1. Confidential | Copyright © 2014 TriZetto Corporation 1

2. 2 QicLink™ 5.0 - An in-depth Look at Changes and Enhancements Susan Scardina – Sr QicLink Product Manager Laura Gerling – Mgr of Product, Partner & Acct Mgmt

3. Confidential | Copyright © 2014 TriZetto Corporation 3 QicLink™ 5.0 Functionality................... Recent Modifications and a Look Ahead

4. Confidential | Copyright © 2014 TriZetto Corporation 4 QicLink™ 5.0 Functionality  Health Care Reform Enhancements  CAQH CORE – Phase I  CAQH CORE – Phase II  CAQH CORE – Phase III  Dual Delivery  Patient Protection and Affordable Care Act (PPACA)  New regulations regarding Pre-existing conditions  Unlimited coinsurance maximums  Entry of a preferred language

5. Confidential | Copyright © 2014 TriZetto Corporation 5 QicLink™ 5.0 Functionality (Cont’d)  ICD-10 Compliance Enabled  Data loads, maintenance and inquiry functionality of ICD-10 diagnosis and procedure codes  Cross-walk data of ICD-9 to ICD-10 and ICD-10 to ICD-9  Translation Processing  Claims Adjudication  Exception Processing  Pre-Certification Case Management  Referral Case Management  Claims Interface Posting

6. Confidential | Copyright © 2014 TriZetto Corporation 6 QicLink™ 5.0 Functionality (Cont’d)  5010 Processing  Medicare Secondary Payer (MSP Reporting)  Enhanced 2010 Updates (Versions 3.0 & 3.1)  MSPLOAD – no longer reporting terminated members  Electronic Fund Transfer Payments  Automated payments directly to the bank accounts of members, agents (vendors) and capitation providers  Days, Visits, Treatments Benefits  Define benefits as days, visits, or treatments  Subset limits for visits or treatments  Hybrid combination benefits  Reinsurance Processing

7. Confidential | Copyright © 2014 TriZetto Corporation 7 QicLink™ 5.0 Functionality (Cont’d)  Automation  Route Claims by Provider  Route Claims by Plan and Network  Enhanced COB Adjudication  Claim Workflow – CEPM options to allow claims to automatically deny or route (QLUG*)  claims in excess of filing limitation  claims with a terminated provider  BI (Billing Inquiry) – modify display options (QLUG*)  Display invoices in ascending or descending order  Option to view Closed invoices only  Option to range Billing periods *QLUG = QicLink User Group Enhancement Request

8. Confidential | Copyright © 2014 TriZetto Corporation 8 QicLink™ 5.0 Functionality (Cont’d)  Exception Processing Redesign  Simplified process of voids, void & reissues, and adjustments  Reprocess claims comparing old payment to new payment  Generate underpayments / Track and recover overpayments  Option to select the same payee from the original check (PM Print checks to changed)  Focus changed to Adjustment (prior was Void)  Voucher Balance Forward  Print subsequent claim detail until voucher claims exceed balance forward amount  Reprocess Claims interface with Flexible Spending  Claims Adjudication – CA Header  Option to cross-reference current claim to an adjusted claim

9. Confidential | Copyright © 2014 TriZetto Corporation 9 QicLink™ 5.0 Functionality (Cont’d)  Claim Workflow – CECM-3 Provider Validation (QLUG*)  Establish Referring Physician and UB Attending Physician criteria without the requirement of defining a mandatory matching data element  Plan Builder – AutoDental Procedure Parameters (QLUG*)  Ability to ‘Next’ through procedure codes  Ability to delete all procedure codes in plan/revision  Apply Coinsurance deductible before copay  Multiple Line Modifiers  Member ID Increased Functionality  ECSIF File specifications  CIL – option to select Range of Received dates *QLUG = QicLink User Group Enhancement Request

10. Confidential | Copyright © 2014 TriZetto Corporation 10 QicLink™ 5.0 Functionality (Cont’d)  Technical and Database Changes  Session Timeout Parameter  Number of minutes of user inactivity before session times out  Default value is 20 minutes  Customize Taskbar Button  WebCSR Technical Updates  Better performance  ClaimsExchange™  Interface with ICD-10 Compliant functionality  ClinicaLogic  Option to define clinical editing administrative edits by Network Identifier

11. Confidential | Copyright © 2014 TriZetto Corporation 11 QicLink™ 5.0 Functionality (Cont’d)  CDH Adapter Replacement  Direct real-time web services requests and responses  SHA Report options (QLUG*)  Range of Claim numbers  Range of Released dates  Range of Processors (who release the claim)  Range of Examiners (AM code and name)  COBM – changed description of ‘-’ default benefit type to “ALL BENEFIT TYPES” (QLUG*) *QLUG = QicLink User Group Enhancement Request

12. Confidential | Copyright © 2014 TriZetto Corporation 12 QicLink™ 5.0 Functionality (Cont’d)  RIP (QLUG*)  Option to report based on claim line data  RPC (QLUG*)  Performance w/Sort Sequencer  Single space  PCR/PCB/HPM/PMMNT (QLUG*)  Expand dollar/percentage amounts to allow entry of 2 decimals  CEA (QLUG*)  Process same batch/ref on a second claim number will not retain remark codes from first claim *QLUG = QicLink User Group Enhancement Request

13. Confidential | Copyright © 2014 TriZetto Corporation 13 QicLink™ Development and Release Plan

14. Confidential | Copyright © 2014 TriZetto Corporation 14 QicLink™ Release Update  Development focus is on the 5.00 Release and Beyond  Remediation efforts to address QicLink client reported issues will be made primarily at the 5.00.00.10 point-in-time release  Final software maintenance build for the 4.20 release of QicLink is scheduled for August, 2014  QicLink 2014 Planned Change Package Schedule on Customer Exchange

15. Confidential | Copyright © 2014 TriZetto Corporation 15 2014 Planned Change Package Schedule

16. Confidential | Copyright © 2014 TriZetto Corporation 16 See Customer Exchange for: - QicLink™ User Group Enhancements - Product modifications & documentation - QicLink release schedule QUESTIONS?

17. Confidential | Copyright © 2014 TriZetto Corporation 17 Workshop Survey We would like to extend you an opportunity to provide candid feedback. During the workshop you should have received an e-mail 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.

18. Confidential | Copyright © 2014 TriZetto Corporation 18 Thank You!