As an industry leader, IEBP provides its Membership with the sophistication of cutting edge technology to maximize accuracy in claims adjudication and claim cost management services. IEBP and the United Medical Resource Alliance (UMR) use the fully integrated, state-of-the-art Trizetto QicLink claim adjudication system. The QicLink software includes the full range of claims administration functions consisting of enrollment and eligibility, group and individual billing, plan setup, provider demographic and network information, claims adjudication, reinsurance, utilization management and reporting. The adjudication component includes the ability to auto adjudicate claims by submitted batches.
The QicLink system interfaces to claim screening software for out of network claims. Interfacing for screening of in network claims is done via the Repricing process with UnitedHealthcare. The system was upgraded in March 2014 for acceptance of the diagnosis conversion from ICD 9 to ICD 10. Additionally, the system was converted from legacy character-based screens to Windows GUI screen technology, and the database infrastructure was converted to Microsoft SQL.
IEBP continues to face the pressures of mounting health costs, lingering economic uncertainties and increasingly complex reimbursement rules. IEBP will continue to stay focused on managing the administrative costs of the plan. The Health Information Technology Act assists IEBP in managing administrative costs by beginning the conversion from a paper process to electronic communication.
IEBP has implemented an on-line enrollment system with the value added beneﬁt calculator. Per Membership request, IEBP upgraded their Internet, mobile devices, on-line access to prescription and medical pricing transparency, electronic claim look-up, explanation of beneﬁts, and the production of Electronic Fund Transfers (EFT) with the Electronic Payment Option.