Pacific Life, which is based in Newport Beach, Calif., likes the software because it removes some of the complications from the difficult processes in the life insurance market. If you are trying to take a distribution from a qualified plan, there are a lot of different calculations involved, whether it is a minimum distribution or you are taking the maximum, Peterson says. There are a lot of calculations involved that [with the software] they don't have to do by hand."

Pricing for Qualified Plan Distribution Analysis is based on an annual subscription basis.

Product: CLEAR (Clear Logic Edit and Rules)
Company: CGI Group, Inc.
Web site: www.cgi.com

CGI, an information technology services firm based in Montreal, has teamed up with one of its insurance partners, the Regence Group, to develop CLEAR (Clear Logic Edit and Rules), a claims validation system with an open-knowledge base that shares claims edit rules with providers to help them manage claims submissions more effectively.

Regence is an affiliation of four Blue Cross and/or Blue Shield companies in the Northwest and mountain states. It serves more than three million members in Washington, Oregon, Idaho, and Utah and generates $5 billion in revenue with 23,000 provider relationships.

Regence and CGI have had a working relationship for over five years, according to Robert Haskey, M.D., a medical director for Regence. Two years ago, both sides met to discuss claims processing and code adjudication. A small team of professionals was put together to start working on what has evolved into the CLEAR product, says Haskey. It was designed specifically to put forth the rule set we feel is applicable to coding in this country at this time.

Haskey felt there was a business perspective to this, he says, and Regence wanted to partner with CGI through a licensing agreement. The system was not designed to be proprietary for Regence. We felt perhaps there would be others who might be interested in a similar concept, he says.

Rob Rolf, a principal at CGI, says from his companys perspective there already was a great working relationship with Regence, and CGI had more than a decade of experience in claims auditing and developing claims edits. The [CLEAR] system really matches our belief, says Rolf. Lets have an open set of rules for everyone to see, and lets enforce those rules.

Rolf says individual companies still have the opportunity to use specific rules that apply to an individual plan, even if they differ from national standards. Insurers have the opportunity to implement those, but our approach has always been that [the rules] are out there in either the provider-reimbursement policy guidelines or in their contract.

Regence and CGI did not create new rules for coding, Haskey notes. They were already out there, he says. We reviewed all the documents and worked them into a format that would be applicable to a claims processing system.

Portions of the CLEAR system are intellectual property, Rolf says, but the overall product is part of our joint desire to see this become more of a standards marketplace approach. It can be used by any payer on any platform. Using proprietary edits creates an administrative burden for both the provider and the payer. The provider doesnt know what rules are being held to, and the payer has to deal with numerous provider inquiries on those rules, Rolf explains.

Haskey believes if everyone knows a rules set, regardless of what the application is, both parties will be able to navigate the system in a more efficient manner: If we in health care can help reduce the paper chase, it will save the entire [health care] system a tremendous amount of money and also make it easier to navigate the system.

CLEAR has been rolled out in Idaho, Haskey says, and the other three plans will get the system in 2003. Its working well, he claims. Whenever you enter into a new venture you never know. He says only minimal issues have cropped up and adds the business side of Regence has been satisfied with what has been accomplished.

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Product: MIB Web Services
Company: MIB Group, Inc.
Web site: www.mib.com

Web services designed to extend in-house IT solutions to clients by providing software functionality via the Web are now available from the MIB Group, the Westwood, Mass., facilitator of electronic insurance commerce via dedicated networks and Internet-based systems. Included in the Web services are MIBs Security Alert Entity Look-up Utility and Security Alert ID Look-up Utility, both part of MIBs Security Alert Services, a compliance solution for the USA Patriot Act and Canadas OSFI regulations.

The MIB Web services use a representational state transfer (REST) architectural style that utilizes standard Internet technologies such as XML, URI, and HTTP to improve integration with a customers existing business systems.

Product: Genelco Reinsurance+
Company: Genelco Software Solutions
Web site: www.genelco.com

Genelco Software Solutions, St. Louis, a division of Liberty Insurance Services Corp., recently released version 3.0 of its Genelco Reinsurance+. Genelco vice president of client reinsurance services Craig Carothers says features of the new version include risk pooling, unlimited joint policies, and the ability to schedule interface files with the system as frequently as every minute, which simulates real-time interface to connected applications.

The product automates the processing of ceded life insurance, he says. Using a client/server application, the system supports full life-cycle administration of reinsured benefits from new business to termination. The system, Carothers says, can receive data from any life administration system, automatically analyze it for the requirements of reinsurance, and process reinsurance transactions.

Product: Acquire
Company: Superior Access Internet Software, Inc.
Web site: www.sais.com

A new e-business solution designed to enable property/casualty insurance carriers to acquire new business has been introduced by Superior Access Internet Software (SAIS). Called Acquire, the solution brings SAIS components into a seamless processing solution that serves carriers and producers. Acquire automates rate quoting and underwriting while integrating with the carriers legacy rating engines and issuance systems to achieve end-to-end processing of P&C policies. Mike Mayo, president of the Irvine, Calif.-based SAIS, says Acquire will create new revenue capabilities, reduce production costs, and enhance organizational efficiencies.

Product: Bladeworks
Company: Infoglide Software Corp.
Web site: www.infoglidesoftware.com

Another tool in the battle against fraud has been introduced by Infoglide Software of Austin, Tex., a provider of enterprise solutions for classifying, analyzing, and investigating data stored in multiple, disparate, remote databases. Called Bladeworks, the product is a fully integrated design process solution for real-time risk assessment, decision automation, and relationship discovery. The systems remote search capability creates a virtual data warehouse for its different databases. Privacy issues are addressed as well, says Michael Schultz, president and CEO of Infoglide. Bladeworks can return risk assessment scores without returning the associated data. Todays environment of protecting information privacy while assessing risk demands a solution like Bladeworks, says Schultz.

Product: Agora Interchange
Company: AgoraINS
Web site: www.agorains.com

AgoraINS has released Agora Inter-change, a reinsurance administration clearinghouse service for direct writers and reinsurers. Carol Sullivan, vice president operations of the Chicago-based solutions firm, says, Agora Interchange provides an express route to fast and easy communication between business partners. Agora Interchange accepts reinsurance administration transaction information from direct writers in any record typetape, CD, or paperand converts it into each reinsurers preferred record format. Custom formats or ACORD XML formats can be used. Reinsurers no longer have to keep up with the format requirements of their transaction partners to send compatible information, says Paul Buckley, vice president of technology for AgoraINS.