Confidential | Copyright © 2014 TriZetto Corporation 1

2 QicLink™ EFT Processing Susan Scardina – Sr QicLink Product Manager Laura Gerling – Mgr of Product, Partner & Acct Mgmt

Confidential | Copyright © 2014 TriZetto Corporation 3 Agenda  Purpose and Benefit  Overview  EFT Workflow Overview  Setup  Pre-Note Processing  Electronic Fund Transfer  ACH File Format

Confidential | Copyright © 2014 TriZetto Corporation 4 Purpose and Benefit  Electronic Fund Transfer (EFT)  Allow for electronic fund transfers (EFT) in the National Automated Clearing House Association (NACHA) – ACH file format  Prearranged Payment and Deposit Entry (PPD)  Benefit – Recipient payments directly transferred to desired savings/checking account in lieu of printed checks

Confidential | Copyright © 2014 TriZetto Corporation 5 EFT Advantages to Participants  Administrators  Reduction of administration and operating expenses  Reduction of costs for check account reconciliation  Elimination of stop payment and check reissue costs  Recipients  Elimination in time and cost involved to deposit checks  Consistent availability of funds  Vacation  Business trips  Illness  Elimination of lost or stolen checks

Confidential | Copyright © 2014 TriZetto Corporation 6 NACHA Participants  Originator  Initiates ACH entries into payment system  Originating Depository Financial Institution (ODFI)  Receives payment instructions from Originator  Forward entries to ACH Operator  Automated Clearing House (ACH) Operator  Central clearing facility  Receiving Depository Financial Institution (RDFI)  Receives and posts entries to participant (receiver) accounts  Receiver  Authorizes an Originator to initiate an ACH entry to the receiver’s account

Confidential | Copyright © 2014 TriZetto Corporation 7 Types of Receivers  Pay-To Enrollees / Members  Unassigned claim payments  Disability payments  Flexible Spending payments  Billing Vendor  Agent Commissions  Capitation Providers ** EFT claim payments for providers via 835 process only

Confidential | Copyright © 2014 TriZetto Corporation 8 Illustration of ACH Credit Flow Originator ODFI ACH Operator RDFI Receiver

Confidential | Copyright © 2014 TriZetto Corporation 9 EFT Workflow

Confidential | Copyright © 2014 TriZetto Corporation 10 EFT Process  Pre-notification (pre-note) sent through ACH network  Non-dollar entry  Alert RDFI of future live dollar transactions  Verification of Receiver’s account number  14-day “quiet” period  Allows for acceptance/rejection of pre-note by RDFI  Paper checks will continue to be generated  Direct Deposit eligibility begins  Pre-arranged Payment and Deposit Entry (PPD)  ACH Credits only – voids/refunds will not be processed electronically

Confidential | Copyright © 2014 TriZetto Corporation 11 EFT Processing Workflow

Confidential | Copyright © 2014 TriZetto Corporation 12 Setup

Confidential | Copyright © 2014 TriZetto Corporation 13 Checking Account Maintenance (SB)  Checking Account Number  Line 16 – ABA Routing Number  Line 17 – EFT Trace Number  Line 22 – EFT Payment Method to ACH  Four new display-only EFT processing fields  File Create Date  File Create Time  File ID Modifier  Batch Number

Confidential | Copyright © 2014 TriZetto Corporation 14 Checking Account Maintenance (SB)

Confidential | Copyright © 2014 TriZetto Corporation 15 EFT Participant Maintenance (EFTPM)  Create EFT receiver information  Member / Provider / Vendor  Bank information  RDFI routing number  Account number / Account type  System date range-based revision levels  Financial institution changes  Pre-note information  One-to-many source financial institution (ODFI) records  ODFI routing numbers and account numbers  Date pre-note sent for each ODFI

Confidential | Copyright © 2014 TriZetto Corporation 16 EFTPM – Member Record

Confidential | Copyright © 2014 TriZetto Corporation 17 EFTPM – View Records

Confidential | Copyright © 2014 TriZetto Corporation 18 EFTPM Deletion Rules  Multiple future date ranges can be deleted  Gaps in date ranges allowed  Records where system date is greater than or equal to Effective From date cannot be deleted  Audit trail  Anti-fraud measure

Confidential | Copyright © 2014 TriZetto Corporation 19 Pre-Note Processing

Confidential | Copyright © 2014 TriZetto Corporation 20 EFT Pre-Note Processor  Generate EFT pre-notification authorization records  One-to-many ODFI-specific records  Check group/bank account driven  Group Revision Maintenance (GR)  Plan Benefit Overlay (Plan Builder PPO / GBO)  Flex Control Maintenance (FSGM)  Disability Group Revision Maintenance (JGRM)  HMO Revision Maintenance (HMR)  Billing Commission/Fund Maintenance (BCFM)  Billing Installation Maintenance (BIM)  Process only when new EFTPM records are created  Cannot be run concurrently with EFT File Create

Confidential | Copyright © 2014 TriZetto Corporation 21 EFTPNP

Confidential | Copyright © 2014 TriZetto Corporation 22 EFTPM After EFTPNP

Confidential | Copyright © 2014 TriZetto Corporation 23 EFT Processing

Confidential | Copyright © 2014 TriZetto Corporation 24 EFT File Create  Creates output files to communicate  Pre-notification authorization records  Electronic fund transfer payment records  Output based on NACHA ACH Format  Separate output file for each ODFI  Printable summary report  Maximum number of 36 output files per ODFI per system date

Confidential | Copyright © 2014 TriZetto Corporation 25 AGPMAIN

Confidential | Copyright © 2014 TriZetto Corporation 26 EFT File Create (EFTFC)

Confidential | Copyright © 2014 TriZetto Corporation 27 EFTFC File Naming Conventions  Dynamically named output files  Each output file name begins with ACH  ODFI Routing Number  Year (CCYY format)  Ordinal Date  File ID Modifier  ACH A  Represents an output file created on August 1, 2013 for Routing Number and File ID Modifier A

Confidential | Copyright © 2014 TriZetto Corporation 28 EFTPM After EFTFC

Confidential | Copyright © 2014 TriZetto Corporation 29 EFT File

Confidential | Copyright © 2014 TriZetto Corporation 30 Sample EFT Output in NACHA ACH format Pete Foskaris PPDCLAIM PMNT

Confidential | Copyright © 2014 TriZetto Corporation 31 ACH File Format

Confidential | Copyright © 2014 TriZetto Corporation 32 ACH File Format File Header Record Company/Batch Header Record Entry Detail Records Company/Batch Control Record Company/Batch Header Record Entry Detail Records Company/Batch Control Record File Control Record

Confidential | Copyright © 2014 TriZetto Corporation 33 File Header Record Contents  Immediate Destination – SB Line 16 Routing Number  Immediate Origin – SB Line 16 Routing Number  File Creation Date – Store date in new SB field  File Creation Time – Store time in new SB field  File ID Modifier – Store in new SB Field  Permits multiple file created on same date and participants  Store last used by date

Confidential | Copyright © 2014 TriZetto Corporation 34 Company/Batch Header Record Contents  Company Name – SN-1 Line 01 Name  Company Discretionary Data – SB Account Number (ODFI)  Company Identification – SN-1 Line 06 Federal ID  Company Entry Description (based on ck type )  CLAIM PMNT (A – EFT claim ck, O – EFT enrollee voucher ck)  AGENT COMM (Z – EFT billing commission check)  CAPITATION (U – EFT capitation check)  FLEX SPNDG (X – EFT flex check)  ODFI Identification – SB Line 16 Routing Number  First 8 characters only  Batch Number – Store in new SB field

Confidential | Copyright © 2014 TriZetto Corporation 35 Entry Detail Record (PPD) Contents  RDFI Identification – Routing Number for receiver’s financial institution  RDFI Account Number – Account Number for receiver  Amount – EFT check amount  Nochk and nopay records/amounts will not be written  Individual Identification Number  Enrollee internal sequence number and employer group ID  Vendor internal sequence number  Provider internal sequence number

Confidential | Copyright © 2014 TriZetto Corporation 36 Entry Detail Record (PPD) Contents (cont’d)  Individual Name – Payee Last Name  EDM (if applicable), otherwise EM  PM Line 03 (if applicable) otherwise Line 01  BVM Line 01  Trace Number  Sequentially updated by ODFI Routing Number  Last Trace Number used will be stored in new SB field

Confidential | Copyright © 2014 TriZetto Corporation 37 Company/Batch Control Record Contents  Entry Count – Total of all PPD Entry Detail Records  Total Credit Entry Dollar Amount  Company Identification – SN-1 Line 06 Federal ID  ODFI Identification – SB Line 16 Routing Number  First 8 characters only  Batch Number – Store in new SB field  Sequentially assigned

Confidential | Copyright © 2014 TriZetto Corporation 38 File Control Record Contents  Batch Count  Total number of Company/Batch header records  Entry Count  Total number of all Entry Detail Records  Total Credit Amount  Total of Credit Entry Detail Records dollar amounts

Confidential | Copyright © 2014 TriZetto Corporation 39 NACHA ACH Rules Information  Basic online access  Requires user self-registration 

Confidential | Copyright © 2014 TriZetto Corporation 40 Workshop Survey We would like to extend you an opportunity to provide candid feedback. During the workshop you should have received an 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.

Confidential | Copyright © 2014 TriZetto Corporation 41 Thank You!