This summary analyzes TriEpic Lab Group's billing system. The company receives billing data from external clients that employees manually verify and input into the billing system. The system assigns billing codes and automatically sends claims to insurance companies for payment once all information is entered. Insurance companies process claims electronically and send payments or denials. A payment posting team handles approved claims while another team manually processes denials. The document recommends improvements to the billing system process.

1. Group #5
Chermaine Slocum
Tam Mai Thanh Cao
Yang Yang Wong
Colby Nicholson
Erica Petty
TriEpic Lab Group
300 N. Meridian Ave.
Oklahoma City, OK 73012

2. 4C. Executive Summary
An analysis of TriEpiq Lab Group’s billing system
This document is a summary of Group 5’s investigation into the bulling
system for TriEpic Lab Group. The company receives billing data from external
clients that it verifies and inputs into the billing system manually. Billing codes are
assigned to each case by the billing system based on a database of codes that the
system holds. The billing system automatically send cases to external insurance
companies for payment one all of the required information is entered into the billing
system.
Insurance companies process the claims electronically and either send a
payment that is appropriate with the corresponding codes or sends a denial and a
reason for the denial. The payment posting team posts payments from the insurance
company and another team processes denials manually.
Although we find this to be a fairly efficient process, our team was able to
make a number of recommendations that we found to be helpful for this
organization. We discuss these recommendations in depth throughout our analysis.

3. 1B. Company Agreement Form
TriEpiq Lab Group, LLC agrees to grant Chermaine Slocum, Colby Nicholson, Yang
Yang Wong, Erica Petty, and Tam Cao (students) and the University of Central
Oklahoma the right to examine all or parts of its information system. The students
agree to restrict use if the information so gathered to the classroom and to make no
commercial or other use of said information.
Title of Company Agent ________________________________
Signature of Company Agent _____________________________
Date _______________________________
Signature of Students
Chermaine Slocum _____________________________
Yang Yang Wong _______________________________
Colby Nicholson ________________________________
Erica Petty _______________________________________
Tam Cao __________________________________________

4. 1B. Group Agreement Form
The following students agree to accept responsibility for completing and turning in
project drafts:
Part First and last name Phone Email
1 Chermaine Slocum 405-802-6975 Chermaineslocum@gmail.com
2 Chermaine Slocum 405-802-6975 Chermaineslocum@gmail.com
Tam Cao 405-404-4646 Tcao4@uco.edu
Yang Yang 405-888-1831 ywong5@uco.edu
3 Tam Cao 405-404-4646 Tcao4@uco.edu
Chermaine Slocum 405-802-6975 Chermaineslocum@gmail.com
4 Yang Yang 405-888-1831 ywong5@uco.edu
Erica Petty 405-401-4774 epetty1@uco.edu

5. 1C. Company Description
TriEpic Lab Group is a national company that is headquartered in Oklahoma City.
The company is an outsourced laboratory for hospitals across the country. TriEpic
primarily processes urine samples for toxicology screenings. They provide
additional oral swab testing as well as blood testing. The company has roughly 200
local employees and is expanding across the country via joint venture partnerships
with hospitals and new laboratories opening in rural areas with smaller hospitals.
The objective of this company is to provide fast, accurate results to hospitals and
patients for affordable prices.

6. 1D. Objectives of the Subsystem
Our team’s objective was to analyze the billing system that the company uses
to bill claims and receive payment for its testing of samples. The billing system is
integral to the company’s success because if there is a hold up in the billing system
then cash flow and payments to suppliers will be held up and the company could
have difficulty meeting its financial obligations. It is important for the billing system
to not only function at a high level, but to have to proper controls in place as well to
help prevent fraudulent activity from occurring internally.

7. 1E. Operating Environment
The billing system uses a combination of batch and immediate posting. The
billing team enters the company’s samples for the day into the system and verifies
the batch total entered with the total sent from the corresponding hospitals. When
they do this, if the totals match, they finalize what has been entered and the system
automatically bills the insurance companies based on what the billing team has
entered.
Each billing associate has a desktop computer with Windows 7 installed.
Each computer also has the proprietary billing system installed as well. The
company is all on a network that allows employees to communicate and share their
different files in order to be more efficient.

8. 2A. Billing System Narrative
The external hospital clients submit the number of samples sent and an
accountant prompts the computer to display the internally calculated figure from
the database. The accountant verifies that the number matches the internally
calculated figure. If the internal and external numbers match, the accountant
submits the file into the computer. The computer captures the file in the database.
The database displays the claims by billing code and assigns a billing amount
based on the billing codes that are industry wide and recognized in all medical claim
environments. The database automatically submits claims to insurance companies
based on the day of the week. Certain regions bill on certain days of the week to
ensure that bills do not overload the system.
Insurance companies electronically send claim approvals; the computer
captures this data in the database. The claims that come back with a payment code
are sent into a posting queue and the billing system transmits them to the posting
team supervisor. The supervisor has a team whose sole responsibility it is to post
payments. The posting team enters claims in the computer. The computer captures
the claims received in the database. The posting team alerts the accounting team
when posting is complete.

9. 2B. Chronologically Sorted Table of entities and activities
Entity Paragraph Activity
clients 1 1. submit the number of samples sent
an accountant 1 2. verifies that the number matches the
internally calculated figure
computer 1 3. does not match number
the accountant 1 4. does an analysis of which cases are
missing
computer 1 5. matches the internal and external numbers
the accountant 1 6. submits the file into the billing system
computer 2 7. parses out the claims
computer 2 8. assigns a billing amount based on the
billing codes assigned
computer 2 9. submits claims based on the day of the
week
computer 3 10. has a denial code
computer 3 11. sends into a queue that is marked for
review
computer 3 12. parses out by the system to determine
denial
reason
computer 3 13. comes back with a payment code sent
into a posting queue
computer 3 14. transmits them to the posting team
supervisor
supervisor 3 15. posts payments received all month
supervisor 3 16. alerts the accounting team
accounting team 3 17. uses this information to post revenue
entries
accounting team 3 18. begins working on the monthly financial
statements

10. 2C. Context Diagrams

11. 2E. Level 0 Data Flow Diagram

12. 2F. Systems Flowchart

13. 3A. System Security Controls
The control activities of a system are a set of rules and guidelines that are
used in order to protect the system and the company from errors and omissions that
may damage processes or cause things to be incorrect. TriEpic Lab Group has a
number of guidelines and system settings that are designed to limit a users access to
certain functions, and try to ensure that information is entered correctly.
Additionally, dealing with public health information requires a higher level of
securitization as certain laws require the protection of health information.
The first major control measure that TriEpic uses is unique usernames for
every employee with access to the billing system. This username is assigned and
monitored by the IT department. It tracks the user’s movements all the way through
the billing system and can identify any command that a user enters into the system.
This not only helps the IT department to track what a user is doing in the system, it
allows the user to retrace his or her footsteps to help remember whether he or she
has performed a certain task or not. If you want to track who placed an account on
hold or who manually billed an insurance that was not on the patient’s account, you
can see all of these things by tracking a username.
Another major control that the system has in place is that it limits user access
to certain areas of the system. There are levels of security that are in place based on
the user’s position and the level of access. This is beneficial for a number of reasons.
It ensures that there is a separation of duties and that not everyone is given access
to all parts of the system. Access is limited to the job that a particular employee
does. Payment posters don’t have the ability to bill claims and vice versa. This

14. segregation of duties ensures that people do not cross boundaries that they are not
supposed to.

15. 3B. Control Matrix
Control Objective
Risk (what could go
wrong)
Risk Level
(High,
Medium, Low) Control Plan Description
Preventive, Detective,
Corrective, Manual,
Automated
Bill all claims
within 3 days of
receipt
Claims aren't billed on
time and go
unreimbursed Medium
Make billing as automatic
as possible Automated, Preventive
Ensure billing
data is accurate
Claims are billed to
incorrect payors Medium
Double check pertinent
information on claims Automated, Preventive
Ensure insurance
information is
correct
Claims will be denied
and cause a slow in
cashflow Low
Insurance manually
applied when entering
claim information Manual, Preventive
Fix claim denials
immediately
Continue to bill denied
claims without fixing
errors High
Accumulate all denied
claims in a report daily Automated, Corrective

16. 3C. Description of Control Matrix Plans
Control Plan #1 – Bill all claims within three days of receipt
Billing claims is the primary source of revenue for TriEpiq Lab Group. It is of
the utmost importance that claims are billed in a timely fashion. There are certain
requirements that federal payors have put in place, which require any claim
submission to be filed within a certain amount of days from the date a physician saw
a patient. These timely filing deadlines are non negotiable and can cause serious
cash flow issues if ignored. This is why billing clients as promptly as possible is
imperative. As soon as all pertinent information is entered into the billing system,
the claim is ready to be released.
Control Plan #2 – Ensure billing data is accurate
Ensuring that the billing data is accurate is very important to the billing
process. Once billing data is entered into the system the claim is billed. If any of the
data that is on a claim form is incorrect, the insurance company will likely deny the
claim. Once a claim is denied, it could take several weeks for the company to be
notified and this slows down cash flow. Additionally, once a denied claim is
appealed, it could take another several weeks payment to be remitted.
Control Plan #3 – Ensure insurance information is correct
Insurance information is a vital part of the claim and the billing process. If
billing data is not sent to the correct insurance company, it obviously does not get
paid. The claim gets rejected and the company is left trying to figure out which

17. insurance company should have been billed. This can be a long process and one that
takes time away for other activities for the people who work on it. This is another
issue that possibly slows down cash flow.
Control Plan #4 – Fix claim denials immediately
A common issue that the company works hard to combat is cash flow
stoppages or slow downs. There are a million things that can go wrong when billing
a medical claim and only one way to get it right. If too many things go wrong or one
thing is not fixed in a timely manner, it could be extremely detrimental to the
company. This is why so much time and effort is placed on fixing errors.

18. 3D. Control Analysis
After analyzing the controls on the billing system for TriEpic Lab Group, it
looks like the company has a number of controls in place and is implementing them
properly. These controls are primarily built in to separate duties and prevent
employees from making mistakes while simultaneously keeping the company’s cash
flow coming in. The number one risk that the company faces in this regard is that
there are a number of moving parts that must be coordinated in order to maintain
proper cash flow.
Although no company is perfect, it appears that all of the controls that
TriEpiq has in place are working properly.

19. 3E. Pending Changes
There are currently no pending changes.

20. 3F. Conclusions and Recommendations
After analyzing the billing system for TriEpic Lab Group, we believe that
there are a number of processes in place that are working for the company. With
that being said, our group did find a number of changes that we believe can be made
in order to improve some of the processes and tighten up some of the things that we
have found holes in. Some of the recommendations include:
▪ Scrub claims on the front end to prevent processing delays
▪ Develop “Expected Payment” report (shows amounts that should be expected
based on code on claim)
▪ Monitor reports daily (claim rejection, expected payments)
We believe that these are the areas that the company needs to focus on in
order to maintain its success and help to improve the company’s overall operations.
The responses that we have received from the company in regards to our
recommendations have been incredibly positive. We are glad that we have been able
to take an objective look at a company and been able to show them some of the
things that they may have been overlooking.