Using an integrated set of software and services to help a non-profit community healthcare organization to comply with the new requirements of healthcare reform, the TriZetto Group has announced that it has helped the non-profit complete the steps to start meeting the regulations for compliance certification, according to a company press release.
El Paso First Health Plans, Inc., serving 95,000 people in the El Paso, Tex., worked with TriZetto to achieve a compliance plan, stated the press release.
“With the support of TriZetto’s consulting services team, El Paso First has fully grasped what to do, what the next steps are, and where we need to place strategic emphasis,” said Sharon Perkins, director of information systems at El Paso First. “TriZetto helped develop a strategic plan for execution, which was reviewed and approved by the State of Texas with no edits. That was amazing.”
When healthcare organizations’ compliance efforts are certified by the federal government, they are eligible for financial incentives.
The press release notes that, in three weeks, TriZetto’s consulting services team researched and designed a compliance strategy and plan, “identifying El Paso First’s needs, defining next-steps, and determining how to collaborate with group practices and medical facilities to ensure financial neutrality in claims administration.”According to the press release, El Paso then used the strategic roadmap to guide the organization’s “go-live” plan for both 5010 and ICD-10 compliance.
The 5010 regulations establish new standards for electronic transactions, while ICD-10 coding requires more specific, diagnosis and treatment information in patient care than the current ICD-9 code set, according to the press release.ICD-10 actually increases the number of codes clinicians use for reimbursement from insurers from about 17,000 a day to more than 140,000, according to Garri Garrison, director of consulting services at 3M Health Information Systems. This “allows for a much greater level of specificity in coded patient data,” said Garrison. This increased code specificity makes accurate clinical documentation critical to achieving accurate coding and billing,” stated Garrison.
“HIPAA 5010 and ICD-10 requirements figure prominently in planning by healthcare organizations around IT infrastructure and business processes,” added Jake Sorg, TriZetto’s senior vice president of consulting services, in the press release. “The most proactive, forward-looking health plans such as El Paso First are doing two things. They’re replacing or making major upgrades to their core administrative systems, and they’re coordinating with providers to secure financial neutrality in benefits administration and care delivery. El Paso First, for example, has turned the challenge of compliance into an opportunity to further improve its administrative efficiency.”
In an earlier move, a TriZetto enterprise core administration solution helped El Paso First improve its auto-adjudication rate for claims from 50 percent to 83 percent, with its average claim turn-around time declining from 30 days to eight to 10 days, and provider complaints decreasing 20 percent, and provider satisfaction rising nearly 30 percent.
Edited by
Brooke Neuman
