Is your medical management provider ready for ICD-10?

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1 Is your medical management provider ready for ICD-10? ICD-10 codes will replace all current ICD-9 codes Customized solutions. Consultative partnerships. Healthy outcomes.

2 What are ICD-10 codes? ICD-10-CM (Clinical Modification) codes are used to document diagnoses ICD-10 codes will replace ICD-9 codes There are more than 68,000 ICD-10-CM codes (compared to 14,000 in ICD-9-CM) Benefits to moving to ICD-10 Greater detail, allowing more specificity Reflects advances in medicine and medical terminology More flexible for future expansion in technology and diagnoses The transition to ICD-10 does not affect CPT codes 2

3 Why transition to ICD-10? Providers, health plan and health care clearinghouses are required to replace ICD-9 codes with ICD-10 codes. Most medical management companies are not required by law to comply with or address ICD-10. So why is American Health adopting ICD-10? We believe the benefits of preparing for ICD-10 outweigh the challenges. ICD-9 will no longer be maintained after ICD-10 is implemented and may become obsolete. These diagnosis codes affect many aspects of medical management: Utilization Management precertifications Referrals to Case Management Disease Management predictive modeling File interfaces Aggregate reporting 3

4 American Health believes transitioning to ICD-10 is not optional. We will implement ICD-10-CM (Clinical Modification) used for diagnosis coding. We will continue to use the industry standard Current Procedural Terminology (CPT) and Healthcare Common Procedures Coding System (HCPCS) used to report services and procedures in outpatient and office settings. 4

5 American Health s timeline Over the last 3 years, we have invested more than $2 million and 20,000 hours in the ICD-10 transition We ve partnered with industry experts Milliman and 3M for clinical code translation review and software management tools Impact Assessment 12/28/12 System Remediation 02/28/14 UAT Testing 09/26/14 Business Process Remediation 07/31/15 ICD-10 Deployment 10/01/15 Start 01/02/ Finish 03/25/16 Planning 03/23/12 External Vendor Testing 05/30/13 Aggregate Reporting Remediation 08/29/14 External Client Testing 06/26/15 ICD-10 Training 08/28/15 Post Monitoring 03/25/16 5

6 American Health has evaluated: Every client and system impacted by 5010 and ICD-10 Every report The client s intent for each system and reporting rule Which diagnosis code groups require translation (not just a simple mapping exercise) to ensure the client s customizations and intent remain accurate How clients can take advantage of the increased specificity of ICD-10 For example, making referrals to case management more appropriate 6

7 Where your provider should be now Your medical management provider should be addressing your testing needs and have a plan or budget to address training. American Health has: Reached out to clients regarding impacts and testing Completed initial training and is positioned for more detailed training 7

8 The basic questions you should be asking your provider 1. When will your ICD-10 compliant system be ready? 2. Who is my dedicated contact person? 3. Will your crosswalk or mapping strategy ensure that the intent of my rules and customizations are maintained after the transition to the new codes? 4. What steps have you already completed in your ICD-10 project? 5. Are you planning end-to-end external testing? 6. Will you provide training? 8

9 Questions? Contact Rich Surgener Senior Director, IT Program Management

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