AN INTRODUCTION TO RISK MANAGER Setting the Standard for Claims Administration Software Since 1982

ALL CLAIMS ADMINISTRATION PROGRAMS COLLECT DATA AND PRINT REPORTS “The true measure of a program is a combination of factors: how it handles regulatory complexities, how quickly and easily you can find needed information, and whether it increases productivity. But most importantly, the company that stands behind it”

Specifications and Pricing Effective June 1, 2013

Sales

877-882-3742 or 425-814-2400

ERIC Systems’ Risk Manager is an integrated suite of programs designed for the day-to-day administration of worker compensation, property & casualty, professional liability, and unemployment claims. It is a cloud capable, multi-state, client-server application designed to maximize performance in high volume environments. It is suitable for use by any size organization that is self-insured and self-administered, a third-party administrator (TPA), insurance carrier, association of self-insured’s, and/or retrospective rating group. Risk Manager has been in production use and under continual development since 1982. This long heritage is reflected in the comprehensive nature of its design and the ease with which it can handle the complex regulatory environments of multiple State agencies and the Federal government. An intuitive user interface, extensive configuration options, comprehensive security, and flexible reporting are areas where Risk Manager shines. System access is controlled by a function oriented security system. Access rights may be assigned to individual users or the same set of rights to many users using profiles. Access to claim information can also be limited to one or many organizational levels or to claims associated with a policy carrier. Crystal Reports source files for over 450 standard reports are supplied. An optional module gives users the ability to incorporate their own reports using our proprietary interface to the Crystal Reports run-time system. Risk Manager is a real-time design meaning that there are no posting routines required at the end of day or to prepare for end of period closing. Transactions affect financial totals as soon as the entry is saved. End of period closings can be completed without having to suspend daily operations. Though comprehensive and powerful, Risk Manager remains simple to install and maintain. All data, including correspondence items, image files (pictures and documents), archive copies of ACH and positive pay extract files, EDI files created for regulatory compliance, and third-party bill review details are stored in the Risk Manager database. There is only one file to backup which makes the potential for data loss extremely low. Unlike many older claim administration applications, Risk Manager was initially developed for use on personal computers. As a result, the interface takes advantage of and compliments the user friendly environment associated with desk top computing. We always encourage feedback from our clients, and endeavor to incorporate their ideas to optimize procedures for searching and retrieving information. Risk Manager was developed using industry standard tools for development, including Microsoft NET, SQL Server, and Crystal Reports. Many organizations already use these products allowing them to leverage their existing skills base to customize Risk Manager to meet their specific needs. Most importantly, ERIC Systems offers Risk Manager as an “off-the-shelf” application for claims administration. All versions of the program have essentially the same set of features. Additional capabilities, not of interest or not applicable to all users, may be added by purchasing optional modules. Unlike most other ISD’s, our support policy is to offer continuous distribution of updates and enhancements to all users with a current technical support agreement.

ERIC Systems 9833 NE 120th Place, Suite A, Kirkland, WA 98034 Email: [email protected] Phone: 425-814-2400 or Toll-Free: 877-882-3742

ABOUT ERIC SYSTEMS Who Are We? ERIC Systems was founded in August 1982. ERIC is an acronym for Employee Records and Information Computerized. We are a privately held, independent software developer (ISD) headquartered in Kirkland, WA. The company has remained under the same management since its inception. In 1988 ERIC Systems, Inc., was merged with its sister company, The Professional PC, Inc., (same ownership) to eliminate duplicate record keeping and is now a wholly owned subsidiary thereof. What Do We Do? ERIC Systems is the developer of ERIC Risk Manager. This was our first application developed for sale and remains the company’s primary focus. The first version of Risk Manager was installed in the offices of a Washington based TPA in 1984. The continued improvement and support of Risk Manager is the focus of 100% of our energies. Why Are We Different? ERIC Systems is not your typical software vendor. We have written, marketed, sold, trained, and supported our mission critical software for almost three decades. We understand our responsibilities to our clients and we're dedicated to providing the best possible service and support. Our business model is unique (compared to our competition) and is derived from our philosophy that your software company should be both a resource and a business partner. Risk Manager is offered as an off-the-shelf application for claims administration. We do not sell or support customized versions of the main program modules. For clients with unique requirements, such as import of data from third-party sources, interfaces to other applications, compliance with State-specific reporting requirements, we’re usually able to accommodate with what we refer to as an “Add-in” module. It’s important to understand that “off-the-shelf” means that all of our clients use the same basic program modules with the same feature set. This allows new clients to implement Risk Manager slowly adding additional functionality as they grow and their business needs dictate. The design of Risk Manager recognizes the diversity in the business world by including over 100 user-defined coding schemes and operational rules that can be uniquely customized for different organizational units. This allows companies with diverse operations or TPA’s with a wide variety of client types to configure Risk Manager to meet the specific needs of each of their clients. No longer do the claims of every business unit or client have to be forced into the same mold for data collection, classification, or reporting. We believe our primary responsibility is to provide you with the tools to provide the best possible service to your clients, whether they be co-workers who are managers and department heads or clients for whom your firms provides claim administration services.

Free Programming or How We Respond to Client Feedback If a client suggests a feature or capability not currently offered and, if we believe that enhancement would be of value to a majority of our client base, we will endeavor to add that feature or capability to a future release of Risk Manager at no cost to the requester. Our philosophies… •

We don’t believe a claims administration application needs to cost six figures (or more). A fully featured, single enterprise, single employer version of Risk Manager starts at only $19,995.

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We don’t require our clients to purchase a new program version every year in order to stay current. All clients with a current technical support agreement receive all updates and program enhancements.

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We don’t believe in charging extra for every user accessing our program. Risk Manager is provided with a file server license that allows any number of users to access one production data base and one test data base, attached to a single instance of SQL Server, installed on a single networked data base server.

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We don’t believe technical support response times should be measured in days. Nor do we believe you should have to initiate a “trouble ticket” in order to be recognized by a technical support rep. Do you really have that much time? A phone call gets an immediate response with most problems solved within a few minutes. Corrections for significant programming errors are often made available within a few hours.

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We don’t believe in closed or proprietary system architectures. The Risk Manager database is neither encrypted nor password protected. Access and use your data any way you choose.

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We prefer to use a remote desktop connection to provide the best possible technical support. Time is money and there’s nothing worse than a frustrated operator unable to complete an important work task. The fastest and easiest way to solve a problem is to see the issue and solve it, in real-time, working directly with the operator experiencing the issue. Unlike some of our competitors, this service is provided as a standard component of our annual technical support agreement.

SOME OF THE REASONS WHY WE BELIEVE RISK MANAGER DESERVES YOUR CONSIDERATION Industry Standard Development Tools ERIC Systems has chosen to use industry standard development tools, including Microsoft NET, Microsoft SQL Server 2008, 2008 R2, and Crystal Reports 2008 to develop its applications (earlier versions of these applications are also supported; see system requirements). This ensures the widest possible acceptance and the ability for our clients to leverage the existing skill base of their employees and on-premise resources. A Design that Utilizes Your Existing Resources When we implement a new feature, we attempt to choose an option that’s generic in its function. For example, our correspondence module imports a variety of file formats, including MS Word DOC and DOCX to create both correspondence items and templates. Since most popular word processing programs support saving files in one or both of these formats, existing documents can be used immediately without having to re-do hours of work to support a proprietary format. For claim related email, we’ve implemented use of the “Save as text” option, available in virtually all popular email clients, to easily add emails to the claim history. This means our users wouldn’t be forced to use a propriety email client or have two email clients competing for the same inbox. The design of Risk Manager includes a stand-alone interface to our standard reports allowing our clients deploy the report selection grid so that clients and/or remote users can create and configure their own reports 24/7. There is a custom reports function that allows user created Crystal Reports residing in a common server location to be executed without having to purchase an additional module. For more advanced users, by acquiring our proprietary interface to Crystal Reports engine, known as the Report Configuration module (optional), any user can access the inner workings of our print control module to take advantage of all the same features and functions we use to add and maintain system reports. Utility modules are included within the main program and many optional modules that provide the ability to maintain fee schedules, update time loss calculation tables, coding schemes rd and to periodically import data from 3 party sources with a constant file format such as the AMA, CMS, NCCI, and others. Open System Architecture The Risk Manager database is a completely open system. Utility modules are provided to allow users to maintain every aspect of system operation and keep their systems up-to-date with regulatory changes. We even allow clients to create their own database views for custom reporting purposes. The database is available for query using Crystal Reports, Microsoft Access, Excel, Word, or any other ODBC compliant program. Source files are provided for all standard reports and “QuickPrints”. They may be modified or used as examples to create your own reports. Affordability Risk Manager is offered in the form of a base program with optional modules to accommodate specialized functions, like mandatory EDI reporting. This allows our users to customize their feature set to meet their individual requirements without having to buy modules they’d never use. Installation assistance, user training, administrator training, and technical support (including remote desktop support) are included in the system price.

Unlimited Access to Telephone Technical Support Access to our Help Desk is offered at a fixed annual rate. We never charge hourly or “per incident” fees to support our products. Our preferred method to answer questions and solve problems is by using remote desktop support. This allows us to view your screen while talking on the phone. Most issues can be solved in a few minutes. We also use these connections to show operators different ways to accomplish tasks and to offer follow-up training on new features and capabilities they may not have been aware of. Unlike our competitors, we do not charge extra fees for remote desktop assistance via the Internet. Special Program Extensions Expressly for User Designed Reports Since reporting is one of the most essential aspects of a claims administration system, there are three (3) special tables maintained to facilitate ad hoc reporting. These are the Claims Totals table that summarizes financial transactions by reserve class, the Claim Coverages Totals table that summarizes financial transactions by coverages within policies, and the Period Totals table that removes the mystery from creating reports that show activity between two dates. Each of these tables is easily linked to the Claim Information table that contains detailed information about the claim and the claimant, without the necessity to understand structured query language (SQL). Existing skills with a spreadsheet are likely all that’s required to generate sophisticated reports for any purpose. Customer Service the Way it Should be Done Our approach to marketing Risk Manager is based on our desire to provide a great program with the best possible support. This allows us to provide a level of customer service second to none. We believe response times for critical issues, including fixes requiring changes to program code, should be measured in minutes and hours, not days and weeks. The President of the company answers the phone. A File Server License TPA's and larger organizations having multiple locations will appreciate that Risk Manager includes a file server license. There are no “per seat” or “per user” charges that must be budgeted for the implementation of Risk Manager. We allow one (1) production data base and one (1) demonstration or test data base to be maintained on a single server attached to a single instance of SQL Server. Any number of users may be given access to these databases. We encourage clients to provide remote access to the claims management process, especially the ability to print reports and to enter First Reports of Accident/Injury from remote locations. Of course, licenses required by Microsoft for networking and/or access to SQL Server are still required. Easy to Install, Configure, and Maintain With a functional network and SQL Server installed, the first workstation installation of Risk Manager can be accomplished in less than 45 minutes. Subsequent new installations can be performed in approximately 15-20 minutes per workstation. An Administrator can easily configure optional parameters in less than an hour. There is only one database to backup and nightly backups can be done using existing hardware and software. There are no links to external files used. Once setup, a utility program checks for newer programs each time Risk Manager is executed and, when found, will automatically copy these newer files to the workstation. Updates and Enhancements without Extra Fees The program update policy for Risk Manager is simple and straightforward. We do not subscribe to the "new version for an

additional charge" model. Risk Manager is constantly being enhanced and new features added. ALL updates and new program versions are provided at no additional cost as part of our standard technical support agreement. Your installation of Risk Manager will never go out of date nor will you ever be forced to pay 50% or more of the original acquisition cost for an update to remain eligible for technical support. The availability of updates is announced periodically by email and may be obtained at any time via download from our secure FTP site. Custom Programming and Free Reports? Our policy for development of new program features and standard reports is based on client suggestions. If a new or existing client requests a program enhancement and, in our sole judgment, that enhancement would benefit a majority of our clients and/or add significantly to the marketability of Risk Manager, we will do the programming necessary to implement that suggestion at no cost to that client. The revised program will then be distributed to all clients as part of a regularly scheduled update. Unparalleled User Access Control One of the ways increased Internet access is changing the business landscape is that clients are demanding a more handson role in the administration of claims. The security module of Risk Manager offers hundreds of security items representing more than a thousand individual security attributes that may be individually enabled or disabled for each user login account or security profile. Financial controls and limits are always user login specific. Importing Data from Other Applications There are over 7,500 data fields maintained in the Risk Manager data base. This fact together with our almost 30 years of experience, means we can capture virtually every data item provided when importing historical claim information from a foreign application. Integrated Medical Fee Adjusting (Optional) Reducing claim costs is one of the primary reasons for becoming self-insured. Every version of Risk Manager provides the ability to do basic medical fee adjusting. The Medical Fee Adjusting module is a sophisticated look-up of allowed charges based on a published State Fee Schedule plus additional savings that may be obtained from participation in a PPN/PPO. For maximum savings, ERIC Systems recommends that a medical professional having specific knowledge and experience with Best Practice Medical Treatment Guidelines and other considerations affecting costs for treatment, such as the application of global surgical rules, oversee use of this function. • • •

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Adjust provider invoices based on the State Medical Fee Schedule Use of multiple State schedules is supported as well as any number of user-defined alternate fee schedules. Adjust provider invoices by look-up of CPT codes, AWP for prescription drugs, local codes for travel and expense reimbursements, supplies, dispensing fees, costs for DME. Pay different rates based on Medicare localities including multiple locations for the same provider. Generate detailed Explanations of Benefits (EOB) to send with checks. Easily review claimant medical payment histories. Create multiple preferred provider networks (PPN’s). Providers can belong to one or more networks with different discount rates for one or more procedures. POAC support for adjusting hospital charges. PPN memberships can be assigned at either the employer or enterprise levels for maximum flexibility.

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Duplicate checking for billings and procedures paid. Use the “Quick Entry” form for rapid data entry of up to six (6) procedures to be paid “per fee schedule”. Support use of two (2) schedules concurrently to compare discounts choosing the least costly option.

Specific modules for importing adjusted bills, ready for payment, produced by third-party bill review companies, are also available. Extensive Configuration Flexibility ERIC Systems recognizes that our clients have clients of their own, even if they’re self-administered. The design of Risk Manager includes a wide variety of options for configuring business rules, integrating custom reports, creating client-specific organizational structures, user-defined data entry fields, userdefined coding schemes to classify claim data, and organizational level specific correspondence templates that will satisfy a diversity of needs. OSHA Compliance and Sharps Injury Log Reporting Risk Manager includes the ability to collect data to print the Form 300 Log of Work-Related Injuries and Illnesses, Form 300A Summary of Work-Related Injuries and Illnesses, Form 301 Injury and Illness Incident Report, and the Sharps Report. A majority of required data is collected automatically through the normal dayto-day administration of claims and incidents. The Incident module provides the means to maintain and classify injuries not resulting in the filing of a claim and, in worker compensation environments, those resulting from use of sharp implements and/or tools. Reporting of both is also required by OSHA. Incidents are separate from claims so as not to affect claim searches, counts, and statistics. Flexible Check Printing, ACH, Fund Accounting, and Sub Account Capabilities Risk Manager supports the configuration of multiple check layouts to satisfy even the most diverse business structures. Six different check formats, one for each reserve class, can be defined at the enterprise and/or employer levels. In addition, unique formats for bundled (combined payments to a single payee) and special (non claim related payments) checks can also be defined. If desired, a unique layout can be specified for each user defined payment category. Any number of bank accounts can be defined and assigned to one or more employers or more enterprises. Bank accounts can be set up to use sub accounts for separation of checks for easier coordination of reimbursements and/or checkbook reconciliation. ACH transfer information is defined by bank account and, if a claimant, dependent, other payee, or vendor has ACH information defined, the check processing module will automatically create an ACH file for transfer to the bank. Check data can be exported electronically for use by a third-party AP system or vouchers can be printed if additional approvals are necessary before a check is to be issued from another application. External payee ID’s are available for claimants, spouses, and other payees to facilitate interfacing with AP applications that require all payees to have an assigned vendor number. Quickly Switch Between Test and Production Data Bases (Standard) Easy access to a test environment can be invaluable for a variety of reasons. Therefore ERIC Systems provides the ability to maintain two Risk Manager data bases with the ability to switch between them with only three (3) mouse clicks.

Reasons for maintaining a test data base include: •

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Ensure privacy of sensitive medical and legal notes and/or correspondence items maintained in a production environment. To provide a new user training environment. As a platform for developing and testing of new reports, check layouts, forms, and correspondence items. Testing program update scripts. Evaluating new program features and capabilities. To facilitate verification of the accuracy and completeness of data imports from foreign systems.

When a user changes to the test data base, everything changes. Standard reports contain data from the test system, not the production data base. Security and permissions are uniquely defined for each data base, so users can be given a different set of rights for each. This is the ideal way to train an operator to perform a new function.

defined within that enterprise. An employer form is only selectable for organizational units within that employer. This filtering feature provides the means to organize what could potentially be hundreds of jurisdictional and/or organizational specific files to ensure only the right choices are presented to an operator for selection. Another feature of forms is called “On-the-Fly” fields. When incorporated into a form, they allow the operator to add variable data to boilerplate letters and/or to mark checkboxes in governmental forms. Integrated Word Processor with Template Manager (Standard) Written communications with claimants, claim contacts, witnesses, involved parties, employer representatives, vendors, attorneys, physicians, and others involved with a claim are made easier by provision of multiple instances of a word processing module. Professional looking correspondence can be quickly created by beginning with a predefined template or just starting with a blank page. There is no limit to the number of correspondence templates that can be defined. Design custom letterhead for multiple office locations and/or departments. A history of all correspondence is automatically maintained in the data base for rapid retrieval and review. Files created using Word (DOC or DOCX), Notepad (TXT), or WordPad (RTF) or any compatible application can be imported to create templates or correspondence items. Export formats include: PDF, DOC, DOCX, RTF, or TXT. Image files (pictures) may also be included in any document except TXT. There are approximately 95 formatted mail merge fields for claimant correspondence provided for convenience. For example, address block fields for claimants, contacts, and vendors will print address1, address2, city, state, and zip code at one time. If address 2 is not used, the block will be formatted to suppress the unused line at print time.

SQL Server dialog form

Time and Expense (T&E) Billing (Optional) For TPA’s, Risk Manager includes the capability to generate and summarize time and expense billings charged for management of claims and occurrences (events triggering multiple claims). Billings may be entered in one operation, reviewed, and then released for approval at the end of an accounting period. Invoices can be generated for employers, enterprises, and/or carriers. Integrated Forms Handling (Standard) Risk Manager utilizes the power of Crystal Reports for mail merge operations and forms fill-in. The Forms module allows each site to define custom layouts for checks, explanations of payments (EOP’s) to explain time loss benefit calculations, and explanations of benefits (EOB’s) to document fee adjusting operations. Forms can also be printed by triggers and used to print frequently used items like; notices of claim acceptance or denial, and changes in claimant status. For larger TPA’s, forms can be classified as being a system, enterprise, or employer type. A system form is available for an operator to select at any organizational level. An enterprise specific form may only be selected for organizational units

Extensive Facilities for Notes and Diaries (Standard) Notes are text-based entries that are used to document the history of the claim administration process. Note and diary modules are available for claims, enterprises, employers, vendors, incidents, litigation events, occurrences, and property items. A system level diary module is also provided for examiner to examiner (not related to a specific claim) reminders. Text based notes are maintained for two reasons. First, they’re fast to create and second, note entries from third-party applications to import into Risk Manager are generally provided in text form. Diaries are augmented with a “follow-up” function making it convenient for an examiner to create a new diary in the event a task was not able to be completed. There are two methods provided for viewing diary entries. The first is a summary grid showing pending and past due entries within an operator selected period. This grid can be configured to be displayed each time the program is started or displayed at any time with a single mouse click. The second option is a rolling 3 month calendar view that shows the number of diary entries from all 8 diary modules scheduled for that day. Clicking on the day displays the details for each of the entries.

Our imaging interface is optimized for speed, simplicity, and accuracy. With a claim open for edit, paper files and photos can be scanned directly into the claim record. Video files, spreadsheets, email attachments can be added by dragging and dropping the file onto a single form. Multiple page documents are supported. It’s also possible to drag and drop onto a row of a selection grid to add that document to the item without having to open it for edit. All images, files, and document scans are stored in the Risk Manager data base to prevent accidental loss through operator error or hardware malfunction.

Diary 3-month Rolling View

Within each option, the diary can be opened to allow the operator to record an action taken or to open the associated module (for example, a claim module) for review. An assignable right allows managers to see all diary entries for all examiners, if needed. Integrated Document Imaging (Standard) There are eight (8) document imaging modules incorporated within Risk Manager. Each module allows any type of file to be incorporated into the electronic record of the claim. Photographs (JPG, BMP, and FRX), spreadsheets (XLS), word processing files (DOC and DOCX), Fax (TIFF), sound files captured from voice mail systems (WAV), video files (MPG, AVI, FLV), Adobe Reader (PDF) files, and many more formats can be incorporated into claims, occurrences, litigation dockets, employers, enterprises, property items, employer policies, and at the system level for storing blank forms. A special module is provided that shows all documents associated with a claim in a single grid along with a viewing and editing capability. File descriptions, categories, and keywords are available to help find one document from a collection of several hundred with a tedious search. This module also provides the option of viewing all documents, by target, within a user defined period.

Property/Fleet Schedule Module with Inspection and Deficiency Tracking (Optional) For organizations administering P&C claims, ERIC Systems offers an optional property module for tracking descriptive information about vehicle fleets, buildings, machinery and equipment, and personal property. Defined property items are available to be associated with a claim. An Excel spreadsheet template and a merge module are provided for collecting property information from departments and/or clients. Supplement safety programs by maintaining a complete history of inspection reports for each property item. Ensure deficiencies are corrected in a timely manner for a safer workplace. Graph the types and frequencies of violations to identify areas needing additional focus for training and/or supervision. Photographs may be added to reports for reference purposes. Extended Support for Remote Data Entry (Optional) Risk Manager offers support for self-contained modules that may be deployed separately from the main program to allow remote users and/or clients to complete First Reports of Accident/Injury, property loss/damage reports, and incident reports. New claims, occurrences, or incidents are automatically created when a report is submitted and the responsible examiner is notified via the alert system so that he/she may take appropriate follow-up action. Regulatory Compliance More and more standards bureaus, as well as state and federal agencies, are implementing programs to collect claims data for varied purposes. Unfortunately, there are no universal formats for exchanging this data. When reasonable, every module we create for compliance includes the following features: •

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• • Document imaging selection grid

The dedicated imaging module can be deployed separately or launched from within the Risk Manager main program. This allows an imaging function to be administered by designated individuals or by a department, without having to grant access to the full program.

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A purpose specific data entry form to make it as easy and straightforward as possible for operators to know when all required data has been collected A one-way design where data for the export is pulled from the claim into the export module. If errors are noted, corrections are done in the claim, not in the file creation module, ensuring the source data is always the most accurate. An error checking routine or report that scans for missing or invalid data before a file for transmission is or can be created. If applicable, automated processing of acknowledgement files received from the EDI target. Log history files to clearly show the results of processing. A record of all files created is stored in the data base as part of the electronic record. An ability to extract a copy of a file, if an original becomes lost, corrupted, or a question arises about what content was actually sent.

Fast, Easy, and Intuitive User Interface One important reason why Risk Manager is a client-server application, rather than a web-based application, is to preserve our unique user interface. No manager or examiner can plan their day to work on tasks until completion. There are constant interruptions and distractions with a repetitive need to search the data base for information in order to make decisions. A computer program must be designed to accommodate the way people work, not force them into some arbitrary design developed for “universal” use. Think about your experiences trying to find something at a popular online shopping or auction site. You can search by listing ID or part number, but only if you knew what those values are in advance. Searching by a range, like items costing between $100 and $199, means you have to know in advance the price of the item you’re looking for at that site. The use of sophisticated grids throughout Risk Manager offers the ability to do “fuzzy” searches using the best available information that’s both applicable and meaningful to identify a claim or claimant. Why should you have to suffer with such a cumbersome process? What if you don’t know how to spell the claimant’s name or don’t know what employer or department they work in? What if the claimant’s primary language isn’t English? What if they don’t know their claim number? What if the same person has filed 14 different claims over the course of a 30 year employment history? Our interface offers multiple ways to find a specific claim from a single spot. All methods are cumulative, so you can set as many criteria as needed to find an exact claim in a single operation: • • • • • •

Full or partial name Full or partial claim ID Location of the loss (the insured) or company worked for (employer) Claim status (open, closed, denied, or reopened) Policy carrier Examiner assigned to the claim

If the claim is one of the last 15 claims opened for edit, you don’t even have to search. They are available for selection in a drop down list. If more options are needed, there is the ability to search on one, many, or even all of 28 different claim information fields while

viewing every claim in the data base. Filter the grid content based on SSN, DOI/DOL, date received, claim type and status categories, alternate ID’s, policy number, and jurisdiction, to name a few. You can even search for a string of characters within a name. If multiple entries with the same or similar names or even the same SSN (it happens) are returned, move the cursor over designated data items to display additional claim details, such as the nature of the accident or injury, type of injury, body part affected, etc. Our interface also allows multiple claims to be opened for edit at the same time without the fear of data loss. Reporting and Non Reporting Snapshots Reporting financial “SnapShots” have been designed to allow the creation of reports with claim valuations as of any user specified date. A non-reporting snapshot is a tool to value selected claims at more frequent intervals for cost containment and/or examiner reserving practices. This gives a manager the ability to monitor the progress of claims having the potential of high losses or to review the reserving practices of individual examiners over time. Non-reporting snapshots for a single claim can be created individually for any specified date and are retained until manually deleted. All snapshots can be viewed and maintained using the “SnapShot” utility module. All defined non-reporting snapshots can also be applied to a single claim with a single mouse click. Mouse-Over Displays Saving time and convenience of use are two of the most important considerations for operator satisfaction. The information already available in grids is enhanced by the addition of “mouse over” displays. For example, move the mouse over the claimant name field and see descriptive information relating to that claim. Move it over the claim ID and see a summary of the claim financials by reserve class. Shadow Tables for Imported Data Foreign systems will often collect data items that can be imported into Risk Manager but not in a meaningful way. They may have been used in the foreign systems in a manner that’s inconsistent with how Risk Manager functions. Shadow tables allow us to import these data items and relate them to the original transaction for reference purposes. All financial transactions can interface with the shadow table.

SYSTEM REQUIREMENTS BY FUNCTION Risk Manager is a highly scalable, open architecture, clientserver application written in .NET. It accesses a claims database hosted by Microsoft SQL Server. It can be installed and used successfully in a range of business environments from a singleuser, single-computer installation to a multi-office, multi-state organization with 100+ users. Both in-house and remote users can be supported by connections utilizing a LAN, wide area network (WAN), the Internet, or combination thereof. Although the computer hardware and networking equipment necessary to use Risk Manager will vary significantly from site to site, the most important factor is that Risk Manager does not require any special configurations or proprietary hardware/software. Risk Manager is intentionally designed to be easy to install and maintain. The specifications which follow are intended only as guidelines for consideration during the evaluation stage of the acquisition process. Your Server or Join the Cloud? Cloud-based applications (link is to Wikipedia) are being heavily promoted by Microsoft, Google, Apple, Intuit, and others for their “per user” income streams as well as a desire to implement Software as a Service (SaaS). A “cloud” is where your data is stored on servers owned and managed by a third-party. As with most anything, there are both pros and cons to cloud computing and a variety of ways to implement a “cloud”. See the Wikipedia article for additional information. The combination of security considerations and the preservation of our proprietary user interface are the primary reasons why ERIC Systems will continue to develop Risk Manager as a client-server application. Remote access to Risk Manager from multiple locations is best implemented by establishing a SaaS model utilizing a thin client application such as Citrix XenDesktop. Clients are available for most operating systems and devices, including popular tablets. Workstation Requirements for a Local Installation Minimum • •

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Windows XP, Vista, or Windows 7 Professional 32/64 bit version. Intel or AMD CPU operating at 2.0 GHz or faster with 3.0 GB of RAM or the minimum RAM required for the operating system, whichever is greater. 10 Base-T network connection configured for TCP/IP access to the SQL Server. 17" monitor and display adapter capable of a resolution of 1024x768. (Use of Windows large 125% fonts requires a minimum screen resolution of 1152 x 864 to eliminate scroll bars)

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Mouse or other pointing device 200 MB of available hard disk space Workstation-attached printer or access to a network printer with an unprintable area not exceeding .5” from any edge of the paper. NET Framework v4. Crystal Reports 2008 SP3 run-time support files installed (supplied by ERIC Systems).

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Intel Pentium or AMD Athlon CPU operating at 2.4 GHz or faster with 4 GB RAM. 100/1000 Base-T network connection. 20" or larger monitor capable of a display resolution of 1280x1024 or 1920x1080.

Workstation Requirements for Access via Terminal Services with a Thin Client or Remote Desktop/Control When implementing this option, Risk Manager will be running on the host server or host workstation. The client only needs to be capable of running the application used for remote access. Examples include Citrix XenApp, Windows Remote Desktop, and a number of remote control programs that allow one computer to control another. • • •

Minimum workstation configuration as specified by the application developer. Business class broadband connection to the Internet. Locally attached printer for reports.

Database Server Requirements Depending on the size of the organization and the estimated size of the Risk Manager database, either Microsoft Windows Server 2003/2008 AND SQL Server 2005/2008/2008 R2 Standard Edition OR Microsoft SQL Server 2005/8 Small Business Server, each with the proper number of client licenses is recommended. Smaller organizations may be able use SQL Server 2008R2 Express Edition. There is no explicit limit to the number of concurrent users allowed, but the data base engine will only utilize 1 CPU and access 1 GB of RAM. The maximum permitted data base size is 10 GB. IAIABC Release 1 and 3 EDI Transfer An optional IAIABC export module is available that creates FROI and SROI files suitable for transmission to State agencies using these EDI standards. Depending on the agency, a subscription to a value-added network (VAN) may be required for transmittal of files. Generation of Form 1099-MISC The module to process payment transactions for completing Form 1099-MISC filing requirements is a standard component of all versions of Risk Manager. Forms 1099-MISC can be printed or filed electronically. Printing is to single sheet forms using a laser or ink jet printer. Electronic filing requires registration with the IRS and the ability to electronically transfer the file to the IRS. Refer to IRS Publication 1220 for additional information. Document Imaging Modules Document imaging is a standard module in all versions of Risk Manager. The most demanding aspect of imaging is the drive space needed for storing scanned images. Images are stored in the SQL database, not as separate physical files. System Administrators of organizations implementing or planning to implement document imaging should monitor available disk space. Use of a separate disk drive to locate the SQL database or use of a disk array is suggested for larger organizations and TPA’s. Digitizing (scanning) documents requires the workstation to have a locally attached Twain compatible scanner. Exporting Reports to Email or FAX All standard, custom, and "QuickPrint" reports can be exported directly to Email or FAX without having to print to paper. Email export of reports supports the Microsoft MAPI and Lotus Notes. MS Outlook, Outlook Express, and many other mail applications support MAPI. Any workstation or network-based FAX application installed where the FAX device is "seen" by Windows as an installed printer can be used. Windows 2000/XP Professional include integrated FAX capabilities, if access to a phone line and FAX modem are provided. Obtaining Program Updates Program update files are made available for download from the ERIC Systems FTP site on a periodic basis. ERIC Systems utilizes WINZIP to compress files for security and faster

download. An update will consist of multiple files ranging in size up to about 5 MB's when zipped. Any type of connection to the Internet can be used; however, a high speed broadband connection is highly recommended. Medical Fee Adjusting (Optional) Utility programs are supplied to import State Fee Schedules, as well as CPT Codes, Relative Value Units, and ICD-9 codes published by the American Medical Association (AMA). Licenses for use are available for purchase online from the AMA web site. Pricing is based on the number of users. Import modules to update these materials assume the data to be imported has been obtained legally from this source and is in a known format. Check Printing (Standard) Printing of checks and/or vouchers is a standard capability of all versions of Risk Manager. Checks may be printed to blank stock or pre-printed laser forms. Check information can also be exported, using a user-defined file layout, for transfer to a thirdparty AP system. In addition, ACH transaction files (direct deposit) can be produced for upload to financial institutions. Risk Manager supports the use of up to ten (10) different layouts, at multiple organizational levels, to address most any type of business structure. A different layout may be assigned to each of the six (6) available reserve classes plus one layout for bundled checks and one for special checks (used for non-claim related expenditures). Two additional layouts can also be defined for individual payment categories and, in some situations, a level 1 organizational unit. The process of collating supporting documents for checks is simplified by allowing these documents to be printed in a single operation, following the check. This means that EOB’s will print after a provider’s check and even that all EOB’s related to a bundled check will also print at one time. All check and documentation printing decisions are handled automatically, by the program, during the check printing process. No operator intervention is required. In other words, paper checks and/or vouchers, ACH transactions, and files for export are created in a single check printing operation. A configuration option is also available that will allow only vendor checks to be bundled, leaving time loss benefit checks to be printed individually.

Positive Pay Files (Optional) The specifications for positive pay files are specific to each bank and require custom programming to create. The client supplies the bank record and file layouts. Standard practice assumes file transfer by FTP or email. Documentation needs to be obtained at least four (4) weeks prior to the implementation date. Customizing Standard and Custom Reports, Checks, and Correspondence ERIC Systems encourages its clients to personalize Risk Manager by modifying standard and "QuickPrint" reports, checks, and correspondence items to reflect their own business identity or to meet specific requirements of clients. Source files for all reports are provided, at no additional charge, expressly for this reason. Editing source files requires at least one single-user license for Crystal Reports Professional or Developer v9.0 or later. Retrieving correspondence for viewing from the electronic record of the claim requires Adobe Acrobat Reader v6 or later. DataShare and DataViewer Modules (Optional) Sites that are provided a periodic export of their claims data created by the Risk Manager DataShare add-in module will receive this information in the form of a SQL Server database. The data base can be attached to an existing installation of Microsoft SQL Server 2000/5 or to an install of SQL Server 2005 Express Edition installed on either a workstation or network server. SQL Server Express is available for download from Microsoft free of charge. A client workstation using the DataViewer must meet the minimum workstation requirements for an installation of Risk Manager. A separate installation program is provided to install the DataViewer program, Crystal Reports 2008 (v12) run-time files, and third-party controls on client workstations. CMS Section 111 EDI Reporting (Optional) If your organization performs the functions of an RRE, you need only be properly registered and have this module to submit files to the CMS secure FTP site. The HEW packaging application, free from CMS, and a connection to the Internet are required. Support for submittal of CMS required data using services provided by Gould & Lamb is available by special request. State of Washington SIEDRS EDI Reporting (Optional) If your organization is self-insured and self-administered, this module will allow submittal of claim information to the State’s secure FTP site. If properly registered, only a connection to the Internet is required.

CLAIM MANAGEMENT AND INFORMATION RETRIEVAL FUNCTIONS Effective claims administration involves more than simply filling out forms and issuing checks. In today's highly competitive and demanding business environment, the bar has been raised to a higher level. Examiners must have tools that are optimized for efficient and rapid access to information. Without easy-to-use and reliable claims management software, they will not be able to provide the standard of claimant/client services, quality of communications, and degree of regulatory compliance expected of them. Risk Manager has been constantly enhanced and finetuned, specifically in response to the suggestions of our clients, over the course of three (3) decades. All claims management applications will collect data, but the true measure of the caliber of a software program is how it deals with differences in business practices and non-standard occurrences. These are areas where Risk Manager stands head and shoulders above its competition. Intuitive User Interface The user interface is how a program enables interaction between itself and an operator (user). An intuitive and efficient user interface is critical for the performance of day-to-day work tasks and operator morale. How an interface is designed is a function of many variables, including: the capabilities of the programming language, the nature of the embedded controls, the characteristics of the operating system, the nature of the data being managed, the type of output devices available (monitors, printers, etc.), the nature of the business the application supports, just plain common sense, and more.

print claim summary reports, data cards, file folder or address labels, a reserving worksheet, and more without ever having to open the claim for edit. The primary point of entry into all management tasks is a sophisticated selection grid designed to allow rapid location of records. For claims, the grid includes a filter row that allows searches based on the value of any one of more than twenty-eight (28) different claim data fields. These include full or partial claim number, full or partial claimant name, names containing a string of characters, SSN (even when masked for privacy), up to four alternate claim ID's, an associated occurrence ID, the assigned examiner, what enterprise, employer, or the level 6 organizational unit where the claimant worked, the jurisdiction, and more. (The screen capture below shows only one-half of the claim selection grid).

Our exclusive “SmartSearch” technology allows the user to search by claim ID or claimant name using a single data entry field. An "Open History" pull-down selection box provides quick access, without searching, to the last fifteen (15) claims opened for edit. The grid content can be filtered to show only claims associated with specific organizational levels or the entire claims database with a single mouse click. Filters are also available for claim statuses, claims with a DOI after a specified date, or claims assigned to a specific examiner. "Days since access" is calculated for open claims and displayed in the claim selection grid. This serves as a visual reminder if any claim might not be receiving necessary attention.

Claim Selection Grid

ERIC Systems has designed the interface of Risk Manager to be specific to the needs of claims examiners and managers while adhering to the Microsoft published standards governing program design. Emphasis has been placed on rapid access to claim information, data integrity, automation of complex tasks, and flexibility to function well in a fast-paced work environment characterized by constant interruptions and changing priorities. Common and repetitive claim-specific functions and reports are available from the claim selection grid without having to open the claim for data entry. Create notes, diary entries, pay time loss, or

Work flow is enhanced by allowing the examiner to open as many claims as needed concurrently. Switch between claims quickly and easily, even in the middle of entering data into a field, without having to save or clear forms that are in use. A user may also switch to other program functions while leaving multiple claims open for edit. For example, create a new vendor while making a payment entry.

A grid presentation format is used throughout the program because it has been proven to be the fastest and most efficient method to locate information ranging from financial transaction history to notes. Summaries of claim financials, including drill down to individual transactions, are available for reserve classes, reserve categories, and policy coverages. Access to claim notes, diaries, alerts, First Reports of Accident/Injury, property damage/loss reports, and Supplemental Data items can be accomplished with a single mouse click.

Sophisticated help screens show actual formulas for time loss and LOEP calculations described in words and with the variables replaced with the actual values from the data base used by the program for the calculations. A summary form is initially displayed when opening a claim for edit. It provides a comprehensive view of the state of the claim including, but not limited to, current financials by reserve class, T&E billings, basic claimant demographic information, the nature of the injury/event, claim status and claim type, and the assigned examiner. There are prominently displayed "flags" signifying important claim conditions including existence of a litigation docket, subrogation, designation of an occupational injury, whether the claim was previously an incident, and a designation of third-party responsibility. If configured, a color-keyed presentation of total paid to date expressed as a percent of the excess carrier notification level is displayed in the center of the form. The financial summary grid offers drill-down by reserve class with optional display of details for any single transaction. Gross and Net Paid to Date (gross PTD less recoveries reducing) totals are calculated automatically as of the time the claim is opened for edit.

initially, then change to a "?" or SAVE depending upon what information is edited. A point-and-click, multi-year calendar interface is used for tracking and editing days paid, days restricted, days lost, and OSHA days. An integrated spell checker is provided for notes and for all fields containing long descriptive text. A calendar drop-down displays a scrollable onemonth view for entry of all dates. Wherever possible, list boxes are used to present valid choices. The contents of list boxes can be sorted in ID or title order. If the desired code is known, it can be entered directly. Payments can be made on closed claims. If the reserves have already been zeroed, an offsetting reserve transaction will automatically be created. Upon assignment of a closed status class to a claim, prompts will be displayed asking if reserves should be set to zero and if pending diary entries should be cleared. If the response to zero reserves is yes, one entry is created for each non-zero reserve category. Financial Dashboard This tool provides unique views of real-time claim financial information. Choose a client or department, mark the option boxes to show open and reopened claims, and then click FIND.

Claim Financial Summary with the capability to drill-down to individual transactions

Error correction is something no one wishes to think about, but errors do occur. Risk Manager is friendly for correcting errors since it’s a real-time application. This means that there are no posting routines, such as end of day processing that must be performed, in order to see the results of the day’s work. Errors can be corrected as soon as they are discovered. Utility functions are provided for changing parameters such as IDs for claims, vendors, organizational units, examiners, employers, property items, occurrences, and coding schemes. Payment transactions can be edited at any time before being processed as a check. Voiding and reissuing a check can be accomplished with a few mouse clicks. Claims may be transferred between employers. Warning messages are displayed during entry of payment transactions if address information is missing, if reserve balances are inadequate, or if a payment might be a duplicate. Entry of all codes and data items from defined lists is made by selecting from options presented in drop-down combo boxes, ensuring data integrity. Dates may be entered from the keyboard or by day selection from a graphical calendar control. Data quality is also enhanced by implementation of a three-level, userdefined, field properties table that allows the system administrator to designate key data items as being required when a new claim is initially set up and other fields, if not completed, to generate a warning message before the claim is closed. Color-coded field titles prompt operators about the nature of data items on each form. Blue field labels are used for required data, black for optional data, purple for OSHA data collection, and red to show negative financial totals. All forms feature a unique tri-state SAVE button. During new data entry, a question mark (?) is displayed on the button until all required fields have been completed; only then SAVE is enabled. An operator may click on the "?" at any time to receive a program-generated prompt that will explain why SAVE has yet to be enabled. During an edit, 'No Change" will be displayed

Immediately see metrics like total reserves, claim counts, TTD days paid, and the progress of recovery collections. Configure the grid to show just a specific claim type or claim status or both. Integrated Word Processing and Mail Merge First impressions count, so Risk Manager includes a fully featured word processing module for generating professional quality correspondence that will be sent to the variety of individuals and businesses that may be involved in resolving a claim. The five (5) major modules (claims, enterprises, employers, incidents, and occurrences) include the capability to identify an unlimited number of witnesses, involved parties, and/or contacts. A record of all correspondence is automatically saved to the Risk Manager database as part of the historical record for that individual. A separate utility module is provided to create templates that may be imported into a new letter and customized as needed. MS Word document formats DOC and DOCX, as well as PDF, RTF, and TXT, are supported so your existing documents can be easily integrated into Risk Manager. User defined fields are provided that can be used to identify recipients to receive designated types of correspondence in support of mail merge operations. Claim Notes and Diary Functions There are seven (8) separate notes and diary modules provided, each with its own security parameter. They are associated with enterprises (collections of related employers), employers, claims, occurrences, vendors, incidents, property items, and litigation dockets. In addition, there’s an examiner diary module that allows creation of diaries that aren’t associated with a claim. This can be used by managers to assign general tasks. Each note can be up to 7,500 characters, and there is no practical limit to the number of notes that may be entered for a

claim. Ten levels of security are available to assign to a note in order to protect the note content from unauthorized eyes. Notes may also be designated as only being viewable by users with supervisory rights. A feature of notes is user-defined text blocks. Using this option, a system administrator can create a collection of commonly used phrases and paragraphs to rapidly build standard note entries. Ideal applications include paragraphs of strict legal wording or templates to guide the content of special purpose notes, like claim reviews. An automated procedure is available to import emails relating to claims into notes. Risk Manager uses your existing email client (such as Microsoft Outlook) rather than forcing users to install another competing client. A color-coded display of the level of responsibility of note author is provided. A single mouse click will record a copy of a T&E Billing as a claim note entry. When first logging in to Risk Manager, several summary grids will be displayed or can be configured to display. If an event will occur within three (3) days, a litigation summary grid will always be displayed. If enabled, a listing of transactions requiring acknowledgement will also always be displayed. A diary summary and a listing of unacknowledged alerts are optional displays. If the remote data entry module is deployed, the diary and/or alerts screens can include notifications of new claims. With permission, diaries for any examiner can be viewed from this grid, so one examiner can cover for another and no important actions will be missed. A rolling three (3) month calendar view of diary entries is also available to aid scheduling of workloads. Double-clicking on a diary entry will open it for edit. Selecting it and clicking LAUNCH will open the claim without having to search. Event Triggers Staying aware of significant changes or events that can occur during the daily management of claims is essential for all claim managers. The event trigger module has been implemented at the system, enterprise, and employer levels. This allows triggers to be defined for all claims or different triggers for enterprises and employers depending on the needs of each business unit. Detection of a trigger event results in one of three (3) user selected actions to be initiated: • • •

Print any standard or custom report Create a diary entry for an examiner Send an alert to an examiner that requires acknowledgement

Multiple triggers for the same event are possible. For example, if both an examiner and a manager need to be alerted that the medical PTD for a claim has exceeded a specified amount. There are over thirty-five (35) different trigger events defined that can be enabled at the system (applicable to all organizational units and claims), enterprise (group of employers), and/or employer levels for maximum flexibility. Actions monitored as triggers include, but are not limited to, a new claim entered, changes in claim status or type, a new vendor created, examiner reassignment, different litigation events, different types of or changes to injury or diagnosis (ICD-9) codes, and a variety of dates such as date disability began, return to work, notifications. Of particular note is the ability to monitor financial transactions based on reserve class, reserve category, and/or payment category. For example, one of the three actions can be triggered when a single transaction exceeds a specified value, the sum of all transactions of a specified type exceeds a specified sum, or number of transactions of a specified type reaches a target number.

Document Imaging All versions of Risk Manager include eleven (11) individual modules to import documents and photographs into the electronic record of a claim and other entities. Modules are associated with enterprises, employers, litigation, claims, incidents, occurrences, property, vendors, safety/deficiency reports policies, and at the system level. The latter is provided as a place to store blank forms for use in-house or by clients. These modules provide rapid access to signed copies of manually filled-in forms, copies of mail delivery receipts, policy documents and certificates of insurance, accident scene photographs, police reports, original First Reports of Accident/Injury, certified letters, claimant-submitted documentation, legal correspondence, and many other items. Retrieve, view, and reprint any document. All files and mages are stored in the claims database facilitating easy access by remote offices and/or clients. Import existing files in JPG, BMP, FRX, PDF, XLS, DOC and DOCX formats. Scanning utilizes the industry standard TWAIN interface to support any brand of scanner. Documents may be classified by a user-defined type and key words may be associated with each document for automated indexing and rapid computer-based searches. Risk Manager supports import of WAV files created by some voice mail systems and TIFF files created by FAX applications. Support for WAV files allows phone messages to become part of the claim record and support for TIFF allows multi-page FAX documents to be stored. All imported and scanned files are stored in the Risk Manager database for absolute security. There are no links to files located on network volumes or local hard drives that could be lost in the event of a hardware failure or accidentally deleted. Purpose-Specific Claim Data Entry Modules A potential issue with a program that can handle a variety of different claim types is a confusing presentation of data entry fields, some of which might not relate to the type of claim being worked on. For example, examiners administering worker compensation claims wouldn’t need to see information that might be relevant for a professional liability claim or for a State Fund claim being overseen by a retrospective rating group. Risk Manager offers purpose specific claim modules optimized for each claim type. Implementation of module selection is configured at the enterprise level. Choices are available for worker compensation, liability and P&C, retrospective rating (state fund claims), and professional liability. Full Text Search For those times when there’s a need to search history, the full text search utility allows the examiner to query notes within claims, occurrences, incidents, vendors, enterprises, employers, and litigation dockets using a variety of options. Searches can be made across all enterprises (the entire data base), one enterprise, and/or one or all employers within an enterprise. Searches may also be conditioned to examine any combinations of the subject, heading, or text fields. A search parameter may be a single word, multiple words enclosed by quotes, two or more words joined by an “and” operator, and/or two or more words joined by an “or” operator. All notes meeting the search parameters are returned to a grid where they can be opened to read or the module opened for edit. Within a single module, the filter bar of the notes selection grid allows a “contains” search that will return all notes with the exact character string entered. Both the heading and text fields are examined for a match.

FINANCIAL TRANSACTION PROCESSING An essential capability of any claims administration application is the ability to handle the wide diversity of financial transactions occurring between employers, insured’s, and claimants, including benefit payments, expense reimbursements, distributions to a claimant's spouse and/or dependents, and payments to medical providers and to other vendors from whom goods and services are obtained. In addition to simple check writing, summaries of transactions need to be provided to the IRS and to state agencies and carriers who require periodic reports. TPA’s need the capability to bill for services rendered and track accounts receivable. Checking accounts need to be reconciled and financial institutions need to receive payment confirmations to aid their efforts to reduce the potential for fraud. Payees need to receive payments by direct deposit, and the results of bill review need to be posted to claims efficiently without redundant data entry. Risk Manager is versatile enough to handle all of these requirements and more.

is to be classified. The time loss module can calculate the benefit amount, automatically factoring in COLA adjustments and adjustments for the number of eligible dependents, if applicable. These modules can also create up to 12 checks and collect for overpayments based on defined schedules. Risk Manager’s sophisticated benefit calculation help screens are unlike any other. They display both a text version of the daily rate calculation formula from the State regulations and the same formula with the words replaced by the values for each parameter (such as marital status, number of dependents, increase factor, number of days to be paid) being used as the basis for entitlement computations. This same information is printed on the standard Explanation of Payment (EOP) so that the claimant knows exactly how his/her benefit amount was calculated.

In addition to a reserve category, transactions may be classified in a variety of ways by assigning user-defined codes. These include payment category (used for completing periodic reports required by State agencies), general ledger account code, line of business, and policy coverage. The current reserve category balance is displayed to allow the operator to determine if sufficient funds have been allocated. Warning will be displayed if address information is incomplete or if a potential duplicate payment has been detected. A potential for recovery through subrogation can be indicated. For clarity, the fields' purpose and description are available for notations regarding the nature of the transaction. The operator may select from several predefined purposes or enter any desired text. Manual (hand-written) checks are as simple to enter as specifying the bank account and check number used. Recoveries may be classified as reducing or not reducing total incurred and total paid. Payments made to Attorneys on behalf of claimants (G-type attorneys) are automatically tracked and summarized for accurate Form 1099MISC reporting. If associated with an occurrence, selecting a policy and (optionally) a line of business will result in this information being associated with each related claim. If the claim is not associated with an occurrence, it is possible to specify a policy, LOB, and coverage manually. If these selections are made, the coding choices for financial transactions are limited. If an LOB is assigned, but not coverage, any coverage associated with that LOB is available for selection. If a coverage is assigned, all transactions are assigned that coverage. No selection is offered. The ability to associate claims with a Job/Project ID is available for cost accounting. Automated Time Loss Benefit Calculations The calculation of time loss payments, generation and processing of PPD Awards, and implementation of a series of scheduled payments are processes that are error prone and subject to being "missed" if left to the memory of an examiner. Risk Manager greatly automates these processes by using a three-tiered approach. First, State-specific time loss tables are used to establish the rules for entitlement calculations. This ensures that all benefit calculations will use the same set of verified base factors. These tables are user modifiable, so they can always be kept up-to-date. Any number of tables can be used concurrently for clients paying benefits in more than one state. Second, the compensation information can be input directly from the employer wage statement used to calculate gross period wage and the daily rate. And third, the examiner need only specify the type of payment to be made, the period to be paid, the date the check is to be issued, and how the payment

Use of the time loss calculation module with properly defined payment categories captures all data to generate periodic state reports, including the WA SIF-5 Quarterly Report of Supplemental Benefits. Payments to attorneys on behalf of claimants are automatically tracked for Form 1099-MISC reporting. th

Pay time loss for February 30 or recording more than one time loss benefit payment on a single day? Why would anyone want to do these things? In some states, there is an option to pay time loss benefits based on twelve 30 day periods. In these cases, February has to be extended to be 30 days in order to comply. Using Risk Manager you can th th actually pay February 29 and 30 . If an audit results in an order to pay additional benefits to a claimant retroactively, the proper way to make these adjustments is to issue payments referencing the correct period because there are many periodic reports that mandate summaries of benefits paid within a defined time period. Issuing a single check for a total amount inaccurately reports payments by artificially inflating the amount paid in current period.

for sequentially numbered stock. The last option can be used to keep a “perfect checkbook” by sites that print checks using blank stock. Time & Expense Tracking Risk Manager offers support for the generation of invoices based on T&E billings, retainer billings, and fixed fees for administration based on claim type. Optionally, a requirement for supervisory approval of all T&E billings can be enabled. Invoiced and pending T&E billing totals are displayed in the summary form for each claim. The generation of invoices for T&E billings, administrative (non-claim) charges, and for collection of payments made under a Self-Insurance Recovery (SIR) threshold is an automated process. Invoices can be sent to enterprises, employers, carriers, or a combination thereof depending on how the system is configured and how organizational levels are defined. Trial reports are available that show what invoices will be generated, who is responsible for payment, and what the total amount billed will be. A code scheme is used to equate T&E billing categories to third-party accounts receivable general ledger line items. The option to enter Kept on Salary (KOS) transactions addresses situations where an injured worker continues to receive their regular compensation when not working due to an on-the-job injury. Tracking what would have been paid under worker compensation rules is required to be reported to some State agencies and can be important for internal budgetary considerations as well. KOS transactions may be designated as either reimbursable or not reimbursable. These transactions are entered just like standard TL and LOEP payments, except they do not cause a check to be issued. Bank Accounts, Fund Accounting, and Checkbooks Risk Manager allows any number of bank accounts or funds to be defined and associated with employers (departments), enterprises, and or to be available system wide. Bank accounts or funds may be configured to have sub accounts to handle situations where payments are issued on behalf of multiple clients from a master account. The design of Risk Manager includes both a transaction table and a checkbook entries table. This allows multiple transactions to the same payee to be combined into a single check. This process is called check bundling. One checkbook for each defined bank account provides a variety of utility functions for account maintenance, including reconciliation. Bank accounts can be specified as owned or not owned to designate trustee situations. The interface to checkbooks is a multi-column grid, similar to the claim selection grid. Its many sorting and filtering options can be used to quickly and easily locate any check, ACH transaction, bank fee, deposit, voided entry, or voided series. Double-clicking on a grid row will drill down to show all transactions linked to that item. Double-clicking on a transaction will display all of the detail information for that transaction. With sufficient rights, editing is permitted from the check transaction detail form. Searches may include one, many, or all bank accounts. A display of the available balance is provided to ensure a check run will not cause an overdraft. A check facsimile may be printed to aid in verifying and resolving payment questions before having to obtain check images. The checkbook module offers the ability to void a single check or a check series in a single operation. Checks may be voided with or without making a copy of the original transaction, voided for reissue, or voided for reissue while deleting all references to the original check (requires special rights). The first two options leave a record of the original check in the checkbook to account

Scheduled Payments and PPD Awards An included capability of Risk Manager is the ability to define an unlimited number of templates for generating scheduled payments. These are repetitive payments of the same dollar amount for the same purpose at a specified interval. This may be used for time loss, except in the State of Washington. A module for calculating Permanent Partial Disability (PPD) award payment schedules or any annuity type of payment is provided with all versions of Risk Manager. New schedules may be created or existing, partially completed schedules can be input for processing. Pending scheduled payments and PPD award payments are kept separate from other transactions to ensure payments do not affect financial totals until released for processing. ACH Payment Processing Direct deposit by ACH transfer is offered to comply with some state agency requirements that mandate this option be available if requested by a payee. ACH data can be set up for claimants, spouses, vendors, and other payees. If information is entered, during check processing, an ACH transaction is generated in a file suitable for transfer to a bank rather than a paper check. For confirmation that the ACH transaction was created, a usermodifiable summary page showing routing and tracing information is printed in lieu of a check. Supporting documentation for the ACH payment, as may be applicable, is also printed for distribution to payees. For audit purposes, a copy of the ACH file generated during payment processing is saved to the Risk Manager database. A utility is provided to view the contents of the file. If the original file becomes lost or corrupted, a copy may be extracted and resent. Positive Pay Modules (Optional) Positive pay modules are bank-specific, custom programs that provide information about checks that have been issued to the bank. During clearing, the bank uses this information as a baseline against which to compare paper checks as a safeguard against fraud. The positive pay module is run after check processing is completed and the file transferred to the bank. A record is kept of checks that have been processed so that the module can be executed multiple times during a single day. Just as is done for ACH transaction files, a copy of the file generated is saved to the Risk Manager database, and utilities are available to view the file content and to extract a replacement copy if needed.

SECURITY AND DATA INTEGRITY Risk Manager features a sophisticated, function-oriented security system designed expressly to facilitate access to a central database by a variety of users in geographically separated sites. To prevent accidental coding errors caused by having to select jurisdiction specific codes from a single source containing all codes from all jurisdictions, code selections to comply with regulatory are configured by evaluating the jurisdiction assigned to the claim at the time it’s opened for edit. User logins are also designed to facilitate the creation of workgroups where teams will have broad access to those enterprises and employers for which they are responsible, but not to all enterprises and employers. In mixed environments where both worker compensation and P&C claims are administered, the creation of two or more enterprises can separate these functions for HIPPA compliance purposes. Program Security Levels The program security level can be easily configured to meet a variety of needs for any size organization. The no security mode provides easy access to all program functions for testing and training purposes. The login and password only mode is ideal for smaller sites where claim management and financial functions are shared by a few users with a wide variety of responsibilities. The login and password with permissions mode allows a System Administrator to define an unlimited number of user logins and/or profiles, each with a unique set of rights. Login and Profile Permissions The login account assigned to a user determines what rights and privileges he/she will have when using Risk Manager. Permissions can be assigned to each login individually or the same set of permissions can be assigned to multiple logins by using security profiles. Risk Manager has over 475 security Items, each with up to eight (8) assignable attributes controlling some aspect of program operation. Over 1200 security attributes are available to be assigned to a login or a profile. Logins and profiles are easily constructed by scrolling through a grid display of items and clicking on attributes such as View Only, Modify, Delete, Print, Create New, Copy From, and Supervisor. A "Copy From" function is provided to allow sample profiles to be duplicated and modified. A listing of all security items and attributes assigned to a user login or profile can be printed. Reporting Security A not so likable feature of report writers, like Crystal Reports, is they will process and print information from all claims without considering whether the requester is authorized to see that claim information. Two options are to include security parameters in the report design and/or to not allow everyone access to all reports. The first is unacceptable because it would mean maintaining multiple copies of the same report layout, each with individualized record selection filters specific to each organization. The second option just isn’t acceptable. ERIC Systems has solved this problem by creating our proprietary print control module to interface with Crystal Reports. When a user with restricted rights selects a report to

print, this module displays for selection only those enterprises, employers, and/or organizational units authorized by the System Administrator for viewing by this user. This means that there will only be one report layout needed for all users. Restrictions can also be limited to one insurance carrier as determined by the policy assigned to a claim. In other words, a representative of an insurance carrier can be given access to reports and they’ll never be able to view claims associated with policies issued by other carriers. Financial Controls Check and reserve transaction limits are associated with individual user logins and are independent of program access rights. Limits may be set separately for a maximum single payment and reserve transaction and/or total PTD and total incurred. If an operator attempts to enter a transaction that would exceed his/her rights, the transaction cannot be saved. For more control and additional flexibility, a feature called transaction acknowledgement can be enabled. Both single transaction amounts and cumulative claim totals for paid to date (PTD) and total incurred are monitored. If an operator attempts to create a payment or reserve transaction greater than his/her individual limit, the transaction is automatically “pended” and must be acknowledged by someone with a higher limit. If the amount of a transaction is less than his/her limit, an operator may also manually mark a transaction as “pended”, to trigger review and acknowledgement. Payment transactions cannot be processed into checks until acknowledged. A transaction that would cause a configured enterprise threshold value to be exceeded will also require review and acknowledgement by another user with review rights and a higher limit. Threshold values may be set differently for each enterprise. Standard grid and query tool to retrieve, filter, view, and extract transactions based on user-defined criteria. Transfer the record set to a third-party application or a spreadsheet for further analysis. Remote User Access Control Logins can be created which allow access to all claim data or they can be restricted to access only claims for one or more employers, one organizational unit within one of six organizational levels, or claims assigned a policy issued by one insurance carrier. This gives the Systems Administrator unprecedented flexibility to create remote client logins with permissions to view only their claims. Production and Demonstration Databases ERIC Systems is unique in offering the ability to switch from a production database to a demonstration (test) database with as few as three (3) mouse clicks. One reason this function is provided is to maintain the confidentiality of claimant information. A second database gives support personnel, such as members of the IS Department who may be assisting with writing reports or creating data extract routines, a platform containing data that is not of a sensitive nature.

ORGANIZATIONAL STRUCTURES The design and implementation of effective strategies to control claim costs is heavily dependent on the ability to aggregate financial data in ways that clearly identify the locations, causes, and total costs of injuries to employees. Without clear and concise information, it is not possible to effectively allocate limited resources for safety and training. Risk Manager has been designed to produce financial management reports that can document claim costs in a variety of ways. One of the most powerful is by organizational unit or shared activity. This capability adds a new dimension to the process of identifying areas of potential high liability. By organizational unit is the traditional hierarchical reporting format. This is well suited for analysis of claim costs for budgeting purposes and for summarizing losses at multiple locations. However, this approach doesn't consider the diversity of activities engaged in at different locations or the increased risk of accident/injury with some activities.

structures and a wide range of dissimilar activities or if workers spend a large portion of their time away from the employer's property (delivery persons, field service representatives, etc.). The accident location is provided to offer another means of classifying places where injuries/events occur. Consider a distribution warehouse. The warehouse is a level six unit where 32 injuries were reported in a given year. Possible conclusions from this statistic could be that the warehouse was a dangerous place to work, or that the manager wasn't doing his/her job properly. Using an accident location coding scheme to add an additional classification to claims could easily show that of those 32 claims, 31 occurred while a driver was on route or unloading at a customer site, while the employee was not on the employer's premises. Given this information, a strategy to contain costs would be vastly different for one conclusion compared to the other

Reports that group claims sharing a common function or activity creates another view of the same financial data. This provides a different perspective of risk potentials, which is vital for determining how safety training and accident prevention resources should be allocated. For example, patient handling in a hospital could be identified as one activity. Many individuals from different organizational units are involved in this activity, including professional staff (doctors and nurses), housekeeping, security, food service, custodial services, volunteers, and the general public (visitors). If a worker is injured in a patient area, a traditional hierarchical report might distort the true picture by assigning the costs of that claim to the organizational unit to which the employee is assigned, hiding the fact that the event happened at a location not under the direct control of the manager of that unit. Risk Manager's flexibility for defining organizational levels can be used in another way too. For clients having multiple locations with similar structure, for example a school district with many schools or a supermarket chain with many store locations, similar types of claims can be aggregated across all stores for combined reporting. Imagine being able to print a claims run by store, then with a few mouse clicks printing the same report that groups claims for the same department across all locations (i.e. all claims for Bakery Department employees for all stores). The design of Risk Manager allows both techniques to be used concurrently within the same enterprise and each enterprise can have its own structure specific to the nature of its business. The accident locations coding scheme are another tool that can supplement hierarchical organizational unit reports. By default, the physical address of the level six organizational unit assigned to the claim is used as the location of the injury or event. From a safety analysis perspective, this may be misleading if the physical address includes a large property with multiple

Up to eight organizational levels can be defined. An unlimited number of enterprises (collection of one or more employers) may be created, as well as an unlimited number of employers within an enterprise. Use up to six (6) levels of organization within an employer. For each employer there exists the ability to assign a unique set of org unit level names, for example, group, department, division, and region. For reporting purposes, sub groups of employers may be created within enterprises. Report content can be filtered by designating org units as being active or inactive. The assignment of a level 6 org unit to a claim automatically handles how the claim is counted, how the financials are aggregated for reporting purposes, and at what business location an accident/injury occurred.

PROPERTY & CASUALTY, AUTO, AND GENERAL LIABILITY CLAIMS ADMINISTRATION With the enterprise version of Risk Manager, both worker compensation and property & casualty (auto, property, and liability) claims to be administered with a single program. Both the liability and worker compensation claim modules will be required. The design of Risk Manager can accommodate either of the two most common claim management models. The first model is where one claim is created for each coverage to be paid. The second is where one claim may have payments made that are associated with one or more coverages. Within Risk Manager, “programs” are defined as an insurance product offering with a common characteristic that addresses the needs of a specific industry. For example, a program offered to car dealers would be very different from one offered to hotels because of the vast differences in the types of exposures. Of course, a “policy” is a collection of coverages and limits. Only policies are associated with employers and occurrences are the basis for determining eligibility and for tracking losses. Program and Policy Propagation Creating policy definitions for multiple insured’s can be a tedious task, especially when the policies are very similar in content, as would be the case for an industry specific program. To address this issue, Risk Manager provides the ability to create two program definitions, current and future, at the system level. Within each program, policy templates can be created which exclude specific coverage limits and effective dates. When a new enterprise is created, the policy template information for the appropriate program can be copied to the enterprise with a few mouse clicks. Now, at the enterprise level, the policy template can be augmented to add the omitted information. Once saved, this general policy can be copied to all employers in a single operation. If needed, employers can be edited to reflect site specific differences, such as a greater coverage limit or deductible. Policy Structure Polices may have any number of coverages. Coverages may be grouped by lines of business (LOB) for reporting purposes. SIR values may be assigned to coverage’s or LOB's for determining responsibilities for payments. Coverage values and limits may be adjusted during the term of the policy. Only Policies in effect on the date of loss are available for selection and association with an occurrence and/or claim. Policy and (optionally) LOB information are defined with the occurrence. If an LOB is specified, coverage choices for financial transactions are limited to those associated with that LOB. Deductible accounting To handle monies received from policy holders for deductibles and/or SIR’s, Risk Manager maintains two (2) record types that are excluded from total paid to date and total incurred calculations. This allows a complete audit trail, separate

reporting, and display of summary totals without affecting totals that must be reported to agencies with jurisdiction or standard EDI extracts, for example NCCI Unit Statistics Occurrences Occurrences are generally associated with P&C claims and are defined as events that can trigger one or more claims. Occurrences provide a means to define a relationship between claims for reporting purposes. They are also important for defining limits of liability "per occurrence." New occurrence setup collects common data items that apply to all claims that will be generated as a result of the event. This includes specification of policy, line of business, and coverage information, as may be applicable. Only policies and coverages in force on the date of loss are presented for selection. Selecting a LOB at the occurrence level limits the assignment of claim transaction coverages to only those associated with that LOB. View all claims with summary financial associated with the occurrence on a single tab. Open a claim for data entry from within an Occurrence. Occurrences include their own document (imaging), notes, and correspondence modules. View current totals of payments affecting the SIR by coverage or LOB and print SIR Erosion Detail Report. Speed Data Entry Forms In some instances, a requirement to complete multiple data entry forms in order to create a claim is burdensome, especially when the claim is not valid and the data being collected will only be used for correspondence purposes. For example, a citizen requests reimbursement for damage to their vehicle resulting from driving into a pothole, or the windshield of an agency-owned vehicle is damaged by a rock during normal use. Risk Manager provides shortened data entry forms, specific for P&C claims, to expedite handling of these types of claims. Property Schedules (Optional) This optional module allows organizations to maintain an inventory of any type of property or structure to track ownership, location, multiple valuations, usage data (if applicable), descriptions, identification numbers, photographs, and policy information. The property schedule is accessible from within the occurrence and claim modules, making retrieval of data regarding property items involved in loss events quick and easy. Property items are assigned to employers for reporting purposes. For reporting and classification purposes, users may utilize an enterprise-level coding scheme to define any number of property categories within nine (9) available property classes. In situations where multiple property items co-exist within a larger item, such as a utility van with specialized equipment installed, a property item can be designated as subunit of another.

PROFESSIONAL LIABILITY CLAIMS The professional liability claims module is comprised of a subset of the features and capabilities of worker comp and P&C functions designed expressly to handle the characteristics of PL claims. The primary differences between the PL and liability modules are the use of the “small” policies in PL compared to the more comprehensive policy definitions supported in the general liability claims module and a reduced number of data entry fields optimized for these less structured types of claims.

REPORTING Databases are huge repositories for numbers, dates, text, and images. If you were able to look into the heart of a database, nothing you saw would seem to make sense. The function of computers and software programs is to present data in formats where it becomes usable. Usable data is information. Reporting is a primary means of presenting and exchanging information. Reports can be printed, displayed on screen, or electronically transmitted to another individual or computer program. Risk Manager supports the industry standard application Crystal Reports as its primary tool for reporting, although any ODBCcompliant report writer or ad hoc query, such as Microsoft Excel, may be used.

dummy claims or organizational units must be created as placeholders so as not to adversely impact financial reports.

Standard Reports and "QuickPrints" Over 400 standard and 45 "QuickPrint" reports, along with source files, are provided with all versions of Risk Manager. A standard report is defined as one that includes data from many claims with appropriate summary information. Information is presented in either columnar or graphical formats. "QuickPrints" are oriented to a single claim or to a specific purpose. Standard reports are printed using the report selection grid. "QuickPrints" are invoked by clicking on buttons located throughout program.

Explanations of Benefits (generated by the RM fee adjusting module), Explanations of Review (generated by processing thirdparty bill review files), Explanations of Payment (documentation supporting time loss benefit calculations and distributions), check itemizations (in support of bundled checks), and ACH transaction acknowledgements can be printed concurrently with checks, eliminating the need for manual collating.

All standard and "QuickPrint" reports may be previewed on screen, sent to any local or network printer, "printed" to a local or network FAX application, or exported to an application, disk file, or e-mail in a variety of popular formats including Adobe Portable Document Format (PDF), Lotus spreadsheet (WKS), Excel spreadsheet (XLS), Word document (DOC), text file (TXT), richtext format (RTF), hypertext markup language (HTML), and many more. Provision has been made for users to modify "QuickPrint" report formats and to substitute them for the standard "QuickPrint" formats. Forms Fill-in and Correspondence Standard correspondence ("boiler plate") items, such as claim acceptance/denial letters, notifications of a change in benefits, periodic state reports, requests for IME's, can be easily created using Crystal Reports or templates that can be created for use with the built-in word processing module. Both are accessible from within all claims, occurrences, vendors, and incidents. The history of all forms and correspondence items includes an exact copy of the item, the date it was generated, and by whom and is automatically created when the letter or report is printed. Correspondence items may include any field within the database. Forms having checkboxes or form specific data fields may incorporate up to fifty-four (54) available "On the Fly" fields to add non-database information. There are: 10 short text fields (20 characters), 10 long text fields (50 characters), 4 paragraph fields (250 characters), 5 date fields, 5 number fields, and 20 Boolean (yes or no) fields provided. For each form template, the System Administrator may add custom field titles to prompt operators for the nature of the input expected for "On the Fly" fields. Check Printing Checks may be printed using blank stock (Crystal Reports) or preprinted stock (X-Y printing). Check information can also be sent to a disk file for transfer to third-party applications for printing (Append to File). Support for ACH payments and positive pay files are also provided. Checkbook subaccount checks numbering is available. Support for bundled check printing (multiple payments to one payee combined into a single check) is offered. A feature called “special checks” is available for making payments not associated with claims. This avoids limitations in many systems where

Although only four (4) layouts are commonly used, up to ten (10) check layouts may be defined for each employer. A unique layout may be associated with each of the six (6) reserve classes, plus layouts for bundled checks, special checks, org level 1, and individual payment categories. Check printing for enterprises and policy/plans may use up to eight (8) unique layouts. Employers within the same enterprise can have different layouts to incorporate unique graphics, like logos, or signature blocks.

Form 1099-MISC Printing Printing of Form 1099-MISC is supported for single-part, laser forms. MMR Transmitter information and files suitable for electronic transmittal can also be generated. Forms 1099-MISC can be printed individually for each vendor or up to 255 vendors sharing the same Taxpayer Identification Number (TIN) can be combined and a single form printed. The program supports the IRS regulations requiring that payments made to attorneys on behalf of claimants be identified and reported in box 14. To ensure accuracy and completeness of data before loading expensive forms, the process for generating data for Form 1099MISC has been designed to be repeatable and may be done periodically throughout the year. The data validation tools include several plain paper reports that clearly show missing or invalid data. One or more enterprises and one or more employers can be combined in reporting pools for processing. This would be of great benefit to TPA’s who act as the primary payer for a number of clients. Payment summaries for partial periods may be created for instances where data has been imported and is not representative of an entire calendar year. The vendor data entry module will automatically strip hyphens from the vendor ID field. Individual Form 1099-MISC addresses and phone number fields are provided at enterprise and employer levels. An alternate 1099 address is provided for use by larger organizations that collect data from multiple sources for filing from a central location. First Reports of Accident/Injury (FROI) and Property Loss/Damage (PLD) Reports The FROI and PLD reports are the starting point for many claims. Risk Manager offers State-specific program modules optimized for collection of the information required to be gathered for these documents. Using a State module automatically creates a new claim and notifies the responsible examiner either through the diary summary screen or by an alert. After the information is reviewed by the examiner for accuracy and completeness, the examiner marks the FROI/PLD report as approved. This will restrict the remote user from further edits, allowing only view and/or print capabilities. These program modules can be used in-house or deployed via an intranet or internet connection. Good practice would include scanning the original FROI/PLD report and making it part of the claim electronic record. Database Driven Report Selection Risk Manager has outgrown the Windows standard method of searching through a series of drill-down menus in order to find

and select a report to print. The sheer number of reports available has rendered this technique cumbersome at best. Instead, ERIC Systems invented database-driven report selection.

This approach utilizes a searchable grid containing report titles, physical file names, standard and user-defined keywords, and standard and user defined extended report descriptions to facilitate rapid location and identification of important reports. Three keyword list boxes are located at the top of the grid which can be used to quickly identify commonly used or favorite reports by simply selecting the appropriate keyword. Users can filter the contents of the grid by adding their own keywords and report descriptions. Reports not used by your organization can be hidden from display in the search grid. Print Control Module The Print Control module is a proprietary interface between Crystal Reports and the Risk Manager database. The Print Control module provides four (4) very important functions. It provides mechanisms for users to easily request variations of a single report design by allowing them to specify parameters such as sort and selection options, date ranges, “as of” dates, pagination options, show or hide details, specify the organizational levels to be included (subject to their assigned rights), and choose output destinations and formatting options. It enforces organizational and carrier security restrictions, defined by user logins, so that reports contain information from only those units the user has been authorized to access. It provides an interface to incorporate user-developed reports into the report selection grid to take full advantage of all the same security options and functionality offered by standard reports. For ultimate flexibility, power, and convenience in environments where remote users are provided with a desktop with authorized applications, such as Citrix, it may be deployed as a standalone module. This provides remote users with 24/7 access to reports WITHOUT having to give access to the main program.

This capability is much more powerful than other web-based report deployment options. Reporting SnapShots for “As of” Reporting A utility module is provided to create what are called reporting "SnapShots." There are three (3) types of "SnapShots" available. The first is the ClaimTotals table. This type is always created. The second is the ClaimCoverageTotals table. This type is created based on a user-defined setting in the enterprise configuration module. It’s applicable to enterprises with liability claims. The third is the ClaimPeriodTotals table. The ClaimTotals "SnapShot" is used in worker compensation claims and offers a summary of claim financials by reserve class, claim status, claim type, days lost, days paid, and days restricted, as of any historical date. The ClaimCoverageTotals "SnapShot" is an equivalent type of summary for liability and P&C claims. It provides a record of financials by reserve class broken out by enterprise (insured), employer (location), plan, policy number, policy effective date, and coverage type. The ClaimPeriodTotals “SnapShot” summarizes financials between two user-defined dates thereby solving the issue of inadvertent double counting data items, like days lost and days paid, in userdefined reports when there can be multiple transactions on a single day. Current values for the ClaimTotals table and the ClaimCoverageTotals table are maintained automatically by Risk Manager when a claim is opened for edit. There is no way for a user to edit or modify data in a "SnapShot" however, “SnapShots” may be freely created and/or deleted as a function of need. Data Extract Modules (Optional) A benefit of using Microsoft SQL Server to host the Risk Manager database is the seamless integration with other Microsoft applications such as Excel and Word. Claim financial data can be easily extracted from the “ClaimTotals” and “ClaimCoverageTotals” tables into Excel for analysis, or information from the claim information table can be accessed using Word for mail merge functions. Risk Manager integrates well with on-demand label printers, such as those manufactured by Dymo, for address and file folder labels. The label copy and print function is available for claimants, employers, enterprises, and vendors. Report Scheduler (Optional) The necessity to generate periodic reports for clients can be a tedious, time-consuming task. ERIC Systems offers an optional module that allows a user to create any number of report schedules, each containing one or more reports. Any report defined to Risk Manager can be scheduled. Reports can be directed to any local or network drive; any defined printer; one or more email addresses; or printed to FAX. A variety of distribution formats are supported, including the very popular PDF, DOC, and XLS. Both standard and user-created accounting calendars, such as a quarters based on 5/4/4 weeks, are supported. When setting up email distribution, a testing capability is provided for convenience. Multiple to, cc, and bcc addresses may be used.

UNEMPLOYMENT CLAIM MONITORING Unlike worker compensation, unemployment assistance is a monopolistic program administered by the States. Funding is provided by assessment of a tax that is calculated by assignment of a tax rate that incorporates an experience rating weighted against the taxable payroll. There is little opportunity for employers to manage costs or benefit calculations other than by never initiating a in a non-voluntary termination. This is something that’s literally impossible for a variety of reasons. Exacerbating limited opportunities to control costs are understaffed and/or under-funded State agencies where error rates can approach ten (10%), policies that don’t deny benefits except in extraordinary circumstances. For valid claims, under some circumstances, there may be grounds for requesting relief for

may be affecting employee morale manifested by unusually high turn-over rates may be overlooked. Statuses of litigated claims need to be tracked to ensure proper representation for the employer. Risk Manager provides the means the means to address these issues in a comprehensive manner. Entering the basic information regarding an unemployment claim into the system also creates a single, easy to access repository for all information about that claim and claimant. In some states, UI claim data is available in electronic format, making collection of basic data fast and easy. For claims involving termination for cause, managers and/or supervisors can comment using notes, any type of document or image can be added to the electronic record, witness statements can be collected, materials for presentations at hearing can be organized, and maximum financial liabilities projected. Aggregating data across multiple business units that may be registered under different reporting ID’s or summarizing claim liabilities for projecting premiums as a component of budgeting projections can be time consuming tasks. Larger organizations will find the ability to organize and report summary statistics and to document eligibility of workers for special government programs providing full or partial subsidy of unemployment benefits resulting from causes not controlled by the organization. Valuable information to support requests for relief to reduce experience factors.

charges that effect experience ratings. Information about UI claims is generally provided on a claim by claim basis. For this reason, information useful for budget and premium forecasts is difficult to collate, requiring significant labor for data entry to convert numbers on paper to electronic form for analysis. Unless claims can be aggregated and examined by grouping on common characteristics, management issues that

Since it shares many of the features and capabilities offered in the worker compensation module, not specifically applicable to UI claims, this module is primarily offered as an add-in for TPA’s wishing to offer their client base a new service. However, it can be deployed in a stand-alone form where UI claims are the only type of claim monitored.

DATASHARE AND DATAVIEWER The 3 NEEDS…. First, there are hands-on CFO’s, actuaries, and clients who wish to be involved with and to stay abreast of the progress made in the day-to-day management of their organizations claims. They want accurate and timely data for a variety of purposes. They want the flexibility to efficiently gather data for a variety of purposes including: budgeting, funds transfers between accounts, to aid their safety programs, for task-specific financial analysis or special projects, OSHA reporting, and potentially incorporation of claim financial data into other datasets. Second, if a client is lost, there’s almost always a need to provide them with a copy of their data, in a machine readable format, for import into their new application or for transfer to a new TPA.

There’s the same claim search grid, financial summaries by reserve class and/or category with drill-down to view individual transaction details, forms to view claimant demographic data, descriptions of the event causing the injury, details regarding the nature and severity of the injury, status history, claim notes, occurrence details (if applicable), and more. In fact, there are over 750 data fields that can be exported for client use. Data Exporter Module Available with two mouse clicks from within Risk Manager, the Data Exporter utility provides a simple to use interface to create client databases on demand or on a weekly or monthly schedule. Data can be provided in different subsets ranging from the very large to the very small. These include:

Third, there are headquarters or holding companies that don’t administer claims themselves but employ multiple TPA’s to do claims administration on a contract basis. These companies need to collect information in a central data base for combined reporting purposes.

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The PROBLEMS…. How to easily supply and/or collect pertinent claim data in a format suitable for use with Excel, Crystal Reports, or other ODBC compatible reporting application that clients can use for most any purpose without having to deal with:

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The need to acquire expensive hardware and software to provide remote access with data transfer capabilities. Arranging for custom programming to provide for the specific data requirements of individual clients. Security issues relating to allowing remote access to your database via the Internet. Repeated explanations of convoluted data transfer procedures not readily understood by non-computer professionals. Exposing your clients to the potential liability for licensing costs of third-party programs allowing them to view the data you’re providing. Providing a uniform, “human friendly” method to find and view claim data in context instead of in columnar listings contained in a collection of spreadsheet pages. The need to purchase, set up, and maintaining a webbased report server. Providing time consuming technical support for a foreign application. Creating and publishing a new report or extract file each time a client has a new project. Problems associated with combining multiple data sets with different formats into a single data base.

The SOLUTION…. DataShare and DataViewer DataShare is an optional add-in utility for Risk Manager that provides the ability to quickly and easily create a subset of data which is essentially a “mini claims database.” After creation, the data base is sent to the client who then attaches it to an existing instance of SQL Server, or it can be used on a single-user workstation by installing SQL Server Express Edition. The Express Edition is available for download from Microsoft at no cost. The DataViewer is a freely distributable, stand-alone program that is installed on a client workstation. It presents claim data, in a read-only format, in a manner very similar to how an examiner would see the data when using the full version of Risk Manager.

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Entire enterprise (all claims for all employers associated with that enterprise) One employer One employer group (grouped by a user defined coding scheme) One organizational unit (levels 1-6 within an employer) One insurance carrier (all claims associated with a policy issued by that carrier) One occurrence One claim

Data Importer Modules The alternative to exporting is to import data from different sources into a single format. This is accomplished by creating a source-specific import module to load the data into the DataViewer data base. The ability to have consistent and detailed views of claims data is only limited by the nature of the data that can be collected from each source.

Basic claim data can be augmented with one or more of seven (7) optional data items allowing data sets to be customized for a client's specific requirements. Exports can be performed individually whenever desired or multiple exports can be defined and executed according to a defined schedule. DataViewer The DataViewer is a read-only program designed to show claim, occurrence, transaction, and vendor information in forms that look substantially similar to those found in Risk Manager. The following screen captures are provided as examples of what a client will see when using the DataViewer. These are only

samples; there are many, many more forms within the DataViewer. The claim selection grid in the DataViewer has all of the same capabilities as the selection grid in Risk Manager. It allows sorting or searching for claims using one or more of 22 available fields, provides the ability to filter grid content by claim status, and allows exclusion of claims prior to a user specified DOI. Even more rapid retrieval is available by selecting from lists including the last 15 successful searches or the last 15 claims opened for viewing. Searches can also be done by specifying “contains string” or claim ID “ends with”. Claim Selection Grid

The claim summary form provides the client with a concise presentation of all the essential characteristics of the claim plus a complete breakdown of the claim financials by reserve class. Classification of claims by multiple coding schemes (NCCI, IAIABC, OSHA, etc.) is easily seen. Quick access is provided for viewing calendars documenting days lost, days paid, and days restricted. Claim Summary Form

Claim and occurrence financial data is provided to the transaction level organized by reserve class and/or reserve category. Drilldown is achieved by double-clicking on any of the cells in the green and white financial summary grid. Both a summary and a detail view are provided. Transaction Drill-Down – Summary View

Creating a Consolidated Data Base for Analysis and Reporting Since the DataViewer is a stand-alone module that provides an interface to a MS SQL Server Data Base with both standard and

custom reporting capabilities, it’s a straightforward task to write programs that can be used to import data from multiple sources, each with different file types and layouts, into this data base. The import process will, in most cases, deal with the potentially significant differences between the capabilities of the various applications used by each TPA or site by importing transactional data, not financial summaries by claim. The import process uses a simple point and click interface so that importing files on a periodic basis can be done by most any worker with general computer knowledge. Once all data sources have been imported, the data will be viewed in a consistent, easy to read format and will be fully accessible by Excel (ODBC) and Crystal Reports. This will virtually eliminate the need to deal with a variety of reports from multiple sources that may or may not show financial information in ways that are consistent with the reports obtained from other sources. Reports based on a single data base will allow direct comparisons of performance without the requirement to perform additional, time consuming steps to create combined spreadsheets for review and/or analysis. Be sure to ask to see DataShare and DataViewer after your demonstration of Risk Manager.

OSHA DATA COLLECTION AND REPORTING Employers are required by the Occupational Safety and Health Administration of the US Department of Labor to track and report the nature of injuries occurring in the workplace and lost time that may result from those injuries. Risk Manager provides the tools to classify claims and to collect all of the data necessary to produce the following reports: • • • • •

Form 300 Log of Work-Related Injuries and Illnesses Form 301 Injury and Illness Incident Report Form 300A Summary of Work-Related Injuries and Illnesses Form 200 Log and Summary of Occupational Injuries and Illnesses (superseded but still available) Sharps Injury Log

The classification of a claim as an occupational disease or injury is determined at the time the claim is entered into Risk Manager. The nature of the injury is also collected during claim setup. The

collection of lost and restricted time statistics is automated to the greatest extent possible by linking these figures to payments for total temporary disability (TTD) and loss of earning power (LOEP). A complete history of lost and restricted time is clearly presented in a graphical, 12 month calendar with types of days color coded for clarity. The calendar can also be used for entry and/or editing of days lost, days restricted, and estimated days data. A claim privacy flag is provided for suppression of claimant name on Form 300 when warranted. Access to the days lost calendar is provided both from within the claim and from the claim selection grid to facilitate access by remote users who may not have permission to open claims for data entry. All OSHA reports may be printed for any organizational level defined for an employer. Form 301 may be printed from the claim selection grid, from within the claim, or from within an incident for situations where the State First Report of Accident/Injury may not comply with OSHA reporting requirements. Claim data fields necessary to correctly generate all OSHA reports are color coded to ensure data entry operators complete all needed data. The content of the accident/injury description column is shown on the claim summary form so there will be no unexpected results when the forms are printed.

BILL REVIEW (MEDICAL FEE ADJUSTING) AND PRE AUTHORIZATION Risk Manager provides each user with the ability to implement the optional medical fee adjusting module to do their own bill review or to import payment files received from a third-party bill review company. If needed, both options can be used concurrently.

An optional claim data export module is available to create a file of claim data relevant to the bill review process to aid synchronizing databases and reduce potential for errors resulting from miscoding. The injury description codes plus up to ten (10) ICD-9 Codes associated with the claim will be included in this file.

The internal module includes the capability to accommodate multiple state schedules, multiple preferred provider networks (PPN’s), and leased networks.

Risk Manager Fee Adjusting Module Two forms are available for adjusting. The first is a standard form which allows paying a different procedure than was billed, denying a charge, or attaching special comments to explain why an adjustment was made. A speed data entry form is also available. It accommodates entry of up to six (6) procedures that have been approved and will be paid per the Fee Schedule. Help screens are available during data entry showing all assumptions, formulas, and values used to calculate an adjustment to the provider's billing. Two types of comment fields are offered: one that may be associated with each line item, and one pertaining to the entire EOB.

The optional fee adjusting module is essentially an automated look-up function integrated with payment entry and check processing. It’s limited to adjusting individual procedures and drugs. Adjustments that must consider related procedures (for example, global surgical rules), limitations for treatment protocols provided over time, or monitoring a maximum number of procedures that will be authorized must be identified and monitored manually. These types of adjustments are generally associated with claims involving injuries of a more serious nature and must be taken into account by the individual performing the review. An EOB approval process can be implemented that will require a review of EOB's by a manager for accuracy prior to being processed for payment. Support for bill review service companies is provided by add-in program modules that process received files, post the adjustment details to the database, create payment transactions, and generate log files documenting the results of the import. If a vendor ID and name is encountered that cannot be resolved, a vendor selection grid is displayed showing the closest match. The operator may select the suggested vendor, choose another, or update the RM database to reflect the content of the bill review file, or skip to the next record so the problem can be resolved later. A file can be processed multiple times without creating duplicate entries. Negative reserve balances are ignored during processing but are flagged on the log report. Any new vendors created are also listed on the log report so that they can be properly set up and a W-9 requested. All bill review history is retained and a viewing module is provided to facilitate retrieving information on any provider invoice. A facsimile of an Explanation of Review (EOR) may be printed at any time.

Risk Manager permits the definition of any number of Preferred Provider Organizations (PPO’s) with assignment of membership at either the employer or enterprise organizational levels. This means that Risk Manager can be configured to allow employers in different states or departments within a governmental agency to belong to different PPO’s, something that’s common with Police and Fire Departments where a union, with its own medical benefit program, is involved. A provider can participate in an unlimited number of PPO’s at different discount rates. A unique capability of the Fee Adjusting module is to concurrently support an alternative fee schedule such as a leased PPN. In this situation, Risk Manager calculates what to pay twice for each line item billed. The first calculation is for amount payable pursuant to the State Fee Schedule and second to determine if there’s a lower contracted rate for that provider for the procedure billed in the alternate schedule. The lower of the two amounts is returned. Risk Manager includes support for States with fee schedules that include variable reimbursement rates based on Medicare localities.

ADDITIONAL FEATURES Incident Tracking An incident is defined as an event or accident/injury that does not immediately result in a claim but could possibly in the future. Incidents may also be injuries to employees that are reportable pursuant to the requirements of OSHA. Data collected for incidents mimics that collected for claims, but without provision for collection of financial information. An automated function is provided to create a claim from the available incident information. An indicator flag is displayed on the claim summary form to signify the claim was originally recorded as an incident. Incident data is automatically merged with claim data for preparation of OSHA reports. Litigation Tracking This module enables the ability to track key information about legal proceedings involving claims. Identify attorneys for the plaintiff and defense, the venue, the judge assigned (if applicable), and current status in as much detail as desired according to a user-defined event coding scheme. Litigation dockets can include a reference to any number of claims. There are separate litigation-specific note, diary, and document (imaging) modules to limit access to only authorized persons. A user-defined scheme is provided for identifying and tracking materials needed for case preparation or as exhibits. Enter and track all dates established by a docket calendar and have single click access to a display showing all dates for all claims. Never miss a critical date again. Vendors (Payees) Risk Manager maintains a single vendor table used by all enterprises and employers. The primary identifier used is the IRS Taxpayer Identifier Number (TIN). An alternate ID and/or a doing business as (DBA) name may be assigned if needed. All identifiers are included in the vendor selection grid and may be used for searches. The "SmartSearch" feature allows rapid access by allowing entry of either the TIN or vendor name in a single field. Don’t know how the name of a vendor or provider was entered into the data base, but know at least a part of the name? You can search for that character string. What if some names were entered backwards? Ever want to search for the last characters in a name? You can do that too. Grid filters include: a user defined class (nature of vendors business), one or all IRS types (medical, non-employee compensation, gross proceeds), one or all states, plus active only, and/or preferred only. If one or more transactions are associated with a vendor, the TRANSACTIONS button on the grid is enabled. Clicking this button displays another search grid containing all payment transactions associated with that vendor. Clicking on a row will display all details related to that transaction. A "QuickPrint” report listing all transactions is also an option. Payments to vendors may be by check or ACH transfer.

Up to 256 vendors using the same TIN are managed by assigning an instance number that is concatenated to the TIN to create a unique identifier. Form 1099-MISC printing is extremely flexible. It can be configured to send one form to the vendor assigned the master record, one form to each vendor, or multiple forms to two or more groupings. Flags may be set to indicate whether a vendor is active or inactive, is a preferred provider, is on suspension, or has been designated as a hospital. Assignment of an inactive status can be used to suppress a vendor from being displayed in any of the available selection grids. Backup Withholding Upon notification by the IRS, a vendor can be marked as being subject to backup withholding. When done, the currently defined percentage of a payment, established by the IRS, will be deducted from a check and a marker printed to ensure the deduction is identified so it can be sent to the IRS. Form W-9 A request for Taxpayer Identification Number and Certification (Form W-9) is implemented as a “QuickPrint" and turn-around document. It may be printed and mailed to the vendor, sent by email, or transmitted by FAX. Upon receipt of a completed form, mark the vendor as having a W-9 on file to ensure regulatory compliance. Provision is made for recording both a billing and a shipping (physical) address with support for printing a variety of labels for each. Certificate of Insurance Tracking Cities and Counties will appreciate the availability of a standalone program module that facilitates tracking of Certificates of Insurance, additional named insured, and/or proof of insurance, by project, required of business performing contract work. Multiple certificates can be itemized, each with the carrier, coverage limits, and expiration dates. OFAC Foreign Asset Control Compliance Risk Manager includes a utility program for evaluating the names and address of vendors and claimants against the Specially Designated Foreign Nations (SDN) as required by the Office Billing and Invoicing Options Included as standard feature of Risk Manager is the ability for TPA’s to automate fixed fee billings based on the assignment of a claim type. Specify charges for each claim type class with the option for specifying a minimum billing amount for retainer type contracts. Use the optional Invoicing module to generate periodic billings and to track Accounts receivable.

FEATURES FOR RETROSPECTIVE RATING GROUPS To facilitate oversight of State Fund claims by retrospective rating groups, Risk Manager offers a variety of capabilities. These include: • • • • •

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Ability to track employer enrollment status in program years. Full-featured enterprise and employer notes modules. Contact-specific correspondence module with a full featured word processor. Enterprise and employer diary modules. Fields to track effective dates of State orders regarding third-party liability and/or designation of an occupational injury including percentages of liability for the current employer. Ability to define an unlimited number of contact persons within member businesses. User defined fields associated with contacts to facilitate selective mass mailings. Ability to record the name, ID and phone number of the responsible State Examiner. Ability to aggregate members into employer groups for reporting purposes. Historical tracking of changes in developed losses Payroll Premium module to track both summary and detail data related to calculating L&I taxes payable and refund amounts. Data to calculate incident rates.

Of particular note is the ability to designate different persons having responsibilities for claim management and for administering the safety programs for each employer. This

facilitates preparation of reports to meet the unique objectives of each function. Safety program administrators can use the user defined accident locations coding scheme, in addition to the physical address of the assigned level 6 organizational unit, to pinpoint where injuries are occurring in conjunction with other employment data items to help pinpoint where safety dollars should be spent. The organizational level coding scheme provides the ability to group claims by a common activity type in addition to more common hierarchical relationships. Ability to Import State Fund Data (if available) When available, monthly claim payment summary data can be imported by creating postpaid transactions. An import program can process year to date totals from monthly imports or subtract prior period totals from summary information to create a running history of incremental period changes. These transactions are available for supplemental reporting, graphical presentations, or statistical analysis. Provide your membership with detailed and informative reports, specific to their needs, which simply aren’t available from the State. Payroll-based Membership Fees and/or Premiums An optional add-in module provides the means to collect periodbased data regarding total payroll by job class to calculate premiums payable. Calculation can be defined by enterprise to be based on the number of hours worked by job, total payroll, or headcount by job. Class factors and experience modifiers can be assigned for use in premium calculation formulas. A total premium paid for each period can be entered for accounts receivable purposes.

CODING SCHEMES AND CONFIGURATION OPTIONS Codes are used to organize and classify data for reporting purposes because they minimize the potential for errors that can be caused by differences in spelling, use of abbreviations, and even different capitalization or punctuation. Risk Manager includes 60 system level (applying to all claims), 29 enterprise level coding schemes and two (2) schemes available at both the enterprise and employer levels, offering unparalleled flexibility for system configuration, and data classification. Multiple code schemes for data items, such as body part and injury type, are provided to support the individual requirements of OSHA and IAIABC. For each enterprise, sites may choose to implement NCCI codes, a user-defined general coding scheme, or a combination of both. A "Copy From" function is provided for all code tables to eliminate the need for redundant data entry when setting-up a new enterprise. All coding schemes are presented in list boxes which display available options for the user to select from. The option to sort codes by the ID or the extended title makes finding the correct code easier. If the code is known, it may be entered directly from the keyboard. A multi-tabbed display of the values assigned for different coding schemes (OSHA, IAIABC, NCCI, etc.) is shown on the claim summary form for easy reference. Reserve Classes and Categories One purpose of reserve categories is for estimating and classifying the future financial liabilities for a claim. Risk Manager offers the ability to define any number of reserve categories within six defined reserving classes (classes A-F). For maximum flexibility, any name may be assigned to a class (for example: medical, indemnity, other, expense, legal, vocational rehabilitation, etc.). Reserve categories are created and assigned to a class for reporting purposes. All financial transactions are classified by the reserve category affected and are generally summarized by class for reporting purposes. Detail by category is also available. Reserve classes are an enterprise level coding scheme and may be different for each enterprise. Categories may be configured to prevent negative reserve conditions or, in the case of categories such as legal expenses, configured to ignore reserve balances. Medical Fee Schedules Bill review is a function that is heavily dependent on coding schemes. CPT codes, Relative Unit Values, and ICD-9 codes are obtained from the American Medical Association (AMA) and imported into Risk Manager using utility modules. Unit values and pricing parameters are updated periodically by using a database merge routine. History is maintained so that any bill can be properly adjusted regardless of the dates of service. Risk Manager provides support for multiple state fee schedules. Utility functions allow each site to maintain fee schedule data without having to rely on updates from ERIC Systems. Time Loss Tables State specific time loss tables containing the rules for calculating time loss benefit entitlements are a feature of all versions of Risk Manager. The tables store the parameters used by our time loss calculation modules to issue benefit checks. This is done without the need for manual calculations by an examiner thereby minimizing the potential for errors.

System Level Codes These codes apply to all defined enterprises and employers. Claim status and claim type are bi-level schemes that allow an unlimited number of categories to be defined within each class. There are four (4) options for claim status class: open, closed, denied, and reopened. There are five (5) claim type classes: medical, indemnity, liability, no fault, and other. For example, within the class open, examples of categories might be: pending, open, appeal, legal, and investigation. A history of status and type changes is maintained for the life of the claim. Claim statuses and types "as of" any historical date are available for reporting. An example of the maturity of Risk Manager can be seen in the unique manner we’ve implemented claim statuses. Due to the diversity in definitions of a claim status such as “closed”, status categories may have two different class associations. One referred to as the Primary (the legal status), and one as Administrative. Confusing? Consider the example that a State has issued a close order for a claim with a PPD award. The primary status should be closed for reporting purposes, but the claim still needs to be retained as being open for administrative and billing purposes since checks will have to be issued until the award has been paid in full. An examiner ID is assigned to every Risk Manager user. Examiner ID's are distinct from login ID's and are used for identifying diaries, note entries, data entry logging, claim management and client contact responsibilities, signature blocks for correspondence, and new claim (from an FROI) notifications. General coding schemes to support record keeping and regulatory compliance include: combined federal and state filing (CFSF State Codes), policy coverage types, claimant educational level achieved, employment status, ethnicity codes (required by the State of Texas), employer status (to track participation in plan years), ICD-9 diagnostic codes, incident status, explanation of benefits (EOB) line comments to explain adjustments, litigation events and event classes, marital status, note and diary subjects, note text blocks, notification method (used to describe the manner of a notification of an injury or claim to other persons, organizations, or regulatory agencies), personal titles, payment classification categories, place of service codes (for medical fee adjusting), policy types, diary priorities, dependent relationships, state abbreviations, types of expense billings (T&E Billing), and user-defined titles for the twelve(12) free form text fields per claim. Purpose specific coding schemes include: IAIABC codes including return to work qualifiers (RTW), maintenance type codes, claim status, claim type, payment types, EDI targets, late reasons, and benefit adjustment types; NCCI codes for worker compensation claims including cause of injury, nature of injury, and part of body; OSHA codes for occupational injury/disease and Sharps injury device brand and injury device type. Additional Enterprise Related Codes The following schemes can be defined uniquely for each enterprise. General ledger equivalence account codes for classifying transactions, accident locations (to supplement the physical address of the organizational unit), business locations, general codes for accident/injury classification (body part, body position affected, cause action, cause condition, type of injury, and injury severity), job class and job types, loss types, payment categories, type of service (TOS) codes, and twelve (12) list-type coding schemes. These codes would be available to all claims for all employers associated with that enterprise.

Employer Related Codes Multiple coding and configuration schemes are maintained at the employer level. These include: • • • • • • • • •

Up to six (6) organizational levels Field properties (required, warning, no action, or default action) Applicable first report of accident or injury modules Certain business rules regarding reserving and actions to be taken on claim closure Default bank account, check layouts, EOB and EOP layouts PPN membership T&E retainer billing rates Claim auto numbering defaults Employer specific trigger events

Some configuration options are identical to schemes defined at the enterprise level to allow customization between employers associated with the same enterprise. During processing, Risk Manager “looks” for a defined employer option first (if any). If there is no employer setting, the setting for the enterprise is used. This makes it easier to manage enterprises with many employers (or members), with identical characteristics, such as associations or pools.

User-Defined Coding Schemes To facilitate communications with employers (members of an association, trust, or risk pool), five (5) data types are available for customization. There are 12 each of the following; coding schemes (multi select combo boxes), text (50 characters), dates and numbers. In addition twenty-four (24) Boolean fields are available that are easily queried for purposes like targeted mailings or other characteristics not shared by all members of a group.

A REAL-TIME, INTERACTIVE DASHBOARD AND QUERY TOOLS One objective for the design of Risk Manager has been to make available a variety of tools for extracting claims data periodically requested (somewhat randomly) by auditors, CFO's, brokers, safety officers, carriers, agencies with jurisdiction, attorneys, underwriters, and internal users. Although there are many standard EDI formats available, most of these requesters want something specific to their immediate purposes. This means time away from your normal work tasks to figure out how to get the data, organize it, and convert it to the proper format. Another often overlooked, but extremely important, use for query grids is to audit data entry. A grid can show missing and/or out-ofrange data items in seconds. Use functions like greater then, less than, in range, not in range, contains, is null, equal to, before date, after date, begins with and/or ends with. Risk Manager offers a collection of four (4) utilities designed to meet this need. Three of the tools, the Claim Financial Dashboard, Claim Financial Query, and the Transactions grid, are standard components of Risk Manager. The fourth, the Real Time Dashboard, Query Tool, and Chart Editor is an optional purchase. Three (3) are claim oriented grids return summary information for claims based on user-specified search criteria, The fourth, the transaction grid, provides the ability to retrieve financial details by querying transactions directly. Summaries and totals will have to be calculated manually using the functions available in the target application.

Claim Financial Dashboard

The Financial Dashboard GRID The first dashboard is a modified version of our claim selection grid. This works much like a spreadsheet where a user can use a variety of controls and filters, in real time, to create a variety of data sets for review. The grid includes basic information to identify individual claims, provides the ability to open a claim to look at transaction or event detail, and the capability to print or export the data set in different formats, the most notable being directly to an Excel spreadsheet. The grid includes these columns for each claim: • • • • • •

Organizational levels (enterprise, employer, and level 6) Claim status and type categories Primary examiner assigned Current percent of excess carrier reporting level Numbers of days open Claim financial totals o Paid to date o Remaining Reserves o Expected and actual recoveries o Total incurred o Kept on Salary (KOS)

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Policy assigned T&E expenses approved and pending Number of days lost, paid, and restricted NCCI Injury descriptions o Part of body o Nature of injury o Cause of injury

Where applicable, the sums of the rows contained in the grid (the entire selected data set) or just those rows selected by the user (blue rows) are displayed in the yellow totals row at the bottom of the grid. Use the full search and filtering capabilities of the selection grid and the filter bar to quickly aggregate collections of claims, with specific characteristics, for review. Some quick examples of the possibilities: •

Sort the column “remaining reserves” in ascending order to instantly see negative reserve conditions or identify claims that may have insufficient reserves. Now filter the grid to show only closed claims to see closed claims with nonzero reserve amounts.

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Select one or multiple organizational units to view a real time summary of the financials for open and reopened claims. Further, break out the totals by user defined claim type categories like medical, property, TTD, PPD, BI, auto, etc. Find data entry issues by looking at maximum and minimum value in each column. A day’s open value of 30,000+ would certainly be an indication of a date issue with a claim event record. See values exceeding thresholds easily by changes in the background color of the cell. Compare statistical metrics for current and previous periods to monitor changes over time.

A separate security item controls access to the grid, making it easy for TPA’s or managers to offer this feature to clients, carriers, and/or departmental representatives. Of course, they’ll only be able to view data for the organizational units authorized by the System Administrator. A unique function permits a user to choose any date in the claim history and create a non reporting snapshot summarizing the financial for that claim as of that date. Multiple views can be created that make it much easier to respond to difficult client questions like “How and when did the PTD totals get that high?” No need to print multiple reports showing transaction history unless that level of detail is needed.

How are we doing compared to others? - A unique feature is the ability to create graphs that include data for all claims in the data base regardless of organizational level. This allows a client to see statistical information for their organization’s claims and compare it all other claims data in the data base. This is an especially powerful capability where there are multiple clients in similar industries. It can answer the question of how I'm doing compared to other organizations. It's important to understand that when working with all claims, organizational security is enforced so drill down to examine details of individual claims belonging to an organizational level a user is not authorized to view is disabled. I want to see multiple charts at the same time for easy comparisons - Charts are of a vector type meaning they can be resized within the limits of readability. Making graphs larger will make them more suitable for presentations where projection to a wall or screen is involved. Smaller graphs are better suited to reports or other written presentations. As many charts as necessary, each showing a different metric, time period, or as of date can exist in the same session. It's possible to create a series of charts, scrunched down or overlapped to make space. It's even possible to display charts full screen to create a real time slide show.

The Real Time, Interactive, User-Configurable Dashboard with Integrated Chart Editor and SQL Query Tool. The Dashboard and Chart Editor are designed to help respond to the following questions and/or requests by managers and clients: How are we doing? - Access to a tool allowing visual summaries of period comparisons and identification of trends is essential for monitoring and evaluating the effectiveness of safety and training programs. Since each organization is inherently different, the metrics that will be important to their analysis will also be different. The Risk Manager Dashboard and Query module gives any user the ability to create thousands (1,000's) of graphs and charts using a variety of financial summaries, counts, accident/injury characteristics, organizational levels, and more than 50 claim coding schemes. Why is the value so high (or low)? - When an organization unit the user has been authorized to access is selected, the DRILL DOWN option is enabled. This allows the user to drill down multiple levels of the data set to find the answer by looking. Drill down can be to an individual claim or even to a single transaction, depending on the nature of the chart being questioned. This function makes it easy to identify one high or low value that may be skewing the results for a period, potentially affecting interpretation. We believe it's extremely important to understand the detail behind the pretty picture in order to be able to use graphs effectively.

The biggest headaches when trying to create presentations is getting the necessary data in a usable format. Few, if any, users understand data base structures, table linking, or have the expertise to use a product, like Crystal Reports, to do develop custom reports with graphs. The alternative is to use a spreadsheet application. However, that doesn’t eliminate any of the problem aforementioned challenges. The user still has to deal with unknown data base structures, table linking, and using SQL (a programming language) to collect accurate and complete data sets. This is not always a straightforward process. An unsophisticated user may struggle to get rid of unwanted page headings, extra blank columns used for spacing, and unfamiliar number formats. Then, there’s always the issue of confidence in the extracted data. If totals don’t match what the system reports (provided by the developer) are showing, all of the benefits of “doing it yourself” are gone. You either start banging on the calculator to do your own summaries, manually entering the results to create a meaningful graph or call for help and wait.

HELP! Send me the data I need to prepare this custom report my boss wants yesterday - As the claims administrator, clients or departments within your own organization will always look to you to do this part of their job for them. Save time by empowering them with the Dashboard, Chart Editor, and SQL Query Tool. Not only will you be giving them the ability to get the data they want, you'll also be enabling them to answer the inevitable follow-up questions that always surface. Access to the Dashboard module will not only let them create the charts they need but also the underlying data set so they'll be prepared to respond to the most probative of questions asked during presentations. If the client or department representative has been granted remote access, presentations can even be live or at least answers to questions can be augmented with additional charts LIVE!

Oh, did I forget to mention all the editing that's necessary to clean-up the chart so it’s suitable for a presentation? Or am I the only one who has trouble fitting "CUT - Hand Tool, Utensil (Not Powered)" on the X-axis as a label? The Risk Manager Dashboard with its built-in SQL Query Tool offers solutions for many of the common complaints about charting applications. First, the Dashboard is an integral part of Risk Manager so its functions are optimized to work within the environment you’re already accustomed to. A field called "chart text" has been added to many coding schemes to address the issue of having to edit long data labels to make them more suited for charting. Assign the names you want to use for axis labels once and you'll never have to waste time editing labels again. The Dashboard is real time, meaning the data reflected by the chart is accurate as of the time the chart is generated. The data sets are also refreshed each time a scenario is opened for viewing. Without defining a dynamic link (an advanced function), a spreadsheets only present data as of the time it was imported. Spreadsheets are incredible tools with advanced features, like statistical functions and forecasting, that part of the Dashboard. Therefore, we've included a SIMPLE TO USE interface to give a greater number of users the ability to generate data sets, they can be confident in, and export that data to a spreadsheet for any purpose. One of the unique capabilities of the SQL Query Tool is to generate a grid that summarizes claim data based on two userselected codes. We call this Code vs. Code. The information is presented in a grid view, charting isn’t an option. However, the data set can be easily exported to a spreadsheet application. Drill down is enabled. The cell coloring is automatically assigned by calculating the relative magnitude of cell values and assigning color shades based on three (3) user-selected choices. In the sample below, the red cells make it very easy to see the most common injury types and the body part group affected.

The SQL Query Tool Many computer users have acquired advanced skills using spreadsheets because they’re extremely flexible and can be used to collect and manipulate data for a variety of purposes. The Microsoft applications Excel and Word are commonly used to create presentations for management.

With a couple of keystrokes to change the summary from claim counts to PTD, a completely different picture of the same information can be generated.

click in the grid and select switch to native filter mode (or standard mode) from the sub menu. In the native mode, moving the cursor over the column header (the cell where the name of the column appears) will show a black arrow symbol at the right edge of the cell. Click this arrow to show a form containing a unique entry for each value in that column. Warning... this may be a huge list. By default, all items will show as being marked. All values may be unselected and only certain values reselected. Clicking APPLY will filter to grid to show only the selected values. It's also possible to filter the grid for entries within a date range using operators (see above) similar to those available for dates. To have the grid fill automatically when opened with the results of a favorite query, first create the query, then save it using the ID "DEFAULT". The content of the description field is optional. The next time you open the gird, the results of the DEFAULT query will be shown using the preferred layout.

As might be expected, in this data set, cuts to arms are very common but falls with injuries to multiple body parts are the most expensive. Data sets associated with charts will contain a variety of summary information and statistical measurements that may or may not be reflected in a chart. Use the Data Grid menu item to show all of the data fields available. Use just the information you want and discard the rest. Change the “as of” date for financial summaries or add filters, like claim status, claim type, organizational level, and carrier with a few mouse clicks. In short, spend more time working on your presentation than struggling to get the data you need in the form you need it. The latest tool for financial analysis and ad hoc reporting is the Claim Financial Query accessed from the menu item FILE / OPEN / DASHBOARD or from the new query icon in the toolbar. Organizational permissions, assigned by the users login profile, are adhered to so there is no specific security item to control access to the grid. The background colors of this grid are light green and white (like green bar paper) to distinguish this grid from all others.

This query tool will returns 230+ data items for claims that match the specified selection criteria. All fields may be viewed in the grid or just those fields applicable to the purpose of the query can be made visible. The default layout excludes all of the columns related to displays of financial summaries for reserve classes. The criteria for the content of the grid include: as of date (a snapshot), enterprise, employer, employer group, organizational level, examiner, carrier, ID/name, claim status class, claim type class, and up to three (3) codes for grouping (additive). There are also two (2) selectable dates for additional filtering by a standard or user-defined period. The available dates are: DOI/DOL/DOS, received, filed, reported to employer, and reported to excess carrier. Date operators can be: is after, is before, is equal to, in the range, is not equal to, is a entry, or not in the range. Rough calculations suggest millions of possible combinations of criteria.

The grid allows saving an unlimited named of named layouts plus preferred and default. An unlimited number of queries can be defined, saved, and executed again with a few mouse clicks. Two modes of operation are supported, the standard mode and the native mode. The native mode is new. To access it, right

This grid includes a new capability that allows the operator to select a rectangular range of rows and columns that may be printed or copied to the Clipboard and pasted into any other compatible application. Most spreadsheets and word processors support copy/paste operations. in a grid cell that would mark one corner of the area to be captured, hold the button down and drag the pointer to define the area that includes the data to be copied, The selected cells will be colored blue. Now in the blue area and a sub menu will be displayed offering the choices to copy with or without the column headings. Click on one option. The selected data will be available in the target application, like Excel, from the Paste menu item. The select area function is available in both the standard and native grid modes. Remember that you can customize the grid layout to hide columns and filter (limit) its content to exclude data items not relevant to your objective. Area select prevents multi row select using the and Windows keys when the cursor is in the grid. However, selecting a range of rows can still be accomplished by enabling record selectors and clicking in the boxes (selectors) that will be visible at the left margin of the grid. The horizontal lines between selectors boxes are also used for adjusting row heights after changing font sizes.

This is an extremely powerful grid that we hope will allow you to respond to most, if not all, of those non standard requests for financial information by brokers, clients, excess carriers, CFO's, and auditors. Any record set can be exported to Excel, because that's the most common format requested.

The print function will also print the entire content of a grid, whether the rows are visible or not, even if an area has been selected. Hidden columns will not be printed. Use the many selection and filtering options to limit the content of the grid to only the records desired. Use the print preview option to ensure you're not going to waste a lot of paper.

Another use for this grid is as a tool for validating data entry for claims. Define a layout that includes those fields most important to your operations. Create a query based on examiner and quickly see empty cells indicating that data entry standards aren't being complied with.

Saved named layouts (found in the grid) are visible by all users. A preferred layout is user specific. It is possible to allow users to

create new layouts for their personal use but not edit system layouts provided for use by all.

SELECTING THE RIGHT VERSION OF RISK MANAGER All versions of Risk Manager have the same set of features and capabilities. The differences between versions are based on four (4) key factors: • • • •

The type or types of claims to be administered. Only one claim type can be administered within an enterprise. Number of organizational levels to be defined Options to customize claim and financial data coding schemes Compliance with HIPPA privacy regulations

The single-employer, single-enterprise version is offered as a very affordable, “Entry Level” version of Risk Manager for nonprofits and self-insured organizations with simpler organizational structures. Once operational, an organization can easily add any of the optional modules or upgrade to any of the more capable program versions. Number of Organizational Levels The design of Risk Manager provides an extremely simple and flexible mechanism for grouping business units for loss reporting.

Enterprise(s) Emp Groups Employer(s) Org Level 1 Org Level 2 Org Level 3 Org level 4 Org Level 5 Org Level 6

Enterprise and employer are only generic names used to describe the top two organizational levels. These names are user definable and may be changed. An employer group is an enterprise level coding scheme that allows selected employers, within a single enterprise, to be organized into groups for reporting, correspondence, or notification purposes. In the private sector, an enterprise will most likely be a collection of one or more related self-insured employers grouped together for financial reporting purposes. For example, a trust, risk pool, or association. In a governmental agency, an enterprise can be defined as

the City or County with the first level Departments, such as Public Works or Parks and Recreation, defined as employers. In general liability and property & casualty environments, an enterprise or insured could be any collection of related employers, locations, or properties grouped for combined loss reporting. Within an employer or location, six sub levels of organization are possible. Not all levels need to be used. Levels within the employer can be bricks and mortar based (hierarchical, like an org chart) or can be used to combine claims involving an activity common to multiple locations. For example, within a school district, one level could be used to identify the activities of food service, janitorial, teachers, students, administrative, and transportation. Using a standard report and specifying that claims be grouped by that level would show losses for each activity, across all employers. Coding Schemes There are over 80 different coding schemes for data defined at the system level (affecting all claims) and over 45 coding schemes which are specific to enterprises. These include reserve categories and the payment categories used for aggregating data for state reports. In a single enterprise version of Risk Manager, users are limited to one set of these codes that must apply to all employers. This limitation may not be reasonable for organizations doing business in more than one state. Compliance with HIPPA Privacy Requirements Although the administration of worker compensation claims is exempted from HIPPA privacy regulations, considerations must be given to privacy when administering both worker compensation and liability claims within the same database. Since Risk Manager security is implemented at the employer level, worker comp and liability claims should be separated into different enterprises. This will allow user logins to be easily configured to restrict those responsible for liability claims administration from viewing sensitive medical data associated with worker comp claims. A multi enterprise version is strongly recommended for sites administering both worker compensation and liability claims to allow the reserving and coding schemes to be tailored for the individual requirements of each claim type.

FEDERAL, STATE, AND THIRD-PARTY ELECTRONIC DATA INTERCHANGE (EDI) The exchange of data between computers systems is becoming more and more common place, but also increasingly more complex. Risk Manager addresses this need by developing purpose specific modules for extracting and formatting data for transmittal to third-parties. Current modules include: • • • • • • • •

Import and export of IAIABC Release 1 and Release 3 FROI and SROI files Export and import of claim data to comply with CMS Section 111 reporting requirements Export and import of selected third-party submitters for CMS data Export and import of Washington SIEDRS claim demographic and financial data Export of Positive Pay Data Export of Transaction Data for ACH Payments Import and Export of claimant and injury data to support third-party bill review operations Import and processing of name and address files of Persons of Interest published by the Office of Foreign Asset Control (OFAC)

• •

Import of Medical Fee Schedule data including CPT codes with descriptions, ICD-9 codes, etc. Various extracts of data for client specific purposes

PRICE LIST Prices and Program Specifications Effective June 1, 2013

Standard Components for All Versions Base pricing includes: One (1) year of telephone technical and remote desktop support; Crystal Reports source files for over 450 standard and sample reports; Form 1099-MIRC processing, checkbook reconciliation module, examples of check layouts; programming services for up to three (3) periodic reports required by a client or agency with jurisdiction; programming services for development of three (3) custom reports or correspondence items for internal use; and all program updates and/or enhancements for one year. All versions are multi-user and are supplied with a file server license to access one (1) production database and one (1) database for testing and/or training attached to a single instance of MS SQL Server. There are NO “per seat” or “per user” charges assessed by ERIC Systems for use of any version of Risk Manager.

Program Versions and Modules

Price/ Maintenance

RMIS Single Enterprise and Single Employer/Location [SESE] An entry level version for smaller self-insured, self-administered organizations, non-profit groups, and public agencies. Intended to be customized by adding optional modules. Provides the ability to define up to six (6) organizational levels. Includes 24 hours of online training for up to nine (9) users per session. Onsite training is optionally available. Supports one (1) purpose specific claim module. Choice of claim module included in price.

$19,995 $3,749

RMIS Single Enterprise with Multiple Employers/Locations [SEME] A more powerful version of Risk Manager also intended to be customized to meet specific needs. Ideally suited for larger selfinsured, self-administered organizations with multiple business units. Provides maximum flexibility for remote access and distributed data entry. Access to claims data and report content is easily restricted to a single employer/location or a single organizational level. Supports up to seven (7) organizational levels. Includes 24 hours of online training for up to nine (9) users per session. Onsite training is optionally available. Supports one (1) purpose specific claim module. Choice of module included in price.

$39,995 $5,625

RMIS Multi Enterprise with Multi Employers/Locations [MEME] A fully featured version designed for third-party administrators, larger organizations with multi-state operations, and any organization wishing to administer multiple types of claims (WC, GL, P&C, Unemployment Insurance, and Retro). Dynamic loading of purpose specific claim modules based on an enterprise configuration option. Provides the ability to define any number of enterprises and employers. Up to eight (8) organizational levels are available. Each enterprise may have its own set of reserve classes/categories and user defined coding schemes. Includes three (3) days of onsite training and choice of purpose specific claim modules.

$59,995 $7,435

RMIS Enterprise TPA [MEME-TPA] Intended for larger multi-state TPA’s administering claims for a wide variety of organizations with complex business structures, the need to import and export data to/from multiple sources (including third-party bill review) on a daily basis, and with extensive custom reporting requirements. Includes Risk Manager Enterprise plus the following optional program modules: Report Configuration Module, Report Scheduler module, Claim Data Extract module, one (1) IAIABC module, and one (1) Positive Pay module. Includes three (3) concurrent days of onsite training. Includes choice of any or all available purpose specific claim modules.

$69,995 $11,185

Version Upgrades One version of Risk Manager can be UPGRADED to a more capable version at any time by paying an amount equal to the cost of the new version less the price paid for the current version. NOTE: If needed, creating new enterprises, employers, or organizational levels from existing data is subject to an additional charge for programming.

Claim Module - Worker Compensation For the day to day management of worker compensation claims. Provides the framework for standard and optional program features including, but not limited to: claimant demographics; accident/injury/illness descriptions; time loss calculators; PPD award schedule calculation; medical fee adjusting; data collection for IAIABC, CMS, and WA SIEDRS EDI processing; creation of contact correspondence with history; litigation tracking; financial summaries by reserve category with drill down; entry of payments, reserves, debits/credits, recoveries, and posted payments; forms generation and printing; input of documents; defining scheduled payments; tracking return to work progress; overpayment recovery schedules; data collection for OSHA reporting; printing of days lost, paid, and restricted calendars; remote entry of FROI’s; integrated medical fee adjusting; T&E billing; claim type billing with or without a retainer; printing of claim specific reports; monitoring of excess carrier reporting requirements; dependent definitions; organizational level associations, collection of job and employment data, status and type history and much more.

$5,995 $995

Claim Module - Liability and Property & Casualty For the day to day management of property & casualty and general liability claims. Provides the framework for complex policy management, including erosion of SIR’s and/or deductibles by reserve class, and integrated property/fleet schedules. Utilities for copying policy templates created at the system or enterprise levels to multiple employers with a single mouse click are provided. Policy history is maintained at all levels.

$5,995 $995

Claim Module - Retrospective Rating Groups or Claim Information Monitoring/Reporting For the day to day management of claims managed by retrospective rating groups (State Fund claims) or for any organization that retains a TPA but wishes to monitor claims data in house. Provides support for calculation (verification) of industrial insurance premiums, tracking of refunds, and final reconciliations. A claim monitoring function would require a periodic import of claims data from a third-party source.

$3,995 $495

Claim Module - Professional Liability

$3,995 $495

For administration of claims dealing with professional liability only. Has similar features to GL and P&C module but policy information is abbreviated and limited to a single policy definition per claim.

Claim Module – Unemployment Claim Tracking Provides a tool for monitoring unemployment claims, their status, and if desired, benefits paid that can be used to budgeting purposes. User definable coding schemes to monitor progress through judicial proceedings and appeals.

Optional Modules Unless specified otherwise, all module include technical assistance and maintenance for the first year.

Real Time, Interactive, User Configurable Dashboard with Integrated Chart Editor and SQL Query Tool Provides 100 security protected scenario workspaces that can be used to create and store any number of charts depicting varying views of claim data. Design charts using more than 50 claim coding schemes to show relationships between organizational units, financial metrics, statuses, types, and much more. Even generate tables showing the effect of one coding scheme on another, like what types of injuries most commonly affected the upper extremities.

$3,495 $649

Real Time Query Tool A data extract utility for clients who don’t need a dashboard application and/or prefer to use a spreadsheet for preparing presentation graphics. Offered as a stand-alone module that may be deployed separately from Risk Manager for access by remote users or executed from within the main program. The queries provided are similar to those provided in the Dashboard, but there is provision for saving queries (no scenarios), no graphical capabilities, and an enterprise organizational level is always required.

$1,595 $2,95

DataShare and DataViewer Modules Offered as an alternative to web-based reporting tools with limited flexibility. The DataShare module provides the means to create extracts of the Risk Manager database, by a single organizational level or carrier, for distribution to clients or internal users. The companion DataViewer provides two functions. First is the means to view and print reports using the claim information in the data base created by the DataShare module. The second is as a repository to combine data from multiple third-party sources into a single format to facilitate reporting, comparisons, and analysis. The SQL Server data base may be accessed by any ODBC compliant spreadsheet to allow the user to perform custom analysis or to combine with external data for any purpose. Includes a royalty free license to distribute the DataViewer module. Compatible with MS SQL Server 2005/8 Express Edition.

$4,995 $1,995

State Time Loss Calculation Module Although Risk Manager may be used to administer claims in any jurisdiction; these modules offer a time loss table to automate calculating and issuing time loss benefit payments, and one (1) periodic report required by a State agency with jurisdiction. (IAIABC EDI support not included). Price variations are a function of the varying complexities of State requirements and regulations. Updates to address changes in regulatory requirements or conversion to electronic submittal of data are NOT included and will be billed separately. Modules are designed so that the user can update COLA and/or changes in entitlement percentage factors that don’t require changes to calculation formulas. Included with MEME and MEME-TPA program versions.

By Quote

Report Configuration Module This program allows users to create their own reports that can be seamlessly integrated into our report selection grid to take full advantage of all the standard features and capabilities of our proprietary print control module for security, sorting, content filters, control break processing, pagination, and passing of variable parameters. Requires specialized knowledge of SQL, database structures, and use of the Crystal Reports Designer. Includes program updates for one year. Does NOT include technical support for development of reports. Requires one single user license for Crystal Reports v9 or later. Included with the MEME-TPA version.

Medical Fee Adjusting Module All versions of Risk Manager are capable of incorporating this optional module for medical fee adjusting. It’s a standard component of the Enterprise and Enterprise TPA program versions. In addition to the data entry forms and support for multiple fee schedules and EOB layouts, utilities are provided for importing and updating properly licensed data files common to all States. For example; CPT Codes, RBRVS, and the ASA Relative Value Guide. Requires at least one (1) State Medical Fee Schedule module. One custom import module included with the MEME-TPA program version.

$2,995 $7,49

$4,995 $1,595

State Medical Fee Schedule Module States vary significantly in how they implement fee adjusting and the degree to which data is provided in a machine readable electronic format (not Adobe PDF). Utilities for importing generic data from Medicare and AMA sources, such as CPT and ICD-9 codes, are standard features of this module. Medicare localities, ASC values, modifiers, multiple PPN Plans, and multiple alternative schedules are supported by default. Pricing is affected by how unique the calculations of fee reductions are and the nature of the data required. (All possible reductions for complex treatments may not be supported. Contact a technical support representative for additional information).

Price and Maintenance by Quote

Positive Pay Module These modules are specific to a bank or financial institution. Each module produces an electronic file, formatted to the bank’s specifications, containing information about checks printed, payees, and check amounts that is used to help prevent fraud. Includes one year of technical support and all program updates. One (1) included with MEME and MEME-TPA.

$995 $249

Invoicing and Accounts Receivable Module This module supports generation of invoices for claims management services rendered by TPA's. Supports T&E billings, retainer billings, and billings based on fixed fees by claim type. Includes technical support and program updates for one year.

By Quote

Property/Fleet Schedule Module with Deficiency Tracking and Spreadsheet Template for Data Collection Provides the ability to maintain and associate detailed owned property (fleet) schedules with insurance policies. Schedules are defined at the employer (or Department) level allowing multiple schedules to be maintained with multi-employer program versions. Use as a tool to insure adequate coverage and to estimate reasonable risk levels for self-insurance. For convenience, an Excel spreadsheet template for data collection is also provided.

IAIABC Release 1 and Release 3 EDI Reporting Modules This program creates an extract file suitable for import into a third-party Trading Partner application, transmittal to the State via a value-added network, or for direct upload to a State FTP site. All history of submittals is maintained. Pricing and support are per module. One (1) module included with MEME-TPA.

CMS Section 111 EDI Reporting Module Provides the ability to create Query and Input files suitable for direct transfer to the CMS FTP site. Also processes response files received from CMS. A record of all submittals is maintained in the Risk Manager data base. A Log File and viewer program provides the ability to verify the actual content of all files generated. Included with MEME-TPA.

Washington State SIEDRS EDI Reporting Module Creates an extract file suitable for transmission to Washington State Department of Labor and Industries secure FTP site. Includes utilities for error checking prior to file creation, the ability to retransmit records in the event of an error, and maintenance of an extract activity log file, and payment category mapping. A record of all extract submittals is maintained in the database.

$2,995 $749

$4,995 $1,649

$4,995 $495

$1,595 $449

Report Scheduler Electronic Report Distribution Module This module is intended for TPA's or self-insured organizations with a need to disseminate periodic reports to a large number of recipients. Facilitates the creation of collections of standard and/or user reports that may be printed, saved to a disk file, or distributed by e-mail. Execute schedules with multiple reports with a few mouse clicks. Supported report formats include Adobe Reader (PDF), Microsoft Excel (XLS), and Microsoft Word (DOC and DOCX), Rich Text Format (RTF), ASCII text (TXT) and more. Included with MEME and MEME-TPA.

$2,995 $749

Third-Party Bill Review EDI Import Module These are custom programs that process a transaction file received from a bill review company to create claim payment entries without manual data entry. A history of all procedures billed/paid and a processing log are maintained. Unrecognized claim and vendor ID's cause a selection grid to be displayed to assist the operator with proper assignment. Multiple options for handling processing costs are provided. Includes technical support for one data format. These programs are input source specific. Includes program updates for one year. Changes in formats by the bill review company are excluded from technical support. One module is required for each different bill review company or for each data format provided by a single company. Included with MEME-TPA.

$4,995 $949

Web Reporting Interface Allows collection of data items regarding notifications of accidents/injuries and/or property loss/damage reports from a web page.. Consists of an intermediate data base for posting data submitted by remote users and a utility module to read the submittals. An operator has the option to create either a claim or incident in the production data base after evaluating the submitted data. Client is responsible for preparing the web data entry form(s) pursuant to data base specifications provided by ERIC Systems.

Payroll Premium Module A tracking module for use by retrospective rating groups and/or associations whose members pay a membership fee based on total payroll or assessment by job class/type. Can be used to calculate premiums for industrial insurance, taxes paid, refunds, and final reconciliations.

Certificate of Insurance Tracking Module A stand-alone program for organizations and agencies needing to track multiple Certificates of Insurance required of vendors performing contract work.

By Quote

$1,995 $249

$995 $149

Litigation Event and Status Tracking Module This module provides the ability to track the progression and statuses of claims with pending litigation. Docket calendars can be defined for automatic reminders of key dates. Provides the means to separate legal notes, correspondence, and documents from general claim notes, correspondence, and documents with individual data entry points and security items. Supports multiple claims associated with a single docket. Includes a user defined tracking list for items most often requested or needed by attorney’s. Included with MEME and MEME-TPA versions.

$1995 $249

Claim, Vendor, and Transaction Data Extract Modules Utility modules to provide a standard file of claim and financial transaction data using operator entered criteria. Claim data includes basic demographics, addresses and contact information, accident/injury descriptions, and diagnostic codes for reference by third party bill review companies when adjusting provider invoices. Transaction data can be limited to just payments or all transactions (reserves, debits/credits, posted payments, and recoveries). Vendor data is sometimes requested by third-party bill review companies. Offered as a set of three (3) modules. Included with MEME and MEME-TPA.

$995 $249

Training and Programming Services Crystal Reports Design Assistance Custom report design services and technical assistance for sites that need custom reports or to have standard reports modified to meet special requirements. Includes State forms and standard correspondence items.

On Site Operator Training On site training for less than ten (10) users in client supplied space. ERIC Systems will provide computer with software and a projector to show program operation on a screen or wall.

Custom Programming Including data extraction utilities, data conversions, and preparation of scripts to modify existing data.

$150/hr

$650/day plus travel, lodging, subsistence $150/hr

Data Import from a Third-Party Source With a new installation, it’s often required to import data from a third-party source. For example, from the application being replaced or from the TPA previously responsible for managing the claims. For a variety of reasons, the cost of conversions is impossible to estimate in advance of reviewing the data. The time required is most dependent on the number of tables or files provided and the quality of the data, not the number of claims. Our standard practice is to attempt to import all possible data fields; however, import of less detail can result in a substantial cost savings. Estimated cost should only be used for budget estimates. The actual cost cannot be known until after the conversion and validation processes have been completed. Only the time actually required will be billable. A source is defined as a collection of tables or files from a single application. Image data, in common formats, can be imported.

Estimate Only $9,500 per source

Data Import from a Third-Party Source into the DataShare Module Retrospective rating groups and holding companies who employ multiple TPA’s to administer claims in a variety of geographical areas have a need to merge demographic and financial information into a single data base for combined reporting and general oversight. One import module is required for each third-party data source.

By Quote

Supplemental Online Operator Training On line training for up to nine (9) persons per session. Available between the hours of 7:00 AM and 3:30 PM Pacific time, Monday to Friday, except holidays. Client may choose the topic(s) to be covered during the session.

Prices and specifications effective June 1, 2013

$95/hr