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The HCI Group ICD-10 Payer Services

ICD-10 Payer Services

The proliferation of codes and system changes that the ICD-10 conversion necessitate could facilitate smoother claims processing now as well as accommodate future advances in care and technology.

HCI’s ICD-10 Payer Services eases the transition to ICD-10 coding by providing health plans with the people, processes and technology that they need to meet the deadline for compliance—and to improve payment strategies and care guidelines.

Our experienced healthcare payer consultants and candidates will help you pay accurately, operate smoothly and coordinate efficiently with vendors and providers.

From assessment and planning to transition and testing, HCIPayer delivers the health insurance IT specialists that you need to prepare for and benefit from the conversion to ICD-10.

  • Mitigate reimbursement increases by proactively establishing claims policies that account for the additional specificity of ICD-10 CM and ICD-10 PCS.
  • Improve patients’ wellness by establishing provider contracts based on quality of care.
  • Minimize disruptions in claims processing by preparing staff, vendors and providers for new codes and policies.
  • Connect seamlessly with external systems to facilitate end-to-end processing.
  • Collect, analyze and use post-implementation data to align coverage policies, provider contracts and clinical codes with value-based reimbursement initiatives.

Focused on healthcare IT staffing and consulting for insurers, HCIPayer specializes in providing health plans the resources and solutions they need to efficiently process claims, manage wellness and maintain privacy as they address challenges like the ICD-10 conversion.

As part of one of the fastest-growing healthcare companies in the United States, we provide payers with experienced ICD-10 payer consultants and professionals to ease your transition.

  • Adapt system interfaces
  • Establish coverage policies
  • Install ICD-10 codes
  • Review and revise General Equivalence Mappings (GEMs) and reimbursement crosswalks
  • Test changes in your electronic health records (EHR) system
  • Train coders
  • Update software

Our ICD-10 payer consulting and staffing services assist you in improving both your clinical and financial systems.

ICD-10 Payer Consulting

With access to some of the most skilled ICD-10 consultants for health plans through our worldwide talent pipeline, HCI’s Payer Services division can help you reduce your implementation costs and increase the return on your investment by helping you to plan and execute an effective ICD-10 transition strategy.

  • Adapt changes in crucial areas such as quality reporting, preauthorization for services, patient eligibility verification, and documentation of patient visits.
  • Anticipate and address possible increases in reimbursements related to new codes.
  • Avoid backlogs of claims by helping providers prepare them properly and teaching internal staff to process them correctly.
  • Maintain consistency in your relationships with providers, clearinghouses, billing services and software vendors by coordinating plans and preparations.
  • Prepare for a dual-coding environment in which ICD-9 and ICD-10 may be used simultaneously.
  • Promptly pay claims by confirming compatibility between internal and external systems through comprehensive end-to-end-testing.
  • Train staff in ICD-10 coding and assist them in related duties like developing rules for fraud detection, claims auditing and medical policy
     

ICD-10 Payer Staffing

Whether for staff augmentation or permanent placement, insurers can access top caliber health IT professionals experienced in ICD-10, through HCIPayer’s proven placement services. Representative ICD-10 experienced specialties include:

  • Tester
  • Data analyst
  • Quality assurance manager
  • Project manager
  • Systems analyst
  • Report specification writer
  • Claims analyst
  • Claims manager
  • Provider support specialist
     

Easing Your ICD-10 Payer Conversion

The proliferation of codes and system changes that the ICD-10 conversion necessitate could facilitate smoother claims processing now as well as accommodate future advances in care and technology.

As a payer, assessing, planning and implementing improvements to your contracting and clinical operations could help you reduce your costs while attaining better care for your patients by building reimbursement policies and treatment protocols based upon the additional insight that the collection of greater details will provide.

HCIPayer provides you the people, processes and technology to do so.

“With a rapidly changing healthcare financial environment, HCI was able to provide expertise in charge services, revenue cycle management and charge description master—who were not only effective, but transferred knowledge to our own staff.”
—Rob Bart MD, CMIO, LA County Department of Health Services

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