An improved classification of diseases in the diagnostic and the procedure codes is crucial for providing high-quality and effective patient care. The U.S. Department of Health and Human Services (HHS) has proposed that all healthcare organizations replace the current ICD-9-Clinical Modification codes with the ICD 10 codes. The transition to ICD 10 involves multiple challenges, such as substantial investments in ICD business and IT remediation, the development of more-effective models for deriving useful insights from ICD 10 data, an overhaul of existing systems to fit ICD 10 codes, and disruptions in important functional areas such as finance, claims and medical management, and benefits. With vast experience and domain knowledge in healthcare and in the ICD space, HCL can help organizations address most challenges related to the transition to ICD 10. Our ICD 10 transformation framework is designed to mitigate the risks introduced by complex ICD 10 coding structures, align them to the principles of neutrality, and identify and deal with business and technical impacts of the transition. Gain absolute consistency and alignment to the principles of neutrality while ensuring zero impact to business through HCL’s ICD 10 remediation solutions. To know more, read here: http://microsite.hcltech.com/gainwithchange/ICD.asp

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HCL – Healthcare Payer Solutions
ICD Transformation

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ICD -10
 The US Department of Health and Human Services (HHS) has proposed a long-awaited regulation that will
replace the ICD-9-Clinical Modification code sets to report healthcare diagnoses and procedures, with
advanced ICD-10 code sets. The tentative date of compliance is 2014.
 Transitioning to ICD-10 involves an overhaul of the current coding systems, and requires substantial
investments in doing ICD Business & IT Remediation.
 ICD-10 Transformation Services include (Impact Assessment, ICD Remediation, ICD Testing)
 HCL has developed an end- to-end solution called as i-CRM: ICD Crosswalk and Reimbursement Mapping
which helps in mapping, modeling and cross walk between ICD-9 and ICD-10 codes (vice versa).CMS defined
GEMs guidelines provide 1-1 approximate maps for up to 77% of the ICD codes. HCL has built more than
200,000 clinical rules along with the GEMs guidelines so as to reduce the 23% of 1-many ICD-10 code
mappings. With these rules the iCRM solution is able to deliver 1-1 mappings up to 94% vs. only 77% under
GEMs.
 HCL has developed an ICD Testing Tool iDPC: ICD Data Prepare & Compare for end-to-end and system
testing to help payers address the challenges of benefit and financial neutrality testing as part of the ICD-10
conversion. iDPC identifies statistically valid test data from historical claims and provides ICD9 code coverage
statistics at various levels e.g. Test Deck, Test Scenario with proper case mix. It also supports End to End Test
Management from Data Generation, Case/Scenario Management to Test Run Management.
 End to End ICD10 Transformation service to help payers adhere to compliance mandate and remediate claims
processing systems
 One-Stop-Shop Solution for doing end –end ICD-10 transformation services using Tools (i-CRM & iDPC) &
Services
 HCL’s ICD Framework integrate all 3 (Business, Technical, Operation) units, diminishes gaps and stabilizes the
ICD Plan.
MARKET NEED
FEATURES
BENEFITS

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HCL’s ICD-10 Transformation Framework
ICD-10 Services ICD-10 Service Components HCL Enablers
ICD 10 PROGRAM GOVERNANCE
People
Testing Phase
Assessment
Business Impact Assessment
Technology Impact Assessment
Prizm® eXact Methodology
arkMedes™
Process
Policy & Process
Changes
PM Smart
People Training /
KM
Remediation
Solution Phase
Historical Data
Analysis / Reports
Business Intelligence
System Upgrade
Mapping / Crosswalk
iCRM
Functional Testing Integration Testing Parallel Testing
Regression Testing
Neutrality
Testing
Trading Partner Testing
iDPC
Testing Phase
Tech COE
BI & DW
Infrastructure
Mainframe
Java
Domain & Testing
COE
FACETS/QNXT
Medical and
Clinical
Automation/Perfor
mance COE
Configuration Setup
Custom Accelerators
System Integration
Re-usable Artifacts
Post - Remediation

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HCL’s ICD Crosswalk and Mapping Tool
SINGLE SOURCE OF TRUTH FOR CODE MAPPING
Customizable and Robust Code
Mapping rule engine
Ensures Clinical integrity and
Payment neutrality of codes
Multi-Layered Code
mapping Approach
Unique Search capabilities
Workflow driven and
Privilege based access
User friendly
GUI
Integrated batch and
online solution
Customizable reporting and
dashboards
Mapping
Crosswalk
Modeling
iCRM

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ICD-10 Testing: HCL Point of View
 The ICD-10 program impacts virtually every business process and
system within a health plan
 Traditional testing models with an IT-centric focus will be inadequate to
meet the challenges
 Key objective is to maintain business operations successfully in the post
ICD-10 environment.
 Calls for a robust testing framework which addresses –
 Financial neutrality, clinical equivalence, benefit neutrality
 Test data creation specific to ICD-10 migration
 Prioritized testing based on risk based approach both internally and
with external partners
 Multiple partners with varying compliance strategies and timelines

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Core Testing ServicesEnabling Functions
Tools Group
FACETS CoE
Healthcare Payer
CoE
IV&V
Quality Process
Group
Accelerators
ICRM
IDPC
TFIB
XC Accelerator
Reusable Test
Assets
Test Program Management and Governance
Metrics & SLA Dashboard & Reporting
Test Strategy Test Estimation Reviews & Audits
Manage Change & Risk
Supporting Test Services
Test Data Mgmt Test Environment Mgmt External Partners Mgmt
TFIB™ Enabled Test Management
End to End Testing Framework
Testing Type Test Planning Test Design Test Execution
Functional Testing   
System Integration Testing   
E2E Testing   
Financial Neutrality Testing   
Benefit Neutrality Testing   
Operational Stability Testing   
External Trading Partner Testing   

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For Questions,
Please Contact: contact.lsh@hcl.com

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