TriZetto, 3M partner to speed ICD-10 for payers

By Mike Miliard
11:00 AM

The TriZetto Group and 3M Health Information Systems announced an agreement Friday that gives TriZetto certain exclusivity to include 3M's ICD-10 Code Translation Tool with several new services for payers under its TriZetto Advantage 10 Services.

TriZetto will integrate the 3M technology into a provider contract modeling service and ICD-10 translation mapping service, which will help streamline and simplify healthcare payers’ efforts to comply with the ICD-10 and HIPAA 5010 requirements and leverage the code migration to improve the cost and quality of care for their members.

In an interview with Healthcare IT News at the recent Healthcare Information and Management Systems Society (HIMSS) conference and exhibition in Atlanta, Caroline Piselli, global strategic planning manager and ICD-10/ P4P program manager at 3M Health Information Systems, called the new ICD-10 codes "the epicenter of everything that's happening today, as well as in the future."

It's critical, she said, "that those codes are right, because that's what everything else is predicated on."

But with "almost a nine-fold increase" in the codes, with much greater level of detail on top of that, ensuring precision in code assignment poses great challenges. Piselli notes that "an angioplasty is one code in ICD- 9, and in ICD10 it goes to more than 1,100."

The new provider contract modeling service for payers – targeted to be available in the second quarter of 2010, and to be offered as software-as-a-service (SaaS) – will map ICD-9 to ICD-10 codes and identify gaps that payers and providers can work together to fill, mitigating potential payment disruptions from missing, bundled or unmapped codes. An additional ICD-10 translation mapping service will use the 3M tool in conjunction with TriZetto’s own ICD Translation Manager to assist healthcare payers in completing their ICD-10 mapping project by creating equivalency maps between ICD-9 and ICD-10 and mapping them back to the core administration platform.

Piselli describes the partnership as "the best minds coming together … what was important for us was really thinking through how to work on the payer side, and TriZetto was looking for someone with our clinical expertise."

The new services supplement seven existing TriZetto Advantage 10 services, including the most recently launched TriZetto Advantage 10 Compliance Plus. All services are designed to help payers get ahead of the 2013 compliance deadline.

Still in planning phase

In a 2009 report by Gartner, analysts reported that, while there has been “an increased interest in ICD-10 since the beginning of 2009, most U.S. health insurance companies remain in the planning phase. CIOs at healthcare insurers must accelerate their efforts and begin implementing ICD-10 now.”

TriZetto Advantage 10 Services are designed to help speed and simplify payers migrating of their operations to ICD-10. "TriZetto is working hard to help payers prepare for the ICD-10 deadlines,” said executive vice president Mike Jenner.

The 3M ICD-10 Code Translation Tool offers intuitive, menu-driven features that simplify the translation process; the software can be used to convert existing information systems and software applications to ICD-10, or to create customized mappings for specific clinical and business needs. It identifies all reasonable ICD-10 alternatives for the ICD-9 codes held in an information system, and performs automated mappings where a simple one-to-one map exists.

It then isolates the remaining codes and provides the user with reference information and data to assist in fine-tuning the final translations to ICD-10. The software also integrates the complete content of the public domain ICD-10 General Equivalence Mappings (GEMs) published by the Centers for Medicare and Medicaid Services (CMS).

"Using the proven 3M tool for our payer services gives our Advantage 10 offerings unique value for TriZetto’s customers, giving them a competitive advantage for faster, more reliable migration and services for their members and network providers,” said Greg Larson, TriZetto’s director of services product management.