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
...................
Recent Modifications
and a Look Ahead
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QicLink™ 5.0 Functionality
Health Care Reform Enhancements
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
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
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*)
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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