Platform Transformation Overview

1
Self-Funded Billing
2
Self-Funded Billing
Access to invoices and notification system via
e-Bill
Reduction in amount of funds required to have on
deposit with IBC

• New features and enhancements will be available
  after migration.

Self-Funded Billing
Easy access to reports on claims payments,
deposits, and expenses
Stop loss credits available directly on invoices
3
Payment with e-Bill
Simpler and more convenient

• After migration, customers can choose to pay by
  e-Bill, a secure online system that offers
  enhanced notification features.
• Customers receive email notification when
• The invoice is available.
• The amount due changes.
• A payment is returned.

Simple, customizable, and easy payment process
4
Information on InvoicesChanges to Fee
Presentation

• IBC is adopting a new standard for how fees
  appear on customer invoices.
• Not because of new charges but due to changes
  to how some fees are calculated.
• Administrative expenses
• Most admin fees will be billed on a PCPM basis
• Claims Related Administrative Expenses
• A new field type labeled other medical expense
  fee will be created

5
Reporting Hyperlink reports available

• Customers will have an opportunity to determine
  role-based reporting access.
• Customers are able to access summary and detail
  level reports on claims payments, deposits and
  expenses on the same day as invoice is received.

6
Changes to Billing Cycle and Format

• An email with a link to e-Bill will be sent out
  every Wednesday.
• All self-funded customers must move to a weekly
  billing cycle.
• All self-funded customers must pay their invoice
  within 24 hours of receipt.

7
Stop Loss Coverage

• Following platform transformation, claims will be
  fed directly to Highmark Insurance Group (HMIG)
  systems and stop loss credits can be advanced to
  customers who meet certain criteria.
• Customers with stop loss coverage from HMIG may
  receive stop loss credits directly on their
  invoices, eliminating the current need to file
  claims for reimbursement.
• HMIG requires a run-in period for claims and the
  period varies based on the stop loss policy.
  Consistently timely payment (i.e. pays weekly
  amount due, within 24 hours) required for credits.

8
Claims Run Out

• Currently, self-funded customers receive
  information on claims run-out activity on their
  IBC invoice.
• Following migration
• Information on claims run out activity related to
  dates prior to migration will appear on the
  additional item line of the new invoice.
• IBC will continue to send the reconciliation file
  to the customer until run out is complete.

9
Self-Billing of Administrative Fees

• Currently, customers that self-bill
  administrative fees are unable to view an
  administrative fee-only invoice.
• Following migration, self-billed admin fees will
  be filed on a separate admin fee invoice.
• Allows customers to pay the medical invoice as
  billed via e-Bill.

10
Support from IBC
IBC offers support and education about new e-Bill
features

• The following information is available
• Claims billing guide for information on accessing
  invoices through the e-Bill portal, fee types and
  reporting
• Annual calendar of billing cycles (including
  weekly claims and monthly admin cycles)
• Dedicated billing analyst to walk through the
  first invoice and to directly answer questions
  regarding portal access, invoices and reporting