Contractor Contribution Module
The Contractor Contribution module is used to enter, balance and report on contractor contributions. Key features of this module are:
multiple local support - maintains member information
- maintains employer information
- produces contractor contribution forms
- enters employer contributions and allocates to the various funds
- calculates discrepancies and penalties
- allows for reciprocal transfers to other locals
- member inquiry screen
- various contribution reports
Interfaces to Welfare Eligibility, Pension and General Ledger modules.
Welfare Eligibility Module
The welfare eligibility module is used quarterly to calculate eligibility for the welfare fund based on contractor contributions. Key features of this module are:
- multiple local support
- members can be eligible with either yearly or quarterly hours
- tracks self-payments
- produces welfare eligibility report
- produces welfare eligibility cards
- produces self-payment report
- produces self-payment letters
Interfaces to Medical Claims, Prescription Drug and General Ledger modules.
Medical Claims Module
The Medical Claims module can be used for medical, dental, mental, vision, time loss and insurance claims. Key features of this module are:
multiple local support electronic interface to Blue Cross/Blue Shield of Illinois interface for electronic feed of claims in HIPAA format (HIPAA_Link) processes up to three years of claims concurrently processes multiple health plans for the same local duplicate claim and duplicate procedure checking allows for out of network and failure to pre-certify penalties uses standard medical coding for procedures, diagnosis etc. uses reasonable and customary checks on Medical, Dental, HCPCS, Anesthesia and Outpatient Facility procedures the ability to set yearly or lifetime limits on specific types of claims (either dollars or visits) allows for fixed rates on specific procedures the deductible calculation is based on family and/or individual has a separate deductible for dental the co-pay percentage is based on maximum out of pocket claims can be entered immediately into the system and will remain in a hold status until processed automatically produces correspondence requesting missing or incomplete information from the member produces deductible and explanation of benefit letters for paid claims produces denial letters identifying the reason for denial and the specific place in the SPD that is applicable on-line claims inquiry screen
Prescription Drug Module
Used in conjunction with the Medical Claims module. Prescription drug claims are included in medical claim calculations for deductible and co-pay. Key features of this module are:
- multiple local support
- processes up to three years of claims concurrently
- processes multiple plans for the same local
- duplicate prescription checking
- the deductible calculation is based on family and/or individual
- the co-pay percentage is based on maximum out of pocket
- claims can be entered immediately into the system and will remain in a hold status until processed
- automatically produces correspondence requesting missing or incomplete information from the member
- produces deductible and explanation of benefit letters for paid claims
- produces denial letters identifying the reason for denial and the specific place in the SPD that is applicable
- on-line claims inquiry screen
Interfaces to General Ledger and Check Reconciliation Module.
Pension Module
Used in conjunction with the contractors contribution module. Maintains vesting and service credits earned by the member. Key features of this module are:
- calculates vesting and service credits based on contributions
- can prints pension checks or provides a direct deposit option
- provides a pension check register
- produces an annual vesting and service credit letter
- produces actuarial reporting
Interfaces to General Ledger and Check Reconciliation Module.
Check Reconciliation Module
Updates check reconciliation file. Key features of this module are:
- multiple locals, funds, banks
- reconciliation procedure to balance to bank statement
- provides for deposits
- ability to add manual checks
- reconcile BCBS billing
Interfaces to General Ledger Module.
General Ledger Module
Produces the books of the funds. Key features of this module are:
- multiple locals, funds
- double entry bookkeeping
- manual journal entries to reclassify general ledger information
- trial balance
- detailed general ledger identifies source of entry
- journal listing
- general ledger report writer
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