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Q3 Business Technology Corporation

Reports (other than the test report) may only be sent to email addresses approved by the Plan Sponsor!

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Reports

The automated Q3 report server allows the Plan Sponsor to designate certain individuals to submit and receive reports online. The reports are submitted on the Q3 website and returned to the individuals email address.

All reports are returned as a web page (hyptertext markup language). Most email clients have no problem displaying the report. You may receive the reports as an attachment to your email reply by checking the appropriate attachment box. Generally, receiving your report back as an attachment makes it easier to save to your hard disk.

Please do not submit a report request unless the Plan Sponsor has set up an account for you! The report server will only fulfill requests from authorized email addresses. The lone exception is the Test Report below. This report may be delivered to any email address.

If your plan has been set up with Q3 for online enrollment and/or onsite ID card generation, contact Q3 for help performing these functions!


Important Notice about Privacy - Please note that this information will be sent over the internet on an insecure connection. Privacy of this communication cannot be guaranteed.

T001 - Test Report. This is a test report to determine if you can view and print reports from the automated report server.

Return the report as an attachment

Your email address This field is required!


A001 - Check Register

Return the report as an attachment

Show Check Types

Show Location Info

Show Fixed Costs Breakdown

Plan ID This field is required!
Fund ID This field is optional.
Type This field is optional. You may enter more than 1 value.
2=2% COBRA Charge
5=50% COBRA Charge
A=Offsetting Adjustment
B=Billing/Fixed Costs
C=COBRA Payment
D=Employer Deposit
E=Enrollee Contribution
F=Fees by Bank
I=Interest Income
O=Over/Under by Bank
P=Payment/Returned Payment
T=Taxes WH/Payable
V=Check Void
X=Excess Loss Deposit
Start from Check Date This field is optional. Format dates as mm/dd/yy
Through Check Date This field is optional. Format dates as mm/dd/yy
Your email address This field is required!


A002 - Monthly Billing Summary

Return the report as an attachment

Include subtotals for each location

Plan ID This field is required!
Month Due This field is required! Format month as a number (e.g. Submit 3 for March)
Year Due This field is required! Format year as a 4-digit number (e.g. 2002)
Your email address This field is required!


A003 - Held Check Listing

Return the report as an attachment

Show Fixed Costs Breakdown

Plan ID This field is required!
Fund ID This field is optional.
Your email address This field is required!


A004 - Uncleared Transactions Listing

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Plan ID This field is required!
Fund ID This field is optional.
Include transactions through this date This field is optional. Format dates as mm/dd/yy
Your email address This field is required!


A007 - Daily Balance Report

Return the report as an attachment

Show Check Types

Show Location Info

Show Fixed Costs Breakdown

Show All Transactions

Plan ID This field is required!
Fund ID This field is optional.
Start from Check Date This field is optional. Format dates as mm/dd/yy
Through Check Date This field is optional. Format dates as mm/dd/yy
Your email address This field is required!


A010 - Positive Pay Register

Return the report as an attachment

Show Header Record

Show Payee Do not use quotation marks Use 2 digit years

Plan ID This field is required!
Fund ID This field is optional.
Type This field is optional. You may enter more than 1 value.
2=2% COBRA Charge
5=50% COBRA Charge
A=Offsetting Adjustment
B=Billing/Fixed Costs
C=COBRA Payment
D=Employer Deposit
E=Enrollee Contribution
F=Fees by Bank
I=Interest Income
O=Over/Under by Bank
P=Payment/Returned Payment
T=Taxes WH/Payable
V=Check Void
X=Excess Loss Deposit
Start from Check Date This field is optional. Format dates as mm/dd/yy
Through Check Date This field is optional. Format dates as mm/dd/yy
Your email address This field is required!


A011 - Monthly Billing Counts

Return the report as an attachment

Show Detail Lines/Not Totals (data download only)

Include subtotals for each location

Plan ID This field is required!
Month Due This field is required! Format month as a number (e.g. Submit 3 for March)
Year Due This field is required! Format year as a 4-digit number (e.g. 2002)
Sub Plans This field is optional. You may enter more than 1 value. Restrict the results to the following sub plans.
Your email address This field is required!


A012 - Cost of Coverage Report

Return the report as an attachment

Include subtotals for each location

Show SSNs

Show Detail for data download (not totals)

Plan ID This field is required!
Begin Month This field is required! (e.g. 1 for January)
Begin Year This field is required! (e.g. 2013)
End Month This field is required! (e.g. 12 for December)
End Year This field is required! (e.g. 2013)
Sub Plans This field is optional. You may enter more than 1 value. Restrict the results to the following sub plans.
Single Premium This field is required! (e.g. 401.16)
Employee + Spouse Premium This field is required! (e.g. 810.55)
Employee + One Child Premium This field is required! (e.g. 810.55)
Employee + Two or more Children Premium This field is required! (e.g. 810.55)
Employee + Spouse + Child(ren) Premium This field is required! (e.g. 1204.56)
Your email address This field is required!


A013 - Member Count Report

Return the report as an attachment

Include subtotals for each location

Show Detail

Plan ID This field is required!
Begin Month This field is required! (e.g. 1 for January)
Begin Year This field is required! (e.g. 2013)
End Month This field is required! (e.g. 12 for December)
End Year This field is required! (e.g. 2013)
Sub Plans This field is optional. You may enter more than 1 value. Restrict the results to the following sub plans.
Your email address This field is required!


C001 - Group Claims History. Prints a listing of all claims incurred by the group between the incurral dates specified. Use of the date fields are highly recommended as this report can be quite large.

Return the report as an attachment

Plan ID This field is required!
Location This field is optional. If omitted, all locations will be included.
Enrollee SSN This field is optional.
Participant Code This field is optional!. Enrollee=0, Spouse=1, Children=2-9
Provider Tax ID Number This field is optional. Enter a 9 digit Tax ID Number in this field to restrict results to one provider.
Incurred Begin Date This field is optional. Format dates as mm/dd/yy
Incurred End Date This field is optional. Format dates as mm/dd/yy
Paid Begin Date This field is optional. Format dates as mm/dd/yy
Paid End Date This field is optional. Format dates as mm/dd/yy
Your email address This field is required!


C002 - Group Accumulators. Prints a listing of all accumulators for the group.

Return the report as an attachment

Plan ID This field is required!
Your email address This field is required!


C003 - Group Claims Summary. Prints a listing of all claims incurred by the group between the incurral dates specified. Use of the date fields are highly recommended as this report can be quite large.

Return the report as an attachment

Show Diagnosis Info

Show CPT Codes

Plan ID This field is required!
Location This field is optional. If omitted, all locations will be included.
Enrollee SSN This field is optional.
Participant Code This field is optional!. Enrollee=0, Spouse=1, Children=2-9
Provider Tax ID Number This field is optional. Enter a 9 digit Tax ID Number in this field to restrict results to one provider.
Incurred Begin Date This field is optional. Format dates as mm/dd/yy
Incurred End Date This field is optional. Format dates as mm/dd/yy
Paid Begin Date This field is optional. Format dates as mm/dd/yy
Paid End Date This field is optional. Format dates as mm/dd/yy
Your email address This field is required!


C004 - Individual Claims Paid by Incurral Month. Shows claims paid by incurral month

Return the report as an attachment

Plan ID This field is required!
Location This field is optional. If omitted, all locations will be included.
Enrollee SSN This field is optional.
Participant Code This field is optional!. Enrollee=0, Spouse=1, Children=2-9
Incurred Begin Date This field is optional. Format dates as mm/dd/yy
Incurred End Date This field is optional. Format dates as mm/dd/yy
Paid Begin Date This field is optional. Format dates as mm/dd/yy
Paid End Date This field is optional. Format dates as mm/dd/yy
Your email address This field is required!


C005 - Individual Claims History. Lists all claims processed for this participant.

Return the report as an attachment

Plan ID This field is required!
Location This field is optional. If omitted, all locations will be included.
Enrollee SSN This field is optional.
Participant Code This field is optional!. Enrollee=0, Spouse=1, Children=2-9
Provider Tax ID Number This field is optional. Enter a 9 digit Tax ID Number in this field to restrict results to one provider.
Incurred Begin Date This field is optional. Format dates as mm/dd/yy
Incurred End Date This field is optional. Format dates as mm/dd/yy
Complete Begin Date This field is optional. Format dates as mm/dd/yy
Complete End Date This field is optional. Format dates as mm/dd/yy
Paid Begin Date This field is optional. Format dates as mm/dd/yy
Paid End Date This field is optional. Format dates as mm/dd/yy
Your email address This field is required!


C006 - Pended Claims Listing. Prints a listing of all pended claims for this participant

Return the report as an attachment

Plan ID This field is required!
Location This field is optional. If omitted, all locations will be included.
Enrollee SSN This field is optional.
Participant Code This field is optional!. Enrollee=0, Spouse=1, Children=2-9
Provider Tax ID Number This field is optional. Enter a 9 digit Tax ID Number in this field to restrict results to one provider.
Incurred Begin Date This field is optional. Format dates as mm/dd/yy
Incurred End Date This field is optional. Format dates as mm/dd/yy
Paid Begin Date This field is optional. Format dates as mm/dd/yy
Paid End Date This field is optional. Format dates as mm/dd/yy
Your email address This field is required!


C007 - Held Check Listing

Return the report as an attachment

Show Fixed Costs Breakdown

Plan ID This field is required!
Fund ID This field is optional.
Your email address This field is required!


C008 - Disability Benefits Summary. Summarizes Disability Benefits paid (including amounts withheld). If begin and end dates are specified, only checks issued in that range are shown.

Return the report as an attachment

Plan ID This field is required!
Location This field is optional. If omitted, all locations will be included.
Enrollee SSN This field is optional.
Participant Code This field is optional!. Enrollee=0, Spouse=1, Children=2-9
Incurred Begin Date This field is optional. Format dates as mm/dd/yy
Incurred End Date This field is optional. Format dates as mm/dd/yy
Paid Begin Date This field is optional. Format dates as mm/dd/yy
Paid End Date This field is optional. Format dates as mm/dd/yy
Your email address This field is required!


C010 - Claims Summary by Primary Diagnosis

Return the report as an attachment

Sort/Grouping Order

Plan ID This field is required!
Location This field is optional. If omitted, all locations will be included.
Enrollee SSN This field is optional.
Participant Code This field is optional!. Enrollee=0, Spouse=1, Children=2-9
Provider Tax ID Number This field is optional. Enter a 9 digit Tax ID Number in this field to restrict results to one provider.
Paid Begin Date This field is optional. Format dates as mm/dd/yy
Paid End Date This field is optional. Format dates as mm/dd/yy
Your email address This field is required!


C011 - Individual Claims Summary by Payment Type

Return the report as an attachment

Plan ID This field is required!
Location This field is optional. If omitted, all locations will be included.
Enrollee SSN This field is optional.
Participant Code This field is optional!. Enrollee=0, Spouse=1, Children=2-9
Incurred Begin Date This field is optional. Format dates as mm/dd/yy
Incurred End Date This field is optional. Format dates as mm/dd/yy
Paid Begin Date This field is optional. Format dates as mm/dd/yy
Paid End Date This field is optional. Format dates as mm/dd/yy
Your email address This field is required!


C013 - Check Register

Return the report as an attachment

Show Check Types

Show Fixed Costs Breakdown

Plan ID This field is required!
Fund ID This field is optional.
Type This field is optional. You may enter more than 1 value.
2=2% COBRA Charge
5=50% COBRA Charge
A=Offsetting Adjustment
B=Billing/Fixed Costs
C=COBRA Payment
D=Employer Deposit
E=Enrollee Contribution
F=Fees by Bank
I=Interest Income
O=Over/Under by Bank
P=Payment/Returned Payment
T=Taxes WH/Payable
V=Check Void
X=Excess Loss Deposit
Start from Check Date This field is optional. Format dates as mm/dd/yy
Through Check Date This field is optional. Format dates as mm/dd/yy
Your email address This field is required!


C014 - Individual Claims Summary (Detailed) by Payment Type

Return the report as an attachment

Plan ID This field is required!
Location This field is optional. If omitted, all locations will be included.
Enrollee SSN This field is optional.
Participant Code This field is optional!. Enrollee=0, Spouse=1, Children=2-9
Sub Plan This field is optional. If left blank, all Sub Plans will be included.
Incurred Begin Date This field is optional. Format dates as mm/dd/yy
Incurred End Date This field is optional. Format dates as mm/dd/yy
Paid Begin Date This field is optional. Format dates as mm/dd/yy
Paid End Date This field is optional. Format dates as mm/dd/yy
Your email address This field is required!


C015 - Payment Totals by Provider

Return the report as an attachment

Show Incurral Date Range

Show Provider Contact Info

Plan ID This field is required!
Location This field is optional. If omitted, all locations will be included.
Enrollee SSN This field is optional.
Participant Code This field is optional!. Enrollee=0, Spouse=1, Children=2-9
Provider Tax ID Number This field is optional. Enter a 9 digit Tax ID Number in this field to restrict results to one provider.
Incurred Begin Date This field is optional. Format dates as mm/dd/yy
Incurred End Date This field is optional. Format dates as mm/dd/yy
Paid Begin Date This field is optional. Format dates as mm/dd/yy
Paid End Date This field is optional. Format dates as mm/dd/yy
Your email address This field is required!


E001 - Group Eligibility Listing (specified date). Prints a listing of all eligible participants as of a specified date.

Return the report as an attachment
Show zip code information

Plan ID This field is required!
As of Date This field is required! Format dates as mm/dd/yy
Your email address This field is required!


E002 - Group Eligibility Listing. Prints a listing of all participants with their effective and termination dates.

Return the report as an attachment

Show Birthday

Plan ID This field is required!
Your email address This field is required!


E005 - 64+ Report. Prints a listing of active participants approximately age 64 and over.

Return the report as an attachment

Plan ID This field is required!
Sub Plans This field is optional. You may enter more than 1 value. Restrict the results to the following sub plans.
Your email address This field is required!


E007 - Group Eligibility Listing. Prints a listing of all participants with their effective and termination dates.

Return the report as an attachment

Show Birthday

Plan ID This field is required!
As of Date This field is required! Format dates as mm/dd/yy
Your email address This field is required!


E011 - Group Eligibility Listing. Prints a listing of all currently active participants with A ID and date of birth.

Return the report as an attachment

Plan ID This field is required!
Sub Plans This field is optional. You may enter more than 1 value. Restrict the results to the following sub plans.
Your email address This field is required!


E015 - PCORI/Transitional Reinsurance Fee Count Variations Report

Return the report as an attachment

Include subtotals for each location

Show Detail

Plan ID This field is required!
Begin Month This field is required! (e.g. 1 for January)
Begin Year This field is required! (e.g. 2014)
End Month This field is required! (e.g. 12 for December)
End Year This field is required! (e.g. 2014)
Sub Plans This field is optional. You may enter more than 1 value. Restrict the results to the following sub plans.
Your email address This field is required!



E021 - ACA Check Listing. Prints a listing of all participants.

Return the report as an attachment

Show Birthday information

Show SSN

Plan ID This field is required!
Plan Sub IDs This field is optional
Year to run report for This field is required! E.g. 2015
Participant Codes This field is optional. Enter 0 to get just employees
Your email address This field is required!

F001 - Flex Summary (by Month).

Return the report as an attachment

Plan ID This field is required!
Begin Date This field is optional. Format dates as mm/dd/yy. Please note that the Plan Year is usually done on a calendar year basis.
End Date This field is optional. Format dates as mm/dd/yy
Your email address This field is required!


F002 - Flex Summary (by Participant).

Return the report as an attachment

Plan ID This field is required!
Begin Date This field is optional. Format dates as mm/dd/yy. Please note that the Plan Year is usually done on a calendar year basis.
End Date This field is optional. Format dates as mm/dd/yy
Your email address This field is required!


P001 - Type of Service Report. Claims Experience by Type of Service performed.

Return the report as an attachment

Plan ID This field is required!
Location This field is optional. Leave blank to include all locations.
Provider Tax ID Number This field is optional. Enter a 9 digit Tax ID Number in this field to restrict results to one provider.
Include claims incurred on or after this date This field is optional. Format dates as mm/dd/yy
Include claims incurred on or before this date This field is optional. Format dates as mm/dd/yy
Include claims paid on or after this date This field is optional. Format dates as mm/dd/yy
Include claims paid on or before this date This field is optional. Format dates as mm/dd/yy
Your email address This field is required!


P002 - Place of Service Report. Claims Experience by Place of Service.

Return the report as an attachment

Plan ID This field is required!
Location This field is optional. Leave blank to include all locations.
Provider Tax ID Number This field is optional. Enter a 9 digit Tax ID Number in this field to restrict results to one provider.
Include claims incurred on or after this date This field is optional. Format dates as mm/dd/yy
Include claims incurred on or before this date This field is optional. Format dates as mm/dd/yy
Include claims paid on or after this date This field is optional. Format dates as mm/dd/yy
Include claims paid on or before this date This field is optional. Format dates as mm/dd/yy
Your email address This field is required!


P003 - Disposition Report. Report showing disposition of charges between deductible, out of pocket, managed care discounts, not covered items, and payment types.

Return the report as an attachment

Plan ID This field is required!
Location This field is optional. Leave blank to include all locations.
Provider Tax ID Number This field is optional. Enter a 9 digit Tax ID Number in this field to restrict results to one provider.
Include claims incurred on or after this date This field is optional. Format dates as mm/dd/yy
Include claims incurred on or before this date This field is optional. Format dates as mm/dd/yy
Include claims paid on or after this date This field is optional. Format dates as mm/dd/yy
Include claims paid on or before this date This field is optional. Format dates as mm/dd/yy
Your email address This field is required!


P007 - Payment Totals by Provider.

Return the report as an attachment

Plan ID This field is required!
Location This field is optional. Leave blank to include all locations.
Provider Tax ID Number This field is optional. Enter a 9 digit Tax ID Number in this field to restrict results to one provider.
Include claims incurred on or after this date This field is optional. Format dates as mm/dd/yy
Include claims incurred on or before this date This field is optional. Format dates as mm/dd/yy
Include claims paid on or after this date This field is optional. Format dates as mm/dd/yy
Include claims paid on or before this date This field is optional. Format dates as mm/dd/yy
Your email address This field is required!


P008 - Network Status Report. Claims Experience by Network Status.

Return the report as an attachment

Plan ID This field is required!
Location This field is optional. Leave blank to include all locations.
Provider Tax ID Number This field is optional. Enter a 9 digit Tax ID Number in this field to restrict results to one provider.
Include claims incurred on or after this date This field is optional. Format dates as mm/dd/yy
Include claims incurred on or before this date This field is optional. Format dates as mm/dd/yy
Include claims paid on or after this date This field is optional. Format dates as mm/dd/yy
Include claims paid on or before this date This field is optional. Format dates as mm/dd/yy
Your email address This field is required!


P009 - Payment Totals by Zip Prefix.

Return the report as an attachment

Plan ID This field is required!
Location This field is optional. Leave blank to include all locations.
Provider Tax ID Number This field is optional. Enter a 9 digit Tax ID Number in this field to restrict results to one provider.
Include claims incurred on or after this date This field is optional. Format dates as mm/dd/yy
Include claims incurred on or before this date This field is optional. Format dates as mm/dd/yy
Include claims paid on or after this date This field is optional. Format dates as mm/dd/yy
Include claims paid on or before this date This field is optional. Format dates as mm/dd/yy
Your email address This field is required!


P010 - ReAdjudication Report

Return the report as an attachment

Plan ID This field is required!
Location This field is optional. Leave blank to include all locations.
Enrollee SSN This field is optional!
Participant Code This field is optional!. Enrollee=0, Spouse=1, Children=2-9
Include claims incurred on or after this date This field is optional. Format dates as mm/dd/yy
Include claims incurred on or before this date This field is optional. Format dates as mm/dd/yy
Include claims paid on or after this date This field is optional. Format dates as mm/dd/yy
Include claims paid on or before this date This field is optional. Format dates as mm/dd/yy
  Current New
Current/New CYD
Current/New PPO Benefit Percentage (e.g. .80)
Current/New PPO Individual OOP Max
Current/New OV Copay
Report/option name (e.g. Plan 2) This field is optional.
Your email address This field is required!


S999 - Sav-Rx Eligibility File.

Return the report as an attachment

Your email address This field is required!


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