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Employee benefit plans come in many shapes and sizes and, in addition to medical care, may include coverage for one or more specialty areas, such as dental or consumer-directed programs that incorporate a combination of high-deductible health plans and HSA and/or HRA benefits. Alternatively, some TPAs may focus their operation solely on supporting the administration of a specialty benefit, such as disability. No matter the type of coverage being administered, these QicLink-integrated solution modules deliver comprehensive support for the cost-effective administration of specialty benefits.
QicLink AutoDental™ incorporates user-defined dental processing edits to drive increased claim auto-adjudication. When used in conjunction with QicLink ClaimWorkflow, AutoDental can accept claims electronically. The application integrates with dental usual and customary tables and stores member/enrollee dental histories. Tooth charts automatically update with each claim.
QicLink Dental Logic™ allows administrators to develop a series of customer-specific dental claims processing rules that help confirm claim appropriateness prior to payment. QicLink utilizes these rules to determine how to electronically process dental claims based upon the criteria established for a specific plan, revision level, procedure, tooth, surface and age. The Dental Logic rule data ensures that the oral care service provided meets customer plan requirements as well as standard dental practice policy, based on procedure code and prior claim history.
QicLink Consumer-Directed Healthcare (CDH) Suite helps TPAs cost-effectively administer high-deductible health plans, health savings accounts and health reimbursement arrangements. The CDH application integrates plan benefits, debit card utilization and financial institution connectivity to provide real-time bank and debit card processing. The suite of applications automates the combined administration of HRAs/FSAs/HSAs; improves workflows; enables online enrollment and access; and facilitates seamless interoperability across the enterprise.
QicLink Benefits Exchange™ (QBE) lets administrators offer a comprehensive integrated online solution to their client managers and enrollees. With QBE, system users can automate routing of benefits inquiries and provide enrollees, physicians, hospitals, PPOs, employers, and plan sponsors with secure online access to eligibility data and claims status information.
QicLink Disability™ Benefits manages both short- and long-term disability benefits processes—from specifying a disability benefit plan to year-end W-2 information processing. The software stores information for each employer group by effective dates, check group, carrier, policy number, fund account number and minimum fund balance. Each employer group can be maintained using Federal, Medicare, Social Security, State and two user-defined withhold tax tables. Both short- and long-term benefits can be linked for processing—with payments generated automatically based on the duration and frequency defined by the user.
QicLink Flexible Spending™ is a comprehensive record keeping system that maintains enrollee contributions and expense and payment information and tracks year-to-date activity. The application allows for multiple user-defined account types (healthcare, dependent care, pre-tax premiums, etc.) and applies edits when contributions, expenses and payments are entered. Tight integration with Alegeus Technologies allows for real-time account balance access.
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
At Cognizant, we are here to provide you with more information about our TriZetto Healthcare Products software and service solutions and answer any questions you may have.