Transcript Slide 1

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Copyright © 2014 TriZetto Corporation
QicLink™ 5.0 - An in-depth Look
at Changes and Enhancements
Susan Scardina – Sr QicLink Product Manager
Laura Gerling – Mgr of Product, Partner & Acct Mgmt
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QicLink™ 5.0
Functionality
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Recent Modifications
and a Look Ahead
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QicLink™ 5.0 Functionality
 Health Care Reform Enhancements
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CAQH CORE – Phase I
CAQH CORE – Phase II
CAQH CORE – Phase III
Dual Delivery
 Patient Protection and Affordable Care Act (PPACA)
 New regulations regarding Pre-existing conditions
 Unlimited coinsurance maximums
 Entry of a preferred language
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QicLink™ 5.0 Functionality (Cont’d)
 ICD-10 Compliance Enabled
 Data loads, maintenance and inquiry functionality of ICD-10
diagnosis and procedure codes
 Cross-walk data of ICD-9 to ICD-10 and ICD-10 to ICD-9
 Translation Processing
 Claims Adjudication
 Exception Processing
 Pre-Certification Case Management
 Referral Case Management
 Claims Interface Posting
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QicLink™ 5.0 Functionality (Cont’d)
 5010 Processing
 Medicare Secondary Payer (MSP Reporting)
 Enhanced 2010 Updates (Versions 3.0 & 3.1)
 MSPLOAD – no longer reporting terminated members
 Electronic Fund Transfer Payments
 Automated payments directly to the bank accounts of members,
agents (vendors) and capitation providers
 Days, Visits, Treatments Benefits
 Define benefits as days, visits, or treatments
 Subset limits for visits or treatments
 Hybrid combination benefits
 Reinsurance Processing
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QicLink™ 5.0 Functionality (Cont’d)
 Automation
 Route Claims by Provider
 Route Claims by Plan and Network
 Enhanced COB Adjudication
 Claim Workflow – CEPM options to allow claims to
automatically deny or route (QLUG*)
 claims in excess of filing limitation
 claims with a terminated provider
 BI (Billing Inquiry) – modify display options (QLUG*)
 Display invoices in ascending or descending order
 Option to view Closed invoices only
 Option to range Billing periods
*QLUG = QicLink User Group Enhancement Request
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QicLink™ 5.0 Functionality (Cont’d)
 Exception Processing Redesign
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Simplified process of voids, void & reissues, and adjustments
Reprocess claims comparing old payment to new payment
Generate underpayments / Track and recover overpayments
Option to select the same payee from the original check (PM
Print checks to changed)
 Focus changed to Adjustment (prior was Void)
 Voucher Balance Forward
 Print subsequent claim detail until voucher claims exceed
balance forward amount
 Reprocess Claims interface with Flexible Spending
 Claims Adjudication – CA Header
 Option to cross-reference current claim to an adjusted claim
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QicLink™ 5.0 Functionality (Cont’d)
 Claim Workflow – CECM-3 Provider Validation (QLUG*)
 Establish Referring Physician and UB Attending Physician criteria
without the requirement of defining a mandatory matching data
element
 Plan Builder – AutoDental Procedure Parameters (QLUG*)
 Ability to ‘Next’ through procedure codes
 Ability to delete all procedure codes in plan/revision
 Apply Coinsurance deductible before copay
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Multiple Line Modifiers
Member ID Increased Functionality
ECSIF File specifications
CIL – option to select Range of Received dates
*QLUG = QicLink User Group Enhancement Request
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QicLink™ 5.0 Functionality (Cont’d)
 Technical and Database Changes
 Session Timeout Parameter
 Number of minutes of user inactivity before session times out
 Default value is 20 minutes
 Customize Taskbar Button
 WebCSR Technical Updates
 Better performance
 ClaimsExchange™
 Interface with ICD-10 Compliant functionality
 ClinicaLogic
 Option to define clinical editing administrative edits by Network
Identifier
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QicLink™ 5.0 Functionality (Cont’d)
 CDH Adapter Replacement
 Direct real-time web services requests and responses
 SHA Report options (QLUG*)
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Range of Claim numbers
Range of Released dates
Range of Processors (who release the claim)
Range of Examiners (AM code and name)
 COBM – changed description of ‘-’ default benefit type
to “ALL BENEFIT TYPES” (QLUG*)
*QLUG = QicLink User Group Enhancement Request
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QicLink™ 5.0 Functionality (Cont’d)
 RIP (QLUG*)
 Option to report based on claim line data
 RPC (QLUG*)
 Performance w/Sort Sequencer
 Single space
 PCR/PCB/HPM/PMMNT (QLUG*)
 Expand dollar/percentage amounts to allow entry of 2 decimals
 CEA (QLUG*)
 Process same batch/ref on a second claim number will not retain
remark codes from first claim
*QLUG = QicLink User Group Enhancement Request
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QicLink™
Development
and
Release Plan
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QicLink™ Release Update
 Development focus is on the 5.00 Release
and Beyond
 Remediation efforts to address QicLink client
reported issues will be made primarily at the
5.00.00.10 point-in-time release
 Final software maintenance build for the 4.20 release
of QicLink is scheduled for August, 2014
 QicLink 2014 Planned Change Package Schedule on
Customer Exchange
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2014 Planned Change Package Schedule
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See
Customer Exchange
for:
- QicLink™ User Group Enhancements
- Product modifications & documentation
- QicLink release schedule
QUESTIONS?
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Workshop Survey
We would like to extend you an opportunity
to provide candid feedback.
During the workshop you should have received an e-mail
notification for you to take an on-line survey.
If you could take a few minutes to complete at this time ,
we would greatly value your feedback. For your convenience,
the survey will be available throughout the remainder of the conference
should you not be able to complete immediately.
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Thank You!
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