transition to icd-10||digital strong

World’s Largest PBM Seamlessly Transitions to ICD-10

transition to icd-10||digital strong
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AgileThought Develops Smart Assessment Patient Services Process and Supporting Architecture


Pharmacy ICD Code Updates

The World Health Organization uses an alpha-numeric classification system to publish known diseases. The system, named International Classification of Diseases, or ICD, has been updated regularly since 2003. U.S. health organizations were required to update their codes by October 2016.

The update was substantial, affecting the way many systems read and processed patient data.

ICD-9 to ICD-10 Updates:

  • 55,000 more diagnostic codes
  • An increase of maximum characters from five to seven
  • Double the number of disease and condition categories

This PBM, one of the most prominent and well-known in the U.S., hired AgileThought to guide them through the transition. ICD codes are closely tied to the organization’s main pharmacy enterprise system. For this organization, the codes are primarily used to document patient status, as well as for dispensing medication, claims processing, billing, and other processes.

If the organization did not update its systems, they would face government financial penalties and disrupt patient care. ICD codes are tied to patient records, hospitals, and pharmacy manufacturers. The update also affected dispensing. If a dosage limit is ever exceeded, that patient faces serious health risks.

Challenge: Update ICD Codes from Version Nine to Ten without Disrupting Patient Services & Ongoing Processes

The code update required knowledge of the main pharmacy ERP system processes. AgileThought, as a long-time trusted
partner, was the only vendor who intimately knew the system well enough to handle the project.

The customer originally thought that the transition from ICD-9 to 10 would include a simple code update, taking only a few months, but approached the AgileThought team to be certain.

The team performed a comprehensive analysis of the code update and found that ICD-10 would impact sensitive areas such as dispensing as well as several claims and billing modules. As trusted advisors, AgileThought showed the customer that the scope and complexity of the project was much larger than they had originally anticipated, and encouraged them to budget accordingly.

Navigate Digital Transformation Faster.

Ditch the Complexity.

A vendor who does not learn your unique system setup and processes will develop a generic model. AgileThought has
developed a rapid transition methodology that the team uses to quickly learn and adapt new technologies to customer business models, partnering in the broader mission – because there is no generic organization.

AgileThought has been a trusted advisor of this PBM for over ten years.

Taking the Digital Strong Path

digital strong

Releasing Both ICD-9 & ICD-10 Code

The longer ICD-10 codes affect every process in the pharmacy ERP system. To make sure that the system would continue to run as planned, AgileThought released both ICD-9 and ICD-10 codes. This process ensured that, if one screen wasn’t working as intended, that they could instantly pinpoint the affected area, and adjust.

Reporting was also affected. The team needed to set up rules within the ERP system in order to identify which version needs to take the report, the screens, and the processes.

Clean Delivery in Only Nine Months

The clean analysis and design optimized delivery. AgileThought divided deliveries into several releases so that teams could work in parallel. Several code releases were not the same size – which is a major reason the team did not wait to release everything at once.

Zero major issues occurred during the nine-month update, which was extraordinarily low considering the size of the project.

Why More Hospitals Turn to AgileThought as ICD-11 Approaches

According to the WHO, ICD-11 will be ready in 2022. ICD-10 was published in 1990, and was only recently mandated that HIPAA-covered health institutions use the version. While it may take years before another mandate, ICD-11 will include:

  • Multiple languages
  • An interactive web platform
  • Search functionality

The path to digital transformation involves a large investment and technology changes. AgileThought ensures customers are prepared to meet those changes by optimizing their current systems and processes so that, when they do upgrade, they know exactly what to expect.

Download The Success Story!

transition to icd-10

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