Pegasystems (News - Alert) Inc., a major player in Business Process Management (BPM) software solutions and a provider of customer relationship management (CRM) solutions, has announced several enhancements that address the healthcare industry's critical business imperatives.
Officials with Pegasystems said that the new product enhancements are further supported with transactional automation and business-friendly decision management to sustain optimal straight-through-processing (STP) of claims and authorizations.
According to company officials, Pegasystems' solutions are widely used by major healthcare organizations including the three largest US health plans, two of the four largest pharmacy benefit managers, several leading healthcare delivery systems, and US government agencies at the state and federal level.
Company officials claimed that healthcare transactions for more than one of every two Americans, including members from over 60 percent of the Blues network, are processed with Pegasystems technology.
"Healthcare payers must view ICD-10 as a strategic disruptor and manage ICD-10 remediation to reassess business and technology strategies and future differentiation models”, said Janice Young, program director, IDC (News - Alert) Health Insights, in a statement.
Young said that viewing ICD-10 as a strategic change agent will position healthcare payers for success in the future business market after the conversion.
"Our solutions already provide healthcare companies with efficiencies foreseen by the original HIPAA standardization. In fact, multi-million dollar savings are being achieved annually by payers using our solutions to automate healthcare transactions”, said Elizabeth Hart, principal, healthcare solutions, Pegasystems.
Hart said that the benefits from moving to ICD-10 are expected to be even larger, and the company’s enhanced solutions will help the industry move beyond the first steps of remediation and compliance to true business transformation.
The enhancements include consistency of electronic healthcare information-New ICD functionality in Pega includes general equivalence mapping (GEM (News - Alert)) crosswalk tables for ICD-9 to ICD-10 conversion, plus reverse mapping capabilities for diagnosis and procedure codes. Organizations can use both code sets, critical for historical reporting as well as for on-going refinement.
Increased efficiencies and standardization in healthcare payer and provider patient information-Pega technology gives full support for HIPAA 5010 message standards which impact most payer and providers' electronic transactions, including claims, claims status and eligibility requests, and authorizations.
Impending government deadlines with healthcare reform, company officials said that Pega's HIPAA 5010 solution enhancements are being used by healthcare organizations to conduct internal testing necessary to achieve Level 1 compliance, and will also be used for their external testing with the Centers of Medicare and Medicaid Services when it officially begins in January 2011.
HIPAA 5010 and ICD-10 rulings impact as much as 80 percent of a health plan's business processes and systems.
Healthcare organizations that are able to successfully address reform and improve operational agility can increase member satisfaction, reduce costs and see improved outcomes.
Anil Sharma is a contributing editor for TMCnet. To read more of Anil’s articles, please visit his columnist page.
Edited by Erin Monda