jawood hipaa 5010 solution (3)
DESCRIPTION
TRANSCRIPT
[email protected] 888.822.5984 www.jawood.com
GARTNER COST STUDY
Cost Category
Percentage of Total Costs(Providers)
Percentage of Total Costs
(Health Plans)
Hardware Procurement 0% 0%
Software Costs 15% 10%
Transmission Costs 0% 0%
New Data Collection 0% 0%
Customized Software Development 5% 2.5%
Testing CostsTesting Costs 60%60% 70%70%
Training Costs 5% 2.5%
Transition Costs 15% 15%
Total 100 % 100%
“HIPAA systems implementation costs form the majority of costs associated with the HIPAA Version 5010 proposed rule. The following table summarizes the cost categories and an estimate of each category as a percentage of total costs incurred. The major cost item is the TESTING COSTS – these costs on average are estimated to account for 60% to 70% of the total costs that will be incurred.” - Gartner*
*Gartner. Version 5010 Regulatory Impact Analysis – Supplement. September 2008
3
Testing CostsTesting Costs 60%60% 70%70%
4010A1 – 5010
[email protected] 888.822.5984 www.jawood.com
Questions
4
1.What are the impacts to your enterprise in support of HIPAA 5010 Implementation?
2.Have you considered ALL the projects spanning the 5010 go-live date and those requiring HIPAA transaction input? ICD-10!
3.Will your existing test beds based on HIPAA transactions for Benchmark, Release Management, QA Validation, UAT be converted?
Let the Jawood Solution funnel out your Data Conversion Requirements all while saving you 50% in cost over
5010 DATA REQUIREMENTS / SCOPE
Tools Processes Resources
[email protected] 888.822.5984 www.jawood.com5
4010A1 – 5010
[email protected] 888.822.5984 www.jawood.com6
Questions1.What is the volume of EACH transaction within your enterprise that will need to be converted? 10,000? 100,000? More?
2.How will you provide quality in test data creation to mitigate enterprise risk?
3.How much will the conversion cost?
5010 TEST DATA COSTS
5010 Data Conversion
Cost
Test Coverage / Risk Mitigation100
Risk
Jawood
Solution
Man
ual
Save
up to 6
0%
0
Costs for Manual Claim Conversion
Time: 1 claim = 30 minutesCost: 1 claim = $ 22.00
1,000 claims = $ 22,000.0010,000 claims = $ 220,000.00100,000 claims = $ 2,200,000.00
[email protected] 888.822.5984 www.jawood.com7
Savings with the Jawood Solution
The greater the risk mitigation / the greater the test coverage – THE GREATER THE SAVINGS / THE LOWER THE RISK!
RISK MITIGATION
[email protected] 888.822.5984 www.jawood.com
• To minimize risk, the volume of claims, membership records and inquiries required to meet the acceptable mitigation levels:
• 100% of high dollar claims
• 100% of high volume transactions
• 100% of special claims where errors become media worthy (HIT, HOT, PT, Chiro)
• Highly visible accounts or encounter/ non-reimbursable accounts
• Historically, organizations have assumed high levels of risk due to the cost of finding and creating the right amount of test data to properly test conversion type projects.
• Small number of transactions created
• Transactions created did not test high risk areas
• Validation flawed, human intervention required
8
VALUE PROPOSITION
[email protected] 888.822.5984 www.jawood.com
By utilizing Jawood’s Products and Services your plan can:
• Lower Project Costs
• Reduce time to develop test data to meet all test types and project expectations
• Reduce project staff due to Jawood expertise (PM, DM, SA, PA, Test Specialist)
• Reduce project costs using offshore blended model
• Additional savings with shared test strategies and tool load with other Blue Plans
• Reduce project lags due to test support in the early stages versus identification in UAT
• Improve risk mitigation, meet audit expectations
• Improve provider/account satisfaction scores
• Reduce post implementation errors and recoveries
• Meet key Business Objectives thru extensive test support• Verification: Payout, First Pass Rate, TPA/Provider/Clearinghouse, System Performance
9
JAWOOD TOOL SET
Tools
• Felix@4010-5010:
• Easy to use, high volume 4010A1-5010 converter testing mapping, field expansion, new code
sets, and non compliance.
• Felix@ANSI-Claim-Generator:
• Fully functional, highly customizable ANSI X12 837 Claims Test data generator that caters to
all business and technical scenarios.
• Felix@Payer-Testing-Platform:
• On multiple cycles of execution, for any size IT projects, you will be able to analyze, trend,
report, and store data in any file format.
• Jawood@Claim-Locator-Extractor
• Based on claims identification (diagnosis, procedure, provider, etc), filter incoming data and
track the success of building the perfect test file to meet enterprise risk mitigation.
[email protected] 888.822.5984 www.jawood.com10
TOOL ASSESSMENT
• Automatic conversion to:
• Test all new field boundaries
• Test all new / revised code sets
• Force non-compliance
• Generation of multiple 5010 test claims based on a single 4010A1
• Full comparison and storage of multiple test cycles to demonstrate progress
• Ease of setting default values for all new data fields
• Capability to complete conversions real-time or batch for files in excess of 5,000
[email protected] 888.822.5984 www.jawood.com11
4010A1 – 5010 : JAWOOD Enterprise Tool Deployment
400,000 claims
ClaimLocator /Extractor
Based on Test Grid Loaded
4010A1
10,000 claims
4010A1
Jawood / Felix: Tool Set
[email protected] 888.822.5984 www.jawood.com13
Jawood@Claim-Locator-Extractor
•Load criteria for identifying claims needed to mitigate risk of 5010 project •Build the criteria once within corporate and push to the remaining claim systems area to ensure common risk mitigation•Each site will pull production claims and send thru the tool until all matches have been found.•Extensive reports will report on progress after each successive run.
4010A1 – 5010 : JAWOOD Enterprise Tool Deployment
GlobalDefaults
Based on Companion
Guide /Plan Setup
User Pref: 1
StraightConversion
User Pref: 2
Test FieldBoundaries
User Pref: 3
Test CodeVariations
User Pref: 4
TestNon-Compliance
Jawood / Felix : Tool Set
[email protected] 888.822.5984 www.jawood.com14
Felix@4010-5010
• Define 5010 Companion Guide using the Felix@4010-5010 tool at the corporate level.•Define the Global values at the Corporate level•Define the User Preferences to meet the overall corporate test objectives at the corporate level•Copy the tool at each location with a decision to either allow minor changes or to force control at the corporate level•Ensures consistent risk mitigation•Applies to all HIPAA transactions•Automated compares of each load of the tool to document the gaps which would require resolution to meet the goal of a common companion guide for the enterprise per transaction.
4010A1 – 5010 : JAWOOD AUTOMATED TEST CLAIM CREATION
GlobalDefaults
Based on Companion
Guide /Plan Setup
User Pref: 1
StraightConversion
User Pref: 2
Test FieldBoundaries
User Pref: 3
Test CodeVariations
User Pref: 4
TestNon-Compliance
File: 1 10,000 Claims
400,000 claims
ClaimLocator /Extractor
Based on Test Grid Loaded
4010A1
10,000 claims
4010A1
5010
File: 2 10,000 Claims
5010
File: 3 10,000 Claims
5010
File: 4 10,000 Claims
5010
Jawood / Felix : Tool Set
Jawood / Felix: Tool Set
[email protected] 888.822.5984 www.jawood.com15
5010 PROJECT OPTIONS
[email protected] 888.822.5984 www.jawood.com16
Supply all test resources• Project / Test Team Leads• Test Analysts, Test Specialists Supply all test tools• Jawood Claim Locator / Extractor
Blaine Mallat, VP248-833-8000
SCHEDULE YOUR ASSESSMENT REVIEW
TODAY!!!See a Jawood Representative for more details!