Partner Collaboration Blueprint for ICD-10 Transition

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1 Partner Collaboration Blueprint for ICD-10 Transition 1

2 ICD-10 Transition Framework ESTABLISH A COLLABORATIVE BUSINESS PROCESS TRANSITION PLATFORM FOR ICD-10 AND BEYOND Migrating to the ICD-10 coding system holds great promise for the healthcare industry in the United States, bringing much more clarity and insight from healthcare diagnostic and procedural information. The transition touches virtually every system and procedure across the healthcare continuum and is fraught with complexity and risk financial, clinical, and operational that could bring a healthcare organization to its knees if not implemented in close collaboration with all its trading partners. Moreover, failure to implement ICD-10 by established government mandated dates can result in significant fines and negatively impact the smooth operation of your day-to-day business. To succeed, it is critical to address the transition in a way that takes into account all the affected systems, processes, and stakeholders - both internal and external. A Collaborative Platform for Change While most solutions focus primarily on code mapping, TIBCO has taken a holistic approach to the ICD-10 transition, providing a reusable platform for facilitating project governance, stakeholder collaboration, code mapping, internal and partner testing, comparative analysis, and continued governance over the ICD-10 initiative and future disruptive business changes requiring partner collaboration. No organization can make this transition alone. With powerful visual analytics, a flexible, rules-based mapping tool, an automated testing engine, and secure social networking platform, TIBCO s collaborative ICD-10 enablement platform allows you to work with your partners to understand the impacts of coding decisions and work together to mitigate risks before moving to production. By its nature, TIBCO s framework is flexible, so it can be used in virtually any IT environment, and the components can be implemented individually to meet your specific needs or together for a comprehensive solution. 2

3 TIBCO Empowers All Stages of Transition Assessment and Planning TIBCO provides tools for facilitating the capture, analysis, and management of projects and processes, whether staffed with internal resources or external partners. Rather than focusing solely on automation, TIBCO takes a broad view of the work being done by bringing together process with contextual information that include transactions, documents and policies, training, and compliance as well as process automation. Define, capture, and deploy business process changes both manual and automated with a visual tool that makes them understandable while managing input from and acknowledgement by all stakeholders. Mapping and Analysis Get a clear understanding of what your production data will look like with a detailed analysis of activity, based on real-world data whether you rely on a TIBCO s framework for code translation mapping or bring your own. Automatically prepare volumes of ICD-10 test data based on historical production data to fine-tune internal rules, workflows, and procedures. TIBCO s framework helps address all aspects of overall Business Neutrality for the ICD-10 transition, which can be viewed as the cumulative impact of: Payment Neutrality minimizing the effects of shifts in DRG payments Benefit Neutrality avoiding expansion or reduction in benefits or out-of-pocket costs to members Revenue Neutrality ensuring no significant change to reimbursement Clinical Neutrality maintaining consistent levels of candidates in care management and wellness programs Operational Neutrality avoiding degradation to key performance metrics such as first pass or pend rates At the heart of TIBCO s ICD-10 framework is a secure, flexible, rules-driven mapping capability that allows you to build an integrated view between claims and reimbursements, and gives complete control of how ICD-9 codes are mapped to and from ICD-10 equivalents. Detailed reporting of historical activity provides the ability to prioritize efforts on the codes with the most volume or financial impact. The maps can even be exposed as services which can be integrated to provide lookup and governance into your systems for all business changes going forward. Collaboration Establish a true collaborative partnership by sharing your plans with partners through a secure enterprise social networking tool, gather feedback, and confirm acceptance of your governance plan. Maintain an ongoing dialog throughout the testing process to identify potential issues and facilitate remediation prior to going live with real-time, two-way communication. 3

4 TIBCO Empowers All Stages of Transition Comprehensive Testing When you re ready for partner testing, TIBCO s platform enables automated, round-trip testing of claims through your entire workflow even routing test files through test adjudication systems and facilitating the return of remittance advice. Detailed, flexible, and highly-interactive reporting with payment neutrality dashboards lets you and your partners dig deep into the returned data for meaningful analysis, comparing the payments under the ICD-9 coding structure to those expected based on ICD-10 codes for the same set of procedures to ensure financial neutrality. TIBCO s comprehensive, automated testing platform lets you: TIBCO s Partner Collaboration Blueprint empowers you to: Master the business change management process Collaborate securely with all stakeholders in real time Understand the business impacts of coding decisions Enable end-to-end partner testing Establish a reusable platform for managing future changes Build and follow an implementation road map involving all stakeholders Dramatically reduce the staff, cost, and time required for partner testing Ensure financial neutrality with detailed, comparative reporting and interactive dashboards Avoid service disruptions by testing the entire process end-to-end to uncover and resolve system problems and mapping discrepancies faster Empower you and your partners to fine-tune code maps through iterative testing to see the impact of coding decisions more quickly Increase the likelihood that partners will participate in testing Continuous Improvement Even in the most well-planned and executed ICD-10 transition, small and continuous changes to existing reimbursement schemas will occur over time. In areas like Medicare Advantage Plans or pay-for-performance, the ICD-10 mapping is likely to evolve considerably over the coming years. By maintaining the community of partners through the platform that you ve implemented for testing, you ll have in place the means for a continued, collaborative environment for facilitating those conversations and adjustments. Because TIBCO s approach and testing platform is flexible and comprehensive, it is designed to be the reusable foundation for future disruptive changes that require full regression testing and the ability to replicate the production environment to see data as it progresses through your system and impacts multiple stakeholders. With an agile platform for analysis and testing and real-time collaboration with trading partners, facilitate potential initiatives like 5010 to 6020, ICD-10 to ICD-11, contract negotiation, adjustments to benefit or medical policy, and changes over time to reimbursement. TIBCO enables healthcare organizations to mitigate the financial, clinical, and operational risks associated with the ICD-10 transition. Both providers and health plans are able to identify any potential impacts of the ICD-10 transition with each of their partners, and establish a collaborative environment for remediating issues prior to the transition date. TIBCO provides the ideal framework for ensuring continued business viability through the ICD-10 transition and other potentially disruptive changes in the future by establishing a reusable, comprehensive testing platform, business process change management tools, and a secure social networking solution for working collaboratively with your trading partners. 4

5 About TIBCO TIBCO Software Inc. (NASDAQ: TIBX) is a provider of infrastructure software for companies to use on-premise or as part of cloud computing environments. Whether it s efficient claims or trade processing, cross-selling products based on real time customer behavior, or averting a crisis before it happens, TIBCO provides companies the two-second advantage - the ability to capture the right information, at the right time and act on it preemptively for a competitive advantage. More than 4,000 customers worldwide rely on TIBCO to manage information, decisions, processes, and applications in real time. Learn more at Global Headquarters 3307 Hillview Avenue Palo Alto, CA Tel: Fax: , TIBCO Software Inc. All rights reserved. TIBCO, the TIBCO logo, The Power of Now, and TIBCO Software, are trademarks or registered trademarks of TIBCO Software Inc. in the United States and/or other countries. All other product and company names and marks mentioned in this document are the property of their respective owners and are mentioned for identification purposes only.

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