalk requirements at the enterprise level seamlessly. Along with the product implementation, Infosys also helped the client with necessary training and support to ensure a hassle free transition with least disruption to business continuity. Infosys iTransform™ product components implemented for ICD-10 transition helped the client with the following capabilities: • iTransform™ Code Helper, a comprehensive knowledge repository of ICD-10 codes, helped end-users in easy understanding of the detailed and diversified new coding system. The component provided accurate knowledge of each character definition of the ICD-10 codes, its increased granularity, laterality, specificity, associated coding guidelines etc., which were pre-requisites for defining the correct ICD-10 mapping. • iTransform™ Mapping+ component was leveraged to evaluate the CMS GEMs and override these to establish necessary business specific custom maps. The direction agnostic and group mapping functionality of the product helped business users in determining the right ICD-10 codes for clinically appropriate translation of the business rules. The robust rules engine contributed significantly in automating the mapping process. The code management feature further eased the maintenance of the mapped code sets. 2 | Infosys Public Services
  • 3. Implementing Infosys’ iTransform™ product and services for ICD-10 mapping delivered several key business benefits to the client: Accurate mapping 1 Well-defined framework, robust rules engine, ability to analyze and override GEMs and tight governance process helped develop clinically accurate ICD-9 to 10 mapping and vice-versa Reduced coder training effort and increased proficiency 2 Through easy-to-use, self-learning training component Reduction in project cycle time and fast-track compliance 3 Through automated one-shot conversion of a range of ICD-9 codes in the business rules to clinically equivalent ICD-10 codes Infosys Public Services | 3
  • 4. About Infosys Public Services Infosys Public Services is a U.S. based subsidiary of Infosys (NASDAQ: INFY), a global business consulting & technology services company. Infosys Public Services helps Healthcare & Public sector clients to transform, innovate and optimize their organizations to build tomorrow’s enterprise. We blend 30 years of commercial best practices with innovative industry solutions, best-of-breed partner content and proven execution to deliver measurable business value with predictability. For more information, contact askus@infosyspublicservices.com www.infosyspublicservices.com © 2012 Infosys Public Services, Plano, Texas, USA. Infosys Public Services believes the information in this publication is accurate as of its publication date; such information is subject to change without notice. Infosys Public Services acknowledges the proprietary rights of the trademarks and product names of other companies mentioned in this document.