CUSTOM PROGRAMMING CATALOG

Z837RFT – Custom ANSI 837 Reformat to ECSIF - Version Supported:  3050
ZAPCR – Custom Average Paid Claims Report This program provides a summary of paid claims broken down by user defined categories (e.g. Medical, Dental, Vision, etc.).  Each category is further broken down by payments made to Employees, Dependents and Spouses.  The average number of covered employees by category is also provided in order to calculate an average paid claim per employee amount.  Sample Report
ZAPCRM – Custom Average Paid Claim Report Maintenance This maintenance program allows the user to define the "Type" (Medical, Dental, Vision, etc.) and what benefit types (M for Medical, D for Dental, etc.) are to be considered for each.
ZBIS - Billing Invoice Summary Report This program generates a report showing Single and Family coverage counts for the selected billing month.  The counts are multiplied by the appropriate billing rates and totaled. The report is sorted by group, location, plan and benefit type.  Sample Report
ZBPCS – Custom Benefit Plan Cost Summary This program is designed to provide an executive summary of plan expenses.
ZBPCSM – Custom Benefit Plan Cost Maintenance This program is used to establish the Plan Costs, Eligibility and Paid Claim categories that are used by the program "zbpcs".
ZBRR - Custom Billing Summary Report This program is designed to resort and summarize billing data contained in a spool job created by billing format nnn.
ZBSR - Custom Benefit Summary Report This is a custom program used to report accumulation and/or benefit detail information.  This report can be run on all groups, a range of groups or a list of groups.  The report can also be ran for a family or a specific individual. Accumulation information is reported for a prompted individual year. Benefit detail information is reported for a prompted range of incurred dates. The report is sorted by group, last name, initials, internal number and dependent code for both accumulation and benefit detail information. For benefit detail information, the report is further sorted by claim benefit type (dental, medical), incurred from date, claim number, worksheet number, worksheet classification and line number. The report has forced page breaks for a new individual, a new claim benefit type for an individual and when a page is full.  Sample Report
ZBSUCR - Custom PPO Discount vs. UCR Report This program compares PPO Discounts against UCR reductions with multiple sorting and subtotaling options.  Sample Report
ZBSUCRM - Custom PPO Discount vs. UCR Report Maintenance This program allows the user to tie procedure codes to a category for use with the program zbsucr. Procedures must be tied to a category in zbsucrm before running zbsucr.
ZCAR - Custom Census Age Report This program produces a report that breaks out census data by Enrollee only, Enrollee plus Spouse, and Enrollee plus Dependent and Family coverage.  Each of these categories are then broken down by the number of employees, spouses and dependents.  Percentages for each are also included.
ZCARM - Census Age Report Maintenance This program allows the user to establish age bands that are used by zcar, by group.
ZCBS - Custom Paid Claims By State Report The regions are hard coded and based upon information provided by New York that cross references zip codes to the appropriate region.  Sample Report
ZCENSUS - Custom Eligibility Listing Custom census report giving basic eligibility information as well as active employee totals, life totals and coverage totals.  The coverage totals are based on user defined categories of coverage.  The program allows for sorting by Group, Location or by Plan.  Based on the sort option chosen, you will be provided with Group, Location and Plan totals.  You will be able to limit the report based on the sort option chosen.  Further selections include effective date, the listing of dependents, termination date and benefit type.
ZCFVR - Custom Claim Frequency - Volume Report This program produces two separate reports. The first report shows the number of claims processed, employees covered and a rolling average of claims per employee for a twelve month period.  These numbers are broken down by a user-defined category (e.g. Medical, Dental, etc.).  Categories are determined by Benefit Type. The second report calculates for each group and category combination the average number of claims per employee for the entire year.  The results are then sorted in descending order using the first category established.  The averages for the other categories are also reported.  Sample Report
ZCRO - Custom Check Reconciliation Output This program extracts issued check information into a standard format.  The program then runs a bank specific overlay that reformats this information into the format required by the bank.  Each bank format is named "zcronnnn", where "nnnn" is the unique format number. The output file is named zcronnnn.ccyymmdd.dat, when zcronnnn is the format name and ccyymmdd is the run date.
ZCROI - Custom Outstanding Check Inquiry This is an inquiry program showing outstanding and cleared check information.  The information can be accessed by entering a Bank Account/Check Number combination. The possibility of duplicate check numbers does exist.  The user will be notified if this situation occurs.
ZEBS - Custom Eligibility By State Report This program was designed to satisfy New York State's requirements for reporting the number of employees in the state.
ZECSDUP – Custom ECS Duplicate Charges Check Program Custom program to check claims submitted via "ECS" or "CBE" for duplicate charges.  The claims will be checked against themselves and against the claims already processed.
ZELCT - Custom Eligibility Count Report This program reports the total number of employees by group and location based on the Benefit Type(s) chosen.  Sample Report
ZEO - Custom Eligibility Output This program serves as the driver for all of the custom eligibility extract formats.  Eligibility data is extracted based on the parameters established in ZEOGM and reformatted into a standard eligibility output file. Eligibility can be determined based on Benefit Type(s) included in the member's benefit class or the member's plan and location. The vendor specific output file is named as follows: zeonnnnn.ccyymmdd.dat, where "zeonnnnn" is the format selected and "ccyymmdd" is the run date entered. Supports Extracts For:
Advance Paradigm	Health Management Systems	PHSI
American Health Holdings	HealthEOS	Pharmacy Advantage
ANSI 834	Healthlink	Plains Health Network
APB America Pharmacy	HealthStar	PPOM
ARAZ Drug	HIP	Pro-America Managed Care
BCBS of TX - Drug	HMC	ProVantage
BCBS of TX - STEP	Hoosier School & Trust	Proxy System
Beech Street	Horizon	Reid Hospital
Caremark	HRM	Restat
Catalyst Rx	Lab One	RxAmerica
Cecil Walker	Lutheran	South GA Health Partners
Claims Pro	Maytag	Systemed
Consolidated Prescription	MDNY-LIA	Timeshare
Consultec	Mede America	United Provider Services
Corum	Medical Mutual of Ohio	Value Rx
DBP	MedPlans Standard	Value Behavioral Health
DCA	Merck Medco	Vision Service Plan
Delta Dental	Midlands Choice	Walgreens
Eckerd Health Services	Midwest Select	WalMart WMS
Emerald Health	MIM Health Plans	Washington Dental
Employer Health Options	MPB/Scriptline	WHP
Encompass	NPA
Express Scripts	Partners Rx
FFI Health Services	PCS
GBAS	Pharmacy Data Management
GHI	Pharmacy Select - Restat
Group Link Dental	Pharma-Link
ZEOGM - Custom Eligibility Output Group Maintenance This program is used by the eligibility extract program "zeo".  The parameters for each eligibility format are entered here and format(s) are tied to the appropriate group(s).  Cross-referencing of group, plan and locations numbers from the RIMS value to the vendor-specific value are also established here.
ZFARS – Fund Account Report Summary This program summarizes fund account information sorted by fund, group and location.  Sample Report
ZFGR - Custom Group Census Report This program is a census report by group for a specific date range.  It provides counts by benefit type for individual months for the entire date range.  It also provides a benefit type recap.       Sample Report
ZGL – Custom Group Listing This program prints a report showing Reporting Corporation, Group Number, Group Name, Federal ID and Termination Date as established in Group Maintenance (GM) with options to include:    Locations tied to the selected groups in Group Location Maintenance (GLM)    Plans tied to the selected groups/group locations in either GM or Group Plan Cross Reference (GPX)    Benefit Classes and their associated Benefit Types tied to the selected groups in Group Benefit Maintenance (GBM).
ZGPCDEL – Custom GPC Delete Custom program to delete entries in the file created and maintained by the program Plan Procedure Cross Reference (GPC).
ZHML - Custom Calculation History Listing This program prints Period-to-date and Prior year last quarter amounts from HCM (Individual History Maintenance).  The information is printed in group number, social security number and dependent code order.  Sample Report
ZIEAR - Custom Internal - External Audit Report Audit report for internal or external use.  Extracts random claims based on selection criteria.  This program can be used to generate a report, a file or both.  Sample Report
ZIEARM – Custom Internal - External Audit Report Maintenance This is a maintenance program for ZIEAR.
ZISA - Custom Specific Reimbursement Report This program is designed to be used for stop-loss reinsurance filings.  All claim dollars regardless of claim status (paid, held or waiting check select) are included in the totals.  Sample Report
ZKILL - Process Termination Script This script will kill all processes of a user who is running QicLink, except for those users running IQ.  It was designed to be used in a cron, so it does not have any screen output, but it does create log files.
ZPCA - Custom Paid Claims Analysis This program outputs paid claim totals into a comma delimited file.  The output can be formatted one of two different ways:  The Clarendon format and the RPC format.
ZPCAM – Custom Paid Claim Analysis Maintenance This maintenance program allows the user to define what benefit suffixes are to be considered for "In Network" and "Out of Network".
ZPCAR – Custom Paid Claims Analysis Report This program is designed to produce a custom paid claim report.  Group, enrollee social security number or name and dependent are the sort options for this report program.
ZPCBCPY – Custom PCB Copy This program will copy data from one plan number to another for a specified PPO contract.
ZPCDI - Provider Contract Data Inquiry This program is designed to provide information about a provider's participation in PPO contract(s) and specific information about those contracts.  Specifically, rates from PFS, exclusions from PCR, notes from PNF and additional notes maintained by the program ZPCDIM. This program is to be used with the maintenance program "ZPCDIM".
ZPCDIM - Provider Contract Data Maintenance This program is used in conjunction with "ZPCDI".  It allows the user to establish user defined descriptions for procedure codes, stop loss codes and additional provider notes.
ZPCLR - Custom Provider Claim Report This program reports paid claim detail by provider.
ZPCT - PPO Claim Transfer This program was designed to reformat paid claim information from the system into the RIMS standard ECSIF format or the 837-Professional format.
ZPDC - Provider Duplicate Check This program evaluates the provider master file, searching for duplicate entries.  The parameters used to determine duplicates are established in the program ZPLCTLM.
ZPDM – Provider Duplicate Maintenance This program allows the user to delete entries in the cross-reference file created by the program ZPDC.
ZPDU - Provider Duplicate Update This program takes the information in the cross-reference file created by the program ZPDS and terminates the duplicate providers.  The termination date, reason and comment code (optional) entered on the terminated provider's record are user defined.
ZPDUD - Custom Duplicate Provider Delete This is a custom program used to delete duplicate providers.
ZPLCTLM – Custom Provider Load Control Maintenance This program controls the matching logic and rules for all programs that involve provider loads, provider duplicate checking and matching. The user establishes system wide (global) and vendor specific (format) rules.  The format rules apply to provider loads.
ZPPCA – Custom PPO Charge Analysis This program produces a comma delimited file to use in the analysis of PPO performance.
ZPPCAM - Custom PPO Procedure Charge Analysis Maintenance This program allows the user to establish reporting parameters used by the program zppca.  Procedure codes are tied to categories, and benefit suffixes are classified as Network, Out of Network or Out of Area for paid claims reporting.
ZPRVDEL - Custom Provider Delete This is a custom program used to delete providers.  In order to be deleted, a provider must have no activity either on a specific directory (if there are separate provider files) or on a system-wide basis (if the provider files are common).  Based on entries in the custom program "zdirmnt". This program allows the user to select an individual provider or a range of providers to be deleted.  The program will check all directories listed in "zpdirmnt" for any activity for each provider.  If a provider has any activity it will not be deleted.
ZPSR - Custom PPO Savings Report This program generates a PPO Savings report.  PPO Discounts and Duplicate Charges are determined by the line item remark code.  Classification of remark codes is done in "zpsrm".  Any remark code not classified will fall into "Miscellaneous Ineligible".   The report can be sorted either by Benefit Code / Group or Provider TIN / Group. Sample Report A       Sample Report B
ZPSRM - Custom PPO Savings Report Maintenance This program is used in conjunction with "zpsr". In this program, remark codes can be designated by group or globally as indicating a PPO discount or duplicate charge.
ZRBR - Custom Benefit Reduction Report Custom report showing benefit reductions.  Benefit reduction amount is based on the ineligible amount from the line item.  The report displays enrollee, patient and claim information including Total Charge, Ineligible Amount, Allowable Amount and Total Paid. The report will be sorted by Remark Code, Benefit Type, Group, Location and Employee Name. Voids will be included in the month that it was voided. ZRBR will not balance to the standard RBR, because the standard RBR rounds and ZRBR does not.  Sample Report
ZRMC – Custom Financial Transaction Register This program duplicates the functionality of the standard "RMC" with the additional feature of reporting and totaling by group and location.
ZSPOOL – Custom Spooler Manager This program allows the user to manage reports that have been sent to the spooler.  This program allows you to view the reports in 132 column mode.  It also has the added feature to allow the user to page forward or backward while viewing the report.  You can list all reports, just your reports or reports by printer.  You can further limit the list by program type.  The program also allows you to delete ranges of reports from the spooler.
ZSRR – Custom Specific Reimbursement Report This program is designed to satisfy reporting and data file requirements issued by Safeco for specific reimbursement and advance funding requests.
ZSWEI - System Wide Eligibility Inquiry This program provides the user with system-wide / multiple production directory eligibility inquiry.
ZSWEIDM - System Wide Eligibility Inquiry Directory Maintenance This program allows the user to maintain the list of directories that the programs zswei and zsweim will access when they execute.  This program must be executed prior to the use of zswei and zsweim.  Up to ten different directories may be entered.
ZSWEIM - System Wide Eligibility Inquiry Maintenance This program allows the user to maintain the group specific information that is displayed in the program zswei.
ZTAT - Custom Turnaround Time Report This is a custom program used to report the turnaround time of claims based on processed or paid dates versus incurred or received dates. Along with date selection, the user can select claims based on group, benefit type and hold type. The user has the option to produce a 30 day report, a 365 day report or both.  The user also has the option to report benefit types as combined or separate.   The user can also choose to include or exclude weekends and holidays when calculating the turnaround.  Sample Report
ZTATM - Custom Turnaround Time Maintenance This is a custom program used to enter days (holidays) that are not to be used in calculating the turnaround time in the custom program ZTAT. This program allows the user to input valid dates in MMDDCCYY format, delete a previously entered date or list all of the dates that have been previously entered.
ZTMCE - Trustmark Claim Extract Program This program extracts claim data and reformats it to the specifications provided by Trustmark.
ZTMCEM - Benefit Code Cross Reference Program - Maintenance Program for ZTMCE This program allows the user to cross reference RIMS benefit codes to a 3 character coverage code that will match a coverage code defined by Trustmark.
ZXEM – Custom Eligibility Maintenance This program is designed to ease eligibility data entry by using default entries (established in "zxemc") for the majority of the fields.  This enables the operator to enter only limited information to establish a complete entry. Upon entry of a group number, the default entries made in "zxemc" will be displayed.  The user then enters the employee data into the remaining fields. All default values can be modified. This program emulates the standard eligibility maintenance program.
ZXEMC – Custom Eligibility Maintenance Control This program is used to establish the default eligibility fields used by the program "zxem". This program emulates the standard eligibility maintenance program.