Case Study: Independent Licensee of the Blue Cross Blue Shield Association achieves ICD-10 compliance and clinical and payment neutrality with HCL's ICD-10 tool suite

Independent Licensee Of The Blue Cross Blue Shield Association - Customer Case Study

Leading Blue Payer, an independent licensee of the Blue Cross Blue Shield Association, faced the regulatory ICD-10 transition that threatened multiple business and IT workflows and required maintaining clinical equivalence, payment and benefit neutrality, and operational stability. HCL was engaged to address these challenges using its proprietary ICD-10 tool suite — including consulting frameworks, mapping and testing tools — to manage complex mapping scenarios, identify impacts to medical policies, and ensure compliance.

HCL deployed its ICD-10 tool suite along with experienced medical coders and clinicians to create custom maps, remediate medical policies, run DRG shift and payment-neutrality analyses, and deliver claims-based analytical reports. As a result, HCL delivered a repeatable code-mapping and governance process, clear visibility into ICD-10 code usage across key policies, data-driven financial neutrality assessments, and measures that preserved clinical and payment neutrality while protecting operational stability.