RDS Solutions is a company dedicated to providing software solutions and full service support to Taft-Hartley fringe fund offices. We have used our knowledge of the funds and their specific needs to create a powerful, yet easy to use system that helps the fund office personnel get their jobs done quickly and efficiently
Version 3.0 Now available!
Version 3.0 incorporates our call center technology into our Fund Office workbench so membership information is immediately available to record and answer membership questions.
Fringe Fund Management System Overview
The Fringe Fund Management System has been in use since 1983. It has been constantly improved and redesigned in response to changes in the industry and to take advantages of new technology. The current system is network based and uses a Microsoft SQL Server™ database. It was designed to be flexible and provide the fund office with the ability to change various features of the plan through online screens. The Fringe Fund Management System is comprised of the following modules:
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
CMS (Medicare) Reporting
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
RDS (Retiree Drug Subsidy) Reporting
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
HIPAA_Link
Is our HIPAA EDI solution which is either integrated into the fringe fund management system and is also available as a standalone product which can be used in conjunction with other Medicalclaims payment systems. It is comprised of four modules:
Transportation & Communication Interface
on-line interface allows user to add Trading Partner Information
maintain communication information (ftp site, login, password, encryption)
HIPAA Translator
TransGen™translator converts HIPAA format to text and text to HIPAA format
Claims Adjudication Interface
Uses TransGen™database for data descriptions
Produces Hardcopy Claims, Dump of files
Maintains Microsoft SQL Server™Claims database of new claims
Can produce "response" transactions independent of claims adjudication system
Web Claim Status Inquiry
Uses Claims database for inquiries by member of claim status, EOB and by trading partner for claim status, EOB and eligibility
TransGen is a trademark of JPN Associates Inc.
Microsoft SQL Server is a trademark of Microsoft Corporation.
Contact Log
The contact log is the interface between the Fringe Fund Management system and the fund office staff. It provides a common point to access member information and keeps a record of the questions and answers so they are available to anyone in the office. Information that is available through the Contact Log screen is:
Estimated pension amount
Pension payments
Healthcare maximums
Contractor contributions
Welfare claim history
Contact history
Web Interface
Is the interface between the Fringe Fund Management system and the funds members, employers and health care service providers.
The web interface allows the members to:
Determine what their estimated pension amount would be
Check contributions made by contractors on their behalf
Check the status and view the history of their medical claims
Show pension history
Contractors can use the web interface to:
Check contributions made
Enter contributions
Service providers can use the web interface to:
Check members eligibility in the health plan
Check the status and view the history of their medical claims
