Edifecs Unveils New Collaborative Testing Solution that Reduces Risk Associated with ICD-10 Transition

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Payers and providers can work together to understand payment variances and minimize disruptions.

Healthcare IT testing has historically focused on compliance with electronic data interchange (EDI) file formats such as those required by HIPAA. However, when mandated changes occur that will affect provider-payer contracts, more extensive testing is necessary to understand and mitigate financial risk. A prime example is the ICD-10 mandate, which must be completed by October 1, 2014. Edifecs Inc., a healthcare IT solutions provider, today announced general availability of the Edifecs Collaborative Testing Solution, a secure, online testing portal that enables payers and providers to jointly design testing requirements, share test data, exchange transactions and analyze results. Using this solution with their contracted healthcare providers, payers can manage contracts and reimbursement rates with mutual confidence in financial outcomes. Edifecs Collaborative Testing is a new, more business-focused approach to payer-provider testing that will support the healthcare industry’s transition to ICD-10 and other mandates.

While external testing is required to demonstrate ICD-10 compliance, the sheer volume of codes and transactions make it time- and cost-prohibitive to test every possible transaction. Most payers will choose instead to focus on the clinical scenarios most likely to create the greatest risk and test with the subset of providers most likely to submit them.

Edifecs Collaborative Testing helps jumpstart payer-provider testing by providing a repository of more than 1,500 clinical scenarios to cover high-risk codes. By sharing test data with their provider network and conducting external testing using these scenarios, payers can leverage the results to minimize payment variances as they shift ICD-9-based components of provider contracts to ICD-10.

As the healthcare industry evolves and adapts to newer mandates, collaborative testing will become increasingly necessary. Healthcare providers and payers both need greater clarity into the content of transactions, rather than just file formats. A collaborative approach to testing will reduce the number of rejected claims and minimize operational and financial disruption.

Edifecs Collaborative Testing addresses the three biggest issues with traditional testing methods:

  • Lack of a collaborative testing framework – Joint development of testing strategies and plans requires better processes, stronger relationships and a more modern infrastructure than traditional methods; otherwise, testing efforts will suffer from increased delays, cost overruns, lack of scalability and data inconsistencies. Edifecs Collaborative Testing is a secure, online payer-provider portal that provides the testing framework healthcare organizations need without costly and difficult-to-manage infrastructure.
  • Difficulty in gathering test data and validating transactions through the lifecycle – Instead of manual processes for determining test scenarios, identifying and exchanging test data, and notifying information trading partners of any questions or errors, Edifecs Collaborative Testing offers an organized, step-by-step program. Payers can take advantage of the existing repository of clinical scenarios, share test data with providers, easily answer their questions and automatically notify them of errors in a secure, online environment.
  • Difficulty in understanding payment variances from ICD-9 to ICD-10 – The key to successful collaborative testing for ICD-10 is the ability to understand payment variances. Payers and providers need to compare payment amounts between ICD-9 and ICD-10 as part of the testing process and then update contract terms to reflect the test results. Edifecs Collaborative Testing provides a portal where providers can view and analyze test results in ICD-9 and ICD-10 for comparable claims. Payers and providers can then use the results to update contract terms to achieve financial neutrality after ICD-10 transition or review coding behavior against expected ICD-10 baselines and peer groups to improve coding accuracy.

"Not only is the transition to ICD-10 resource-intensive for both payers and providers, it holds significant risk because claim reimbursements depend on accurate coding. Given the complexity of ICD-10 and potential for considerable variance, neither payers nor providers can afford to take that chance," said Sunny Singh, CEO of Edifecs. "Our goal with our collaborative testing solution is to ensure our customers—payers and providers alike—experience as little variance as possible in business operations and payment patterns after the October 2014 deadline. Collaborative testing requires the cooperation of both entities to achieve not only the desired results for their own organization, but for their partners as well."

About the ICD-10 Transition

The World Health Organization revises classifications almost every decade. Only a handful of nations—including the United States—have not already embraced ICD-10, where adoption is set for October 1, 2014. The change is profound. On one hand, the new era offers the many advantages of deeper data. On the other, it risks financial, clinical and administrative upheaval. One reason is the volume of additional information. ICD-9 consists of approximately 17,000 codes; however, ICD-10 includes more than 141,000 codes, encompassing a host of new diagnoses and procedures, which provide meaningful information about health conditions and surgical procedures for analysis and reporting.

About Edifecs, Inc.

An industry leader since 1996, Edifecs provides healthcare software solutions that improve operational performance by streamlining the exchange of information among health plans, healthcare providers and government agencies, while enabling compliance with current mandates such as HIPAA, Operating Rules and ICD-10.

Today, more than 250 healthcare customers use Edifecs technology to unify transactions from any information channel source and input mechanism, while automating manual business processes such as enrollment, claims and payments management.

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Robin Rees
Edifecs, Inc.
+1 (425) 435-2606
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