Employee Benefits Administration & Management Corp. uses the TriZetto / RIMS QicLink benefit administration software (www.TriZetto.com). We have been using versions of this software since 1983 and are currently using version 3.1x which incorporates all required features for HIPAA compliance. The QicLink software runs on an IBM RS/6000 with end users connected via telnet sessions. We use the claims, Eligibility / Billing and PPO module. The system is scaleable to an excess of 1 million lives. The following is directly from the TriZetto web site:

Enterprise software – TriZetto's proprietary software offerings include RIMS brand applications specifically designed for the benefits administration market. RIMS applications automate and simplify the claims adjudication, re-pricing and payment process, and are available on a licensed or hosted basis. RIMS' QicLink™ is the leading application for benefits administrators.

This system is backed up three times daily, once to a backup IBM RS/6000 H50, once to network disk storage and once to tape, with the latest 2 tapes being stored offsite in a fireproof safe.

Claims are accepted both in a paper format and electronic HIPAA X12N 837. Paper claims are imaged and stored on our image server and an X12 837 is created by our trading partner ARM / Health e Connex (www.healtheconnex.com). All are stored locally in our datacenter.

EBA&M is currently implementing Auto-Audit (www.solucient.com). This will assist our audit of billing providers enhancing correct claim processing and develop an increased savings for our clients. Auto-Audit will be on-line January 2005.

AUTO-AUDIT claims editing system has historically provided users with an average of 10 percent savings from physician bills incorrectly submitted. AUTO-AUDIT applies thousands of claims edits to help avoid overpayments to providers.

All claims transactions are posted to our Transaction Manager, hosted by HTP Inc. (www.htp.com). This tool enables us to route claims to the major Provider Networks for electronic repricing and returns the correctly priced claims for batch loading to QicLink.

With the HTP Transaction Manager, you can have the confidence that your organization will be HIPAA transaction compliant. In October 2000, HTP, Inc. became the first developer to achieve EHNAC certification for all HIPAA-defined data sets. Additionally, HTP customers are able to successfully secure independent third party transaction certification (e.g., Claredi).

We offer web-based eligibility benefits and claims status lookup through a solution hosted by HealthX. This host offering also enables our client HR departments and individual employees an on-line enrolment option.

We also employ an in-house Interactive Voice Response real-time solution for eligibility benefits and claims status. This solution handles 400 telephone inquiries on an average day.

EBA&M has enhanced the functionality of the RIMS QicLink product with an internally developed data store for reporting, analysis, and client use.