Horizon BCBS of New Jersey

The client was preparing for the eventual replacement of the ICD-9 Diagnostic and Procedures Codes with the ICD-10 version of the same that is used throughout the world and was scheduled for national adoption on October 1, 2014.  In preparation for the national movement to and adoption of this new coding framework, Horizon wanted to insure that they were ready.  The project was initiated examine not only the electronic process of adjudicating claims but the manual edits and overrides that are also a part of that process. All medical policies and procedures associated with this activity were examined.

Lead ICD-10 Business Operational Testing Readiness Assessment Team to help them determine whether or not Horizon BCBS was ready for the ICD-10 implementation on October 1st.  Using a very in-depth master ICD-10 questionnaire (450 questions), the questions were separated into 34 unique department/area questionnaires and were used as the basis of each facilitated question and answer session with those departments or areas.