For Third Party Administrations (TPAs) to effectively compete with larger plans, system functionality and performance must be maximized. These integrated application modules further extend the functionality and efficiency of the QicLink core by addressing areas of strategic business function as well as labor intensive processes that provide opportunity for increased automation.
QicLink Premium Billing™ allows TPAs to tailor billing, receivables, aging, lapse and cash posting control processes to meet their needs and supports automatic premium invoicing and payment via EFT. The application provides multi-level agent commission calculation options and automatically calculates and adjusts invoices due to late notification of enrollment; updates carrier and agent files when invoices are paid; and provides complete 1099 tracking for vendor and agent commission processing.
QicLink ClaimWorkflow™ helps improve business processes via functionality that includes multi-source data acceptance (via clearinghouses and direct provider submission), automated rules-based routing of claims and encounters, and claims adjudication-based on pre-assigned routing conditions.
QicLink ClaimRules™ enables rules-based, procedure-driven claims/encounter adjudication by incorporating efficient plan building and maintenance procedures using a pre-built claim logic matrix. The result is greater claims payment accuracy, increased auto-adjudication and significant cost savings.
QicLink Customer Service™ provides ready access to multiple levels of information using point and click functionality, drop-down boxes, scroll lists and multiple sort and display options. Service call detail is captured and unresolved queries can be referred to another individual or department while management monitors and tracks call volumes and performance levels.
QicLink dataPiction™ allows today’s powerful relational database reporting and query tools to access QicLink application data. The system supports report distribution and offers an Open Database Connectivity (ODBC)—compliant report writing tool for web-based publishing and ad hoc reporting.
QicLink Claims Overflow Services offer an efficient, cost-effective alternative to accommodate those instances where a TPA’s in-house team is temporarily overburdened with outstanding claims and is facing an overflow situation. Cognizant adjusters receive random audits for accuracy and consistency, while the organization’s ready access to extensive on-site QicLink expertise further ensures high performance standards and reliability.
QicLink Application Management Services deliver high-quality hosting services that enable TPAs to focus on client-facing core competencies, while IT infrastructure and application management functions are expertly maintained. Key Business Indicators provide information to assess the quality of services delivered, and specific Service Level Agreements (SLAs) guarantee system availability and performance levels
Optimize operations and extend application functionality
Comprehensive functionality to support specialty lines of business
Effective tools that support today’s complex provider network and care management initiatives
Manage the cost and quality of care with access to affordable, QicLink-integrated solutions
Connect to a vast network of PPOs for electronic claims routing and re-pricing