Administration

Claims Processing: Medical, Dental, Vision and Disability
Audit, Quality Review and Cost Containment
Plan Administration
Flexible Spending Accounts (FSA)
Health Reimbursement Arrangement (HRA)
Health Savings Account (HSA)
HIPAA
COBRA
NYHCRA
Subrogation
Reinsurance Management and Relationships
Data Management and Reporting
Benefits Communications
Automated Enrollment

Claims Processing: Medical, Dental, Vision, Life, Short-Term and Long-Term Disability
Fiserv Health - Kansas adjudicates medical, dental, vision, life, short-term and long-term disability claims on its fully integrated and automated transaction processing system. We use state-of-the-art imaging and EDI technology and processes to ensure accurate, efficient and timely processing of all claims. Our system is highly stable and reliable with system availability rates in excess of 99.99%.

Fiserv Health - Kansas stores all benefits and eligibility information directly within our system. Full integration of this information ensures accurate processing of claims on-line in real time. The system generates explanations of benefits (EOBs), checks and report output. Our automated system and processes check for duplicate claim submissions using a comprehensive matrix of dates of services, types of services, procedure codes, dollar amounts and provider data.

Key components of the system include detailed files for each covered individual, extensive benefits and plan information, a comprehensive provider file which includes preferred provider organization (PPO) affiliations, reasonable and customary (R&C) cost data and detailed fee allowance information for numerous PPOs. Our database maintains full historical information on all claims processed.

Audit, Quality Review and Cost Containment
Fiserv Health - Kansas's audit department conducts a comprehensive audit, quality review and cost containment program to ensure the quality and accuracy of claim processing. The process starts from claim input and continues throughout the entire adjudication process. Our goal is to pay claims in accordance with plan provisions. We work hard to ensure accurate claim processing.

Key components of our program include the following:

1. Ingenix Claim Edit System (CES) - We have integrated a comprehensive claim edit module into our claim processing engine. This allows us to review every claim that is processed for coding accuracy, upcoding, unbundling and errant billing practices by providers. Interactive prompts are provided to processors and reports generated, which are reviewed daily for trends and anomalies. Where appropriate, claims are rebundled or corrected prior to issuing payment.
2. Random audits - Customer claims are reviewed at random to determine accuracy of input, benefit determinations, overall processing and financial accuracy.
3. Dollar Amount Audits - Claims in excess of specified dollar amounts are audited for processing and payment accuracy.
4. Post-Adjudication/Pre-Payment Audits - Fiserv Health - Kansas has forged a strategic alliance with HealthCare Insight to fully review all claims after adjudication but prior to releasing payment. Claims are reviewed to identify potential fraud and billing abuses by providers, identify coding anomalies and to identify suspicious or questionable claims. HealthCare Insight's system and processes are designed to detect skillfully hidden billing patterns which are designed to avoid detection by conventional claim edit and screening software.
5. Self-funded plan audits - We are routinely audited by our self-funded plans for processing and payment accuracy.
6. Carrier Audits - Carriers audits are performed every other year for our fully insured business.
7. Targeted Audits - Targeted audits are performed as requested by management or our clients. These are structured to comply with the specific requests of the party asking for the audits.

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Plan Administration

Plan Document Preparation - Fiserv Health - Kansas will prepare the Master Plan Document and Amendments.

I.D. Cards - I.D. cards are provided upon completion of initial enrollment. (view sample I.D. Card)

Forms - Forms may be customized and Fiserv Health - Kansas offers consultation services to produce forms that are straightforward and easy to use. Claim and eligibility forms can be made available electronically.

Customer service - For non-online members, a toll-free telephone number for employees and providers is available for inquiries on the status of claims, eligibility, and benefit plan information.

Claim Records - Complete claim payment records are maintained.

System Security - Built-in system security offers savings to the employer due to the reduction of errors in several areas, including claim adjudication, eligibility and provider maintenance. This system also provides the maximum protection against claims fraud.

Billing - We have the ability to consolidate multiple lines of coverage with various insurance companies onto one billing statement and we can provide billing statements by locations, groups, divisions, classes, etc.

Fund Administration - For fully insured clients, claim drafts are issued on the insurance company's bank account. For self-funded clients, claim drafts are issued on the client's bank account. Fiserv Health - Kansas will provide a check register and a monthly reconciliation report of issued drafts, voids and refunds.

Data Reports - Fiserv Health - Kansas can provide an extensive array of reports from which to choose. These reporting options include information for management of benefit plans including check registers and eligibility reports. We also provide an extensive reporting package which can be used to manage costs, evaluate trends and identify opportunities for greater efficiencies and improved cost control.

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Flexible Spending Accounts
A Flexible Spending Account (FSA) can enable an employer to reduce their payroll taxes and allow an employee to pay for certain benefits with tax-free dollars. The effects of plan changes that can shift more costs to employees can also be minimized. Fiserv Health - Kansas also offers a flexible spending debit card that reduces paperwork and allows payment at the time of service with the swipe of a card.

Fiserv Health - Kansas manages FSA administration, including Plan Documentation, discrimination testing and communication to employees, while maintaining strict observance of IRS Section 125 regulations. We administer Health Care Reimbursement Accounts, Dependent Care Reimbursement Accounts and Transportation Reimbursement Accounts, which may be purchased individually or as a package. Maximum employee contributions are established by the employer, subject to Federal limitations.

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Health Reimbursement Arrangement (HRA)
Health Reimbursement Arrangement (HRA) Plans work in conjunction with higher deductible medical plans. An HRA is a federally approved program whereby Employers set-up and fund personal accounts for their employees to help pay plan participants' healthcare costs. HRAs allow employees to roll-over any unused balances at the end of the year according to the Plan Design.

Employer contributed funds in HRA accounts are tax-free to employees and expenses paid out are tax deductible for Employers. Employers do not need to fund HRA accounts in advance. These Accounts can be funded as claims are incurred. HRAs give employees the flexibility to choose how best to manage their health care dollars. Debit Cards can be used in conjunction with HRA accounts as a convenience to plan participants.

Fiserv Health - Kansas manages HRA administration and provides claim administration for high deductible medical plans on either a fully-insured or self-funded basis. Our Web-based HRA tracking capabilities are available to plan participants 24 hours a day.

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Health Savings Account (HSA)
Health Savings Accounts (HSAs) offered in conjunction with qualified high-deductible medical plans can be a powerful tool in containing runaway healthcare costs. An HSA is a savings account used to pay for qualified healthcare expenses with tax-free dollars. HSA funds can be contributed by the Employer or Employee and are owned and controlled by the Employee. HSA funds earn interest and grow in the account tax-deferred and may be used for healthcare expenses, COBRA premiums, Qualified Long Term Care Insurance, Medicare and retiree health premium (but not Medicare Supplement Plan Premium). HSA savings roll over annually and are completely portable.

Fiserv Health - Kansas manages HSA administration and provides claim administration for high deductible medical plans on either a fully-insured or self-funded basis. Our Web-based tracking capabilities are available to plan participants 24 hours a day. Debit Cards can also be used to receive HSA distributions as a convenience to plan participants.

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HIPAA
The Health Insurance Portability and Accountability Act (commonly known as HIPAA) is a Federal law enacted to protect health care consumers and plan participants. The protections come in several forms.

First, HIPAA improves the availability and continuity of health insurance coverage to plan participants. It limits exclusions for pre-existing medical conditions, permits certain individuals to enroll for group health insurance coverage when their other health coverage is lost or they have new dependents. HIPAA also prohibits discrimination in group enrollment based on individual health factors.

In addition, HIPAA ensures the privacy and security of each individual's protected health information (PHI). There are numerous requirements which must be followed by covered entities, which include healthcare providers, health plans and clearinghouses, to comply with the HIPAA Privacy regulations.

At Fiserv Health - Kansas we are committed to developing ways to significantly ease the HIPAA burden on our customers. We can assist our clients in meeting the requirements imposed by the HIPAA regulations through the following:

HIPAA Privacy Toolkit - The Toolkit is a comprehensive resource developed with our client in mind. It provides a base from which to begin your HIPAA Privacy compliance efforts. The Toolkit has been developed to be used as a blueprint by your existing staff or you may wish to seek the assistance of a consultant or firm which specializes in HIPAA Privacy and Security compliance.

HIPAA Privacy Turnkey Solution - Our Turnkey product takes a significant portion of the HIPAA compliance burden off of our customers. For customers who enroll in this solution, we will contractually assume responsibility for providing a significant portion of the compliance efforts for your company's health plan. Specific compliance tasks include, but are not limited to, the following:

• Designating a Privacy Official for your plan
• Prepare and mail the plan's Notice of Privacy Practices
• Maintain and manage the Designated Record Set
• Managing contracting efforts between the health plan and its third party vendors (Business Associates)
• Draft, implement and train on required HIPAA policies and procedures
• Draft and implement all HIPAA compliant forms
• Administer complaint procedures, employee review requests, amendment requests, and authorization programs
• Develop and maintain a database to log and track requests and documents required by the regulations

As you can see, we have developed a complete program that will allow our customers to continue their focus on what is most important - your strategic business pursuits and your overall goals in providing excellent health care benefits to your employees.

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COBRA
Fiserv Health - Kansas's regulatory knowledge, administrative expertise, and state-of-the-art technology can alleviate the burden of COBRA administration. We offer a full line of COBRA services, including:

• Distribution of Initial Notices
• Distribution of Qualifying Event Notices
• Billing COBRA premium to COBRA participants
• Annual enrollment packet distribution to COBRA participants

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NYHCRA
The New York Health Care Reform Act of 1996 (NYHCRA) became effective January 1, 1997 , and imposes surcharges and assessments on a variety of medical services provided by New York medical facilities. As a self-funded business, employers are subject to this law if they have employees receiving care or treatment in the State of New York . Employers may "elect" to have Fiserv Health - Kansas remit the surcharge and assessments directly to the State of New York on their behalf. For "non-electing" employers, the surcharge is paid to the Provider, who in turn remits the surcharge to the State of New York . Employers with employees residing in New York will need to report their covered lives obligation to the state of New York .

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Subrogation
Fiserv Health - Kansas can provide access to numerous organizations which assist in providing claim negotiation services. These services help to maximize recovery efforts on claims which result from the actions of third parties.

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Reinsurance Management and Relationships
Fiserv Health - Kansas maintains strategic relationships with the highest rated stop loss carriers throughout the country. Due to our national presence, employers have access to virtually any stop loss carrier and multiple types of coverage while benefiting from the most competitive rates.

Stop Loss Solutions - Fiserv Health - Kansas has access to a wide variety of stop loss products and services that include individual and aggregate coverage. We also have access to Managing General Underwriters (MGUs) who represent carriers that provide specific products and solutions to meet unique customer needs.

Vendor Integration - We can bill, collect, and remit monthly premium payments directly to the carrier eliminating the need to process multiple invoices and payments.

Monthly Review - Fiserv Health - Kansas will review paid claims by individual to monitor the progress of claims reaching or surpassing 50% of the Individual Specific Deductible. When necessary, we will notify the carrier of the specific details of the claimant and together, Fiserv Health - Kansas and the carrier, will closely follow the claim. The aggregate claims, if applicable, will also be tracked to ensure awareness of any approaching aggregate claims.

Renewal Review - Fiserv Health - Kansas will evaluate the stop loss pricing at renewal and ensure a fair and competitive market value for the services offered.

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Data Management and Reporting
In addition to plan design and administration, we can provide documentation and plan performance reports that employers need to manage their benefits more effectively. These tools help monitor basic utilization and can be useful in identifying new options for greater savings.

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Benefit Communications
In today's fast paced environment, employers are looking for concise, easier ways to communicate their benefit packages. Additionally, the multi-cultural needs of today's workforce bring a variety of challenges to human resource and benefit departments.

Fiserv Health - Kansas can help. From traditional communication strategies using paper benefit guides, to electronic methods using the internet and interactive voice response via the phone lines, we craft solutions to meet the needs of your staff.

Our online links to your SPD's, claim Web sites, PPO directories and various other resources help your employees understand their benefit programs and assist you with communicating the value of the benefits being offered.

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Automated Enrollment
Workforces that are sizable, diverse geographically or culturally, and employers looking to bring simplified administration to their enrollment process, can all benefit from Fiserv Health - Kansas 's Automated Enrollment Programs.

Online internet access and Interactive Voice Response (IVR) via the telephone can provide important support to the human resource and benefit departments struggling to keep up with the workflow. Our custom enrollment guides give employees the information they need to enroll in their employer's benefit programs and walk them through the enrollment process. Once enrollment has taken place, payroll interfaces can be established to streamline the entry of changes in the employee's annual benefit elections.

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