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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!

Q3 Business Technology

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.

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.
Name		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

A003 - Held Check Listing

A004 - Uncleared Transactions Listing

A007 - Daily Balance Report

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.

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

Show Header Record

Plan ID		This field is required!
Location		This field is optional. If omitted, all locations will be included.
Place of Service		This field is optional. If omitted, all POS will be included. Use standard 2 digit code (e.g. Office=11)
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

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
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!

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

Show totals by location.

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!

C991 - Labs Special. Lists all labs for PV and non-PV. Charges and paid amounts only.

Return the report as an attachment

Show PV Only. No=non-PV.

Show Header Record

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!

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

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

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

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

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

E014 - Banded Age Report.

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.

F001 - Flex Summary (by Month).

F002 - Flex Summary (by Participant).

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!

P015 - Monthly 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.
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!