Invoice Management

Again, thank you very much for taking the time to meet with our team to discuss our challenges, particularly as it relates to the Invoice Management piece. Based on outcomes of that discussion and under your suggestion, our team met and put together a (high level) document outlining our “Must Have To Launch” criteria as it relates to Consolidated Billing. I think it worthy to note that our requirements are limited (at the moment) to the extent for which we understand the Invoice Management process, which quite frankly is vague at best. I don’t believe we have received what we would consider to be thorough training and/or instruction as it relates to your current Invoice Management capabilities and processing and therefore, we can only address those requirements we believe are missing. It might be worthy of a 15 to 20 minute high level discussion of what your actual Invoice Management process consists of and the work flow performed today to ensure that we have not made any assumptions and are not missing any additional critical items that would inhibit us from a going live. The WT folks (and I can’t seem to locate their names) we met with in early August of 2015, including Jennifer Leugers, seemed well versed in your Invoice Management capabilities and perhaps could assist in drafting our spec document for what actual programming would need to take place.

1. The Billing Rules built within the application at the Plan Level would drive the participant level billing outcome (by coverage/by plan) for the Invoice Month for which a client was being run.

Example: Kaiser Medical Billing Rules were built as a 15th of the month rule billing product and the Delta Dental Billing Rules were built as free in/pay out (ie, you must be active on the 1st day of the month to be billed for that month), I would expect that a new hire who was effective on March 14th – would appear on the March Invoice with a full months premium for Kaiser medical (because their hire date was on or prior to the 15th), however, would not be listed on the March Invoice for their Delta Dental Coverage (because their effective date was a date other than the 1st day of the month). The April Invoice would have the new hire with both the Kaiser Medical and Delta Dental Coverage.

Based on those rules, there would be no need to have the questions “Do Not Bill Election Effective” or “Drop Benefits From Retor Adjustments” on the Invoice creation page.

2. The ability to select the Invoice output to be “Columnwise” (similar to your Standard Reporting output).

3. Ability to store multiple vendor numbers by coverage/by plan. Example: A Self-Funded Medical Plan has multiple billing components: Vendor Numbers to be able to report/pay: Aggregrate Co; Stop Loss; ASO Fee; Broker Fee, etc. and to pull on the Invoice

4. Ability to create an Invoice Template for Each Client. Once built, ability to automate its generation on a monthly basis for review. Once reviewed, ability to “post” and/or finalize.

5. Auto Adjustments: ability to have the system auto adjust based on eligibility transactional events – with NO requirement for a person to manually approve each and every adjustment. All adjustments should be auto created and approved unless there is a need for an end User to go in a manually adjust. The current process today appears to require the user to create the Invoice, then run a “discrepancy” from month to month and then finalize each adjustment.

6. Billing History capable. Allow for user to run a billing history by client or by participant and designate the date range to be run.

7. Access to an Invoice Management expert at WT

8. Ability to pull User Defined fields onto the Invoice

9. Ability to “delete” a previously finalized Invoice and then recreate

10. Ability to turn on or off a user’s ability to “delete invoice” or ‘finalize invoice”

11. Ability to run and finalize an Invoice by Classification

12. Ability to allow for applying manual billing adjustments at the participant level.

Lastly, I have attached hereto a copy of our PDF version of our Invoice. The Detail (although a PDF) can also be uploaded into a spreadsheet application from our site.

Again, many thanks for your partnership and willingness to come to the table to discuss some of our challenges – we look forward to our meeting on Tuesday.