EDI 5010 and ICD-10 Assessment and Implementation Services

In response to federal regulations mandating the upgrade to EDI 5010 and ICD-10 code set format, FlexTech now offers system-wide assessment and implementation services. Having completed numerous ICD-10 / 5010 assessments for large national and regional payers across multiple platforms, lines of business, and products, FlexTech is fully aware of the time and financial outlay this federally mandated regulation requires of payer organizations.

Working together with our client's project team, our Project Managers pursue the goal of accommodating the new EDI formats and codes with as little impact on current business operations and systems as possible. Of course, the ultimate decision-maker during the process is the client, and we serve in a project manager/facilitator role throughout the assessment. Our objective is to elicit and present all the information necessary for the client to make an educated choice about how to best fulfill regulatory requirements.

Our services include Assessment and Implementation, and can be tailored to include 5010, ICD-10, or both areas. The following is a basic outline of our approach:

Phase One - High Level Assessment

The initial project scope includes an assessment of all department processes and systems impacted by the EDI 5010 and ICD-10 upgrades. This process takes 8 to 10 weeks and includes: 

  • A complete systems inventory, including department interviews, to assess the impact of the required changes upon your organization
  • Vendor assessment and gap analysis
  • Evaluation of all data using a proprietary tool developed by FlexTech
  • Use of the data-analysis tool to build a list of implementation options

Phase One Deliverables

  • All documented EDI 5010 and ICD-10 Compliance Assessment results
  • Client education
  • High-level implementation plan including recommendations and roadmap, scale of work, and staffing requirements
  • List of implementation options plus vendor planning, cost assessment, high-level risks, and timeline for subsequent phases
  • Detailed implementation plan to meet all EDI 5010 and ICD-10 regulatory requirements

Phase Two - Implementation Planning

This phase consists of an in-depth analysis of all business and system impacts, followed by implementation strategy planning sessions.

Phase Two Deliverables

  • A detailed implementation plan
  • A comprehensive staffing plan
  • High-level implementation plan including recommendations and roadmap, scale of work, and staffing requirements
  • A vendor impact statement including risks and strategy
  • A timeline for implementation

Phase Three - Implementation Plan Execution

This final phase incorporates execution of the agreed-upon plan, resulting in compliance with the federally mandated regulatory changes.