ICD-9, the current standard for reporting medical diagnosis and inpatient procedures, is being replaced by ICD-10. The transition from ICD-9 to ICD-10 is complex and far reaching. ICD-10 will affect everyone covered by HIPAA, not just those submitting Medicaid or Medicare claims. The mapping from ICD-9 to ICD-10 codes is not simply one-to-one. It will impact benefits, provider reimbursement, clinical editing, medical management, claims operations and customer service.

This white paper describes the Apsana approach to a comprehensive, focused, efficient and effective Test Approach for testing ICD-10 changes. (More)

Nine out of every ten dollars in health insurance premiums are paid out to health care providers in terms of medical claims. These payments are covered by a complex set of rules that are governed by provider contracts, state and federal laws and industry practice. These conditions are constantly evolving and require periodic testing support. Major current changes include the implementation of ICD-10 and the evolution of Accountable Care Organizations. (More)

Health Insurers update their products (plans and benefits) periodically. Product updates may be in response to mandates, market needs or changes in the practice of medicine. Product changes can have wide ranging impacts to customers, members, employees and systems that are used to administer benefits. These changes have to be carefully tested. Since these types of changes are frequent and have a large impact, the testing process needs to be especially efficient and cost effective. (More)

Think what you will of the Affordable Care Act, but October 1, 2013 is a launching pad for some exciting new business opportunities! While a few Health Insurance companies have declined to participate, most major insurance players are excited and rearing to go into this new market place. Unlike many other initiatives, this rollout affects many aspects of your business. With less than 3 months to go, this is a countdown to make sure you are prepared, efficient and organized before the launch. So are you really ready? How can you be sure? (More)

Most of software testing in the health insurance industry is beset with challenges. These challenges affect organizations undergoing large process or technology changes. As with most problems, the first and most important step to developing solutions, is to first accurately diagnose the problem (More)