AUDiT iQ^® 2.5 - Latest Release

Combining advanced software technology with an innovative auditing approach, AUDiT iQ version 2.5 offers the very best in software analytics for auditing medical, Rx, and dental claims. In addition, AUDiT iQ includes a module specifically designed to perform a comprehensive dependent eligibility audit from start to finish.

AUDiT iQ is centered around our proprietary analytical engine FiLTER iQ and its modules - independent functional versions of the software tailored to your specific auditing needs.

Our software is used by health care claims administrators, employers, and employee benefit advisors to help them identify critical areas for cost savings and process improvement.

AUDiT iQ is a Microsoft Windows .NET and SQL Server application.

AUDiT iQ^® Medical

The Medical module comes complete for auditing all aspects of a medical health plan and its associated claims data.

A comprehensive set of medical codes are included with the software and are fully integrated into the auditing process. These code sets include: AMA CPT^®, AMA HCPCS, AMA ICD-9, and CMS Revenue codes.

The Medical module is based on over 80 categories that have been pre-tuned and configured out-of-the-box to use the most appropriate medical codes available. In addition, each category can be configured to capture your specific benefit design metrics related to deductibles, co-insurance, in-network / out-of-network payment levels, dependents, maximums based on occurrences or incidents, and many other factors. Some examples of audit categories include:

• Duplicates
• Unbundling
• Medical Necessity
• Paid After Termination
• Coordination of Benefits
• Potential Other Party Liability
• Copays / Coinsurance / Deductibles
• Excluded Services (acupuncture, cosmetic procedures, ...)
• Limited Services (chiropractic, physical therapy, ...)
  

The software provides extensive functionality to import, verify, and transform claims data in preparation for analysis by our FiLTER iQ engine. The end result of this process are 'flagged' claims that show a high likelihood of error. Our Selection Management feature then allows you to analyze and select the most appropriate claims for further review.

Our robust reporting engine includes a Report Viewer that allows reports to be run on-demand and exported to several different formats: PDF, Excel, CSV, and others.

AUDiT iQ^® Dependent Eligibility

The Dependent Eligibility module has everything you need to complete a dependent audit from start to finish. You can audit anywhere from 2 employees to 200,000 - there is no limitation to the number of dependents that can be audited using our software.

Import, Transform, and Verify Your Data

Prior to starting the audit, our software includes extensive functionality to assist you with importing your data, fixing it if necessary, and verifying that it is correct and without inconsistencies. The module includes over 50 separate verification checks to make sure your data set is ready to be audited.

Forms and Mailings

AUDiT iQ includes a complete set of forms and mailing reports to be used throughout the audit cycle. Each form can be easily customized according to your exact specifications and plan language.

• Amnesty Letter
• Audit Cover Letter
• Dependent Verification Form
• Postcard Reminders
• Incomplete Letter Notification
• Audit Complete Letter and/or Postcards

Our forms and mailings are generated as PDF files that will automatically include the appropriate dependent information where applicable.

Tracking Your Audit

Our tracking feature lets you completely process and track your audit throughout its lifecycle. Each family and member's status is automatically updated as the verification form answers and submitted documents are entered into the system.

An activity log is available to automatically track and record when a member's status has changed. In addition, the activity log can record when email and telephone calls are received, when mail has been returned, etc.

In addition, families and members can be added, modified, and deleted throughout the audit. Addresses can be updated. Attachments can be used to store any kind of file associated with a family or specific member (scanned documents, emailed items, forms).

Reporting

Using AUDiT iQ's report generation engine, there are a number of reports available that can be run on-demand to give you an up to the second snapshot on your audit's progress. These reports include family and dependent status reports, and a comprehensive member detail report designed to be outputted as an Excel document.

AUDiT iQ^® Rx

The AUDiT iQ Rx module can play an important role in controlling your drug costs, monitoring utilization, and ensuring that scripts are being dispensed and adjudicated according to your plan language.

Using the latest, as well as historical, FDA NDC codes, the Rx module is based on over 30 drug class categories that have been pre-tuned and configured out-of-the-box to use the most appropriate codes available. In addition, each category can be configured to capture benefit design metrics related to quantity limits, prior-authorization, age limits, gender checks, and preferred / non-preferred pharmacy differences.

Rx categories include:

• Over 30 Drug Class Categories (Growth Hormones, Diabetic Supplies, Vitamins, Infertility, Impotence Agents, . . .)
• Copay & Coinsurance
• Deductibles
• Duplicates
• Timely Dispensing
• Days Supply Limitations
• Refill Too Soon
• Paid After Termination

Reporting & Utilization

The Rx module includes a number of reports that will summarize and compile the results of the audit. It also includes utilization reports regarding brand / generic utilization, retail / mail-order usage, multi-pharmacy use, top provider utilization, and many others.

AUDiT iQ^® Dental

The Dental module includes a comprehensive set of categories to audit and report on the performance and compliance of any dental plan.

Similar to our other claims modules, each code-based category can be configured to capture benefit design metrics related to deductibles, maximum benefits, incidence limits, and age limits.

Categories and reports cover a wide range of issues:

• AMA HCPCS Code-Based Categories (Preventative, Periodontics, Restoratives, Orthodontics, . . .)
• Coinsurance
• Coordination of Benefits
• Cosmetic
• Deductibles
• Duplicates
• Maximum Benefits

For availability, to see a demo, or to learn more about AUDiT iQ, please contact:

Jim Matthews

Partner, Chief Technology Officer

(800) 826-7041 x119