##### 



Exhibit 10.16
 SOW PHASE I & II
    
    Implementation Agreement
QCSI and Triple-S
 Work Order No.: 
Customer Name:
 LEAP 3 WORK ORDER
 Article 1(Professional Services)
   I.
    
    DefinitionsQCSI and Customer agree that the following terms shall have their respective meanings:Associate Product Consultant(s)shall mean consultants that are enrolled in the QCSI knowledge
transfer program that have yet to achieve bachelor certification.Certified Product Consultant(s)shall mean consultants that have achieved bachelor certification
via the QCSI knowledge transfer program for the Software (defined below).Client Specific Solutions Blueprint (CSSB)is the process by which any client-specific solution
involving the creation of adhoc sql code, stored procedure, or any other mechanism that inserts,
updates, deletes, or otherwise modifies data within any QNXT defined data schema would be
approved, evaluated and/or developed. For greater certainty, to the extent that QCSI develops
any adhoc sql code, stored procedure, or any other mechanism that inserts, updates, deletes, or
otherwise modifies data within any QNXT defined data schema such development will be considered
a Deliverable, and therefore subject to Article 13of the Agreement.Discovery Documentsinclude but are not limited to an Outcome Solution Questionnaire (defined
below), along with relevant and material items to be provided by the Customer and used to
ascertain Customers business requirements.Discover Project Agreementor DPAis a prior agreement between the parties dated November 17,
2006, regarding certain completed phases of LEAP3.Introductory Meetingmeans a meeting whereby QCSI and Customer both participate and define the
guidelines for LEAP3, resolve questions and/or concerns relating to completing the
Solutions Discovery Questionnaire or collecting the required Discovery Documents.
 3
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##### 



SOW PHASE I & II
    
    Implementation Agreement
QCSI and Triple-S
 Job Schedulemeans the production schedule of computing tasks and jobs that must be executed by
Customer on a daily, weekly, monthly, or other frequency to, as examples, load claims, address
member eligibility, complete claim adjudication, and calculate provider capitation.Lead Technical Consultant(s)shall mean seasoned information technology consultants that have:
(a) one or more QNXT (defined below) certifications on the current QNXT Release (or one Release
back); (b) minimally two (2) years of QNXT Professional Services working experience; and (c) the
ability, as determined by QCSI, to lead the technical aspects of a QNXT implementationOutcome Documentmeans the document developed by the parties, and approved in writing by both
QCSI and Customer, which outlines and specifies the measurements for the desired results of this
Work Order.Outcome Solution Questionnairemeans the document used by the parties to capture Customers
necessary input concerning Customers high level business requirements, and utilized to initiate
the Discover phase of LEAP3 which is more fully described herein.Production Cut-Over Schedulemeans production computing jobs defined by Customer , with
assistance from QCSI, during LEAP3that have to process prior to migrating from
Customers existing system, and a listing (execution order and time) of those jobs that must
process once the Software is implemented in Customers production environment.Projectmeans the mutually agreed Professional Services undertaking by QCSI, on behalf of the
Customer, to which this Work Order applies.Project Schedulemeans a customized assessment and work plan created by QCSI with the assistance
and input of Customer. The Project Schedule will include project tasks with durations, estimated
start and finish dates, estimated milestone dates, work effort, baseline estimates and actuals,
and the QCSI and Customer resources assigned to the Action Team, the Steering Committee, and
other resources to be utilized during LEAP3. QCSI will utilize the detailed status
reports that will come from the Action Team to update the Project Schedule on a periodic basis.QCSI Project Manager(s)shall mean the project management professional consultants responsible
for management and effective delivery of the applicable QNXT solution driven by Customer
outcomes. The QCSI Project Manager is responsible for managing all phases
of the Project including overall work plan, scope, issue, and risk management. The QCSI Project
Manager is either Project Management Professional (PMP) or QNXT certified, or both.QCSI Program Manager(s)shall mean the program management professional consultant responsible
for determining and coordination the sharing of resources (QCSI and Triple-S) among their
constituent projects to the overall benefit of the program; and who is responsible for oversight
of Customer strategic outcomes.Senior Business Consultant(s)shall mean highly trained and skilled consultants that have: (a)
achieved at least bachelor certification via the QCSI knowledge transfer program for the
Software; (b) several years of health plan industry experience; (c) experience leading QCSI
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SOW PHASE I & II
    
    Implementation Agreement
QCSI and Triple-S
 software product implementations and/or upgrade migrations (from a Product perspective, not
project perspective).Senior Product Consultant(s)shall mean consultants that have: (a) achieved at least bachelor
certification via the QCSI knowledge transfer program for the Software; (b) participated in at
least one (1) end-to-end QCSI software product implementation; and (c) been engaged in QCSI
software product implementations for at least a total of two (2) years.Senior Technical Consultant(s)shall mean information technology consultants that have: (a)
demonstrable knowledge in regards to QNXT installations and QNXT technical configurations; (b)
working knowledge of Microsoft SQL Server and SQL language; and (c) one or more QNXT
certifications on the current QNXT release (or one release back) as well as other technical
certifications.Solution Blueprint Documentmeans the document(s) describing the configuration of the Software
based on the Customers business requirements and desired outcome(s).Technical Consultant(s)shall mean information technology consultants that are enrolled in the
QCSI knowledge transfer program that have yet to achieve certification.Third Party Vendor or TPmeans a Person (as defined in the Agreement) with whom QCSI maintains
a business relationship as of the Effective Date this Work Order, the names of such Persons are
included in Exhibit A.Validation Activitiesmean the use of the Validation Criteria (defined below) to verify that the
Software is configured in accordance with the Solutions Blueprint Document.Validation Criteriameans those test plans and use cases to be mutually agreed by the parties
and utilized during Validation Activities.II.
    
    Scope of Work and Deliverables
 (A)
    
    Summary
 The Professional Services described herein will be delivered within the context of LEAP3.
The obligations and deliverables are described herein for each phase of LEAP3. As further
detailed in this Work Order, QCSI shall provide the following Professional Services:
 a.
    
    Program Management Servicesb.
    
    Project Management Servicesc.
    
    Business and Configuration Consultingd.
    
    Business Process Transformation Consultinge.
    
    End User Training Development Consultingf.
    
    Unit and Integrated Testing Consultingg.
    
    Architecture and Integration Consultingh.
    
    Conversion, Integration and Reporting Analysis and Development Servicesi.
    
    Knowledge Transfer Consultingj.
    
    Go Live Servicesk.
    
    Coordination of TP implementation(s) as required to comply with QNXT
implementation schedule
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##### 



SOW PHASE I & II
    
    Implementation Agreement
QCSI and Triple-S
 (B)QCSIs Project Management responsibilities span all phases and include:
 
    
    Providing a leading role in the implementation of the core applications
including QNXT and TP products as identified in Exhibit A, including Customer QNXT
related activities required for implementation. As part of coordinating TP, QCSI
will coordinate TP, Customer and QCSI resources and activities required for the
implementation of TP applications and will oversee, manage and monitor the
implementation as required to comply with QNXT implementation schedule to include:
 
    
    Resources:
 
    
    Identifying, securing & managing the proper QCSI Project Management &
Consultant resources needed.
    
    Coordinating with Customer the availability of Customer resources
required for the implementation
 
    
    Conducting detailed planning at the beginning of each phase in coordination
with Customer. Detailed Planning shall include the development of a mutually
agreed upon integrated Project Schedule (QCSI activities, Customer QNXT related
activities, Customer Non-QNXT Dependencies & TP dependencies) and the
development/update of required, mutually agreed upon subsidiary plans such as
Communication, Risk, Resource Plan, Acceptance and
necessary PM procedures to manage and control the Project (e.g., Schedule, Risk,
Cost, Acceptance, Progress Reporting, Issue Management, Change Control).
    
    Directing and managing Project execution and monitoring and controlling
Project work. As part of this responsibility. QCSI is responsible for
determining and coordinating the sharing of resources (QCSI and Triple-S) in
coordination with Customer among their constituent projects to the overall
benefit of the program as well as the coordination and management of TP
vendors. Management of Project execution will include the following:
 
    
    Creating, maintaining, and supervising the mutually agreed upon
integrated Project Schedule to manage the Professional Services provided
pursuant to this Work Order as well as Customer QNXT related activities,
Customer Non-QNXT dependencies and TP key dependencies required for the
overall QNXT solution. For greater certainty, in creating, maintaining
and supervising the mutually agreed upon integrated Project Schedule,
QCSI will only be responsible for maintaining, updating and supervising
QNXT and TP related activities and tasks. Customer will be responsible
for managing and updating non-QNXT related dependencies, activities and
tasks.
    
    Customer Issue Management: Identifying, managing and escalating
Project issues to QCSI and Customer Executive Management and expediting
or escalating critical business decisions that must be made to move
forward to Customer Executive Management
    
    Progress/Status Reporting
 o
    
    Holding weekly progress and status meetingso
    
    Keeping Customer and QCSI Executive
Management apprised of progress with mutually agreed upon weekly
status and progress reports. Status/Progress reports shall include
actual vs. estimates
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##### 



SOW PHASE I & II
    
    Implementation Agreement
QCSI and Triple-S
 for budget and time schedule, including
TP implementation dependencies where applicable.o
    
    Keeping Steering Committee informed of
progress with bi-weekly on-site meetings and reports.o
    
    Providing the Customer with weekly budget
tracking information and managing and controlling QCSIs and
Customer estimated hours.
 
    
    Scope/Change Control: Coordination and management of the mutually
agreed upon Change Control process.
    
    Risk Management: Identifying and evaluating Project risks, maintaining
risk mitigation plans and monitoring risks.
    
    Lead Checkpoint Process and participate in the identification of
acceptance criteria.
 
    
    Oversight of Customer Strategic Outcomes
 (C)
    
    Work and Deliverables
 1.
    
    Phase 1  Provider Conversion
 a.
    
    Transition PhaseThe parties will complete their respective obligations, established below, and
will work together where collaboration is necessary, during the Transition phase
although in no event will the Transition phase begin prior to the execution of
this Work Order. The Transition phase shall be considered complete upon the
completion and acceptance of the Transition Deliverables identified below.
 QCSI Transition Obligations:
 
    
    Assign QCSI resources to this Work Order
    
    Conduct kick-off meeting.
    
    Lead & conduct detailed Project planning in coordination with
Customer. Detailed Planning will include the development of a mutually
agreed upon integrated Project Schedule and other mutually agreed upon
subsidiary plans needed for the successful implementation of QNXT.
 
    
    Project Scope will be validated and mutually agreed upon
deliverables defined. Project Scope validation includes the
confirmation of deliverables that will be produced by each phase,
the definition of the deliverables and who is responsible for
producing it.
    
    QCSI and Customer Roles & Responsibilities will be mutually
agreed upon and documented with QCSI & Customer resources assigned
to them (Resource Plan) and an Action Team. Structure
representation will be provided.
    
    Detailed Project Schedule:
 o
    
    The Project Schedule shall
include all mutually agreed upon activities required for
implementation of QNXT, including Customer QNXT related
activities, Customer
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##### 



SOW PHASE I & II
    
    Implementation Agreement
QCSI and Triple-S
 Non-QNXT related
dependencies, key dependencies with Product Enhancement
Requests (PERs) and TP dependencies (if applicable).o
    
    Mutually agreed upon
activities in the Project Schedule will be defined, based on
required work effort. Upon mutual agreement, durations will
be assigned to activities of QCSI and Customer. During
Detailed Planning and upon mutual agreement, activity
definitions will be provided in the Project Schedule, to clarify what the execution of the
activities will entail and prevent any misunderstanding of
activities to be conducted by Customer or TP.o
    
    Activities to be conducted
by Customer need to have Customer resources and effort
assigned to them by the Customer.o
    
    Project Schedule shall
incorporate mutually agreed upon interim review points for
Customer and mutually agreed upon time frames for Customer to
review and provide feedback to QCSI.o
    
    Project Schedule shall
include mutually identified and agreed milestones and
Checkpoints in the process.o
    
    Project Schedule shall
incorporate mutually agreed upon and required activities as a
result of planning subsidiary plans described below.
 
    
    Subsidiary Plans: At a minimum, the following mutually agreed
upon subsidiary plans shall be developed:
 o
    
    Communication Plan: The
mutually agreed upon Communication Plan will address mutually
agreed upon Issue Management & Escalating procedures, Action
Items Management, Project Progress and Status reporting and
other communication activities mutually deemed necessary
(e.g., document management procedures, such as document
version control). Format of the progress/status reports will
be mutually agreed upon as part of planning activities to
reflect actual vs. estimated cost & time schedule.o
    
    Risk Management Plan:
Identification of risks, risk response planning and
management of such risks.o
    
    Scope Control: Mutually
agreed upon Process to manage scope changes.o
    
    Updating of Project
Schedule: Process that will be used to capture progress data
and the subsequent update of QNXT and TP dependency
activities included in the integrated Project Schedule.o
    
    QCSI will cooperate with
Customer in developing Acceptance Criteria for the
configuration of QNXT and TP products and will facilitate the
management of Customers acceptance processes.
 
    
    Install QNXT Software Suite for Test Environment
 Customer Transition Obligations:
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##### 



SOW PHASE I & II
    
    Implementation AgreementQCSI and Triple-S
 
    
    Identify Customers Action Team members as per resource/roles
requirements identified by QCSI.
    
    Collaborate with QCSI and approve the detailed Project Plan as
described above in Section QCSI Transition Obligations.
    
    Mutually identified and agreed Checkpoints in the process
    
    The Customers operating environment prepared for testing-use of the
QNXT Software.
    
    Acceptance Criteria and Management of Acceptance process: Develop;
in coordination with QCSI, the Acceptance Criteria for the
configuration of QNXT and TP products.
    
    Collaborate with QCSI to define interim and final checkpoints and
mutually agree on the associated processes to manage the checkpoints.
 Transition Deliverables/Milestones:
 
    
    QCSI and Customer shall each document their respective members of
the Action Team. QCSI will produce an overall chart representing
Project (organizational) Structure and a document (Resource Plan)
indicating all Roles and Responsibilities for Customer and QCSI with
anticipated resources assigned to roles.
    
    Mutually agreed Detailed Project Schedule as described above in
Section QCSI Transition Obligations.
    
    Mutually agreed Subsidiary Plans and PM procedures as described
above in Section QCSI Transition Obligations.
    
    Installed QNXT Environment Ready to Use for Providers Phase I
 b.
    
    Discover Phase of LEAP3
 The parties will complete their respective obligations, established below, and
will work together where collaboration is necessary, during the Discover phase
of LEAP3, which shall begin upon the completion of the DPA and shall be
considered complete after the Revised Technical and Business Solution Blueprint
Documents, as they relate to Provider, are finalized and presented by the Action
Team in a Checkpoint Process with the Steering Committee at a meeting conducted
at Customers principal place of business, electronically or by other mutually
acceptable means.
 QCSI Discover Obligations:
 
    
    Project Management:
 
    
    Project Management responsibilities as defined in the
Summary section of SOW
    
    Update gap table with newly identified gaps.
    
    Lead the Checkpoint process.
 
    
    Business Consulting
 
    
    Respond to questions from the Customers Action Team Members
regarding the DPA and Post DPA Discovery Documents.
    
    Review Post DPA Discovery Documents.
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##### 



SOW PHASE I & II
    
    Implementation AgreementQCSI and Triple-S
 
    
    Analyze business requirements presented after the discovery
phase of the DPA
    
    Participate as needed to explain Provider related QNXT
processing.
    
    Work in a collaborative fashion with Customer as the
understanding of the business decisions and deliverables are
being developed to avoid unintended consequences for Customer
and approvals would be expedited.
    
    Update Business Solutions Blueprint with new business
requirements identified during the discover phase, as well as
those mutually agreed to requirements that were not included in
DPA Deliverables.
    
    Collaborate with Customer to support its understanding of
underlying data requirements of mutually agreed upon conversion
formats, where applicable.
 
    
    Technical Consulting
 
    
    Confirm Customers current state data interface points into
process diagrams
    
    Confirm Customers existing network and hardware topology
    
    Assign Technical Consultant to collaborate with Customer to
support understanding underlying data requirement of mutually
agreed upon conversion tools and formats
    
    Update Technical Solutions Blueprint with new business
requirements identified during the discover phase, as well as
those mutually agreed to requirements that were not included in
DPA Deliverables
    
    Assign Technical Consultant to consult with Customer to
support its understanding the underlying data requirements of
mutually agreed upon data analysis.
 
    
    Business Process Design:
 
    
    Collaborate with Customer to support its understanding of the
future business processes prepared in the DPA; identify those
business processes that will needed further development; and
identify interim workflow to be developed.
    
    Collaborate with Customer to review with Customer current
organizational structure, staffing composition and staffing
ratios.
 Customer Discover Obligations:
 
    
    Project Management
 
    
    Facilitate the Checkpoint Process to approve proceeding to
the Design phase of LEAP3
    
    Agree, in writing, to modified Project Schedule; business
requirements not identified and documented by QCSI in the DPA;
or technical interfaces and conversions and reports not
documented and scoped by QCSI under the original DPA project
    
    Mutually identify and agree Checkpoints in the process
 
    
    Business
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##### 



SOW PHASE I & II
    
    Implementation Agreement
QCSI and Triple-S
 
    
    Document and sign off on all new business requirements identified
during the discover phase, as well as those that were, by mutual
agreement, not included in DPA Deliverables
    
    Participate as needed to explain Provider related business
processes.
 
    
    Business Process Design:
 
    
    Understanding of the future business processes prepared in
the DPA; identify those business processes that will needed
further development; and identify interim workflow to be
developed.
    
    Review current organizational structure, staffing composition
and staffing ratios
    
    Identify any business processes and descriptions that require
further analysis or were not identified in the DPA
    
    Confirm current state business processes diagrams and process
descriptions
 
    
    Training and Testing
 
    
    Gathering all additional training and testing documentation,
if any.
 
    
    Technical
 
    
    Document and sign off on all actual technical requirements
identified during the DPA, as well as those that were not
included in DPA Deliverables by mutual agreement
    
    Customer sign off on all Provider related interface
requirements identified during the DPA, as well as those that
were not included in DPA Deliverables by mutual agreement
    
    Installation of all pre-requisite software and hardware
products for QNXT as identified in the QNXT Installation Guide
(or otherwise in the Documentation).
 Discover Deliverables/Milestones:
 
    
    Modified Project Schedule
    
    Functioning Provider test environment
    
    Clean Providers Demographic and Credentialing Data and load it into
a mutually agreed upon format(s)
    
    Complete inventory of Provider related reports and letters
    
    Finalized and sign-off business and technical requirements that were
not included in DPA Deliverables but have been mutually agreed upon
which will be documented and delivered in revised blueprint documents
    
    Updated Gap list with any new identified gaps during the Discover
Phase.
 c.
    
    Design Phase of LEAP3
 The parties will complete their respective obligations, established below, and
will work together where collaboration is necessary, during the Design phase of
the LEAP3 Project. The Design phase of the LEAP3 Project shall begin upon the
completion of the Discover phase of LEAP3 and shall be considered
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##### 



SOW PHASE I & II
    
    Implementation Agreement
QCSI and Triple-S
 complete after the Solution Blueprint Document has been mutually agreed upon.
The Design phase of the LEAP3 Project is formally concluded in a Checkpoint
Process with the Steering Committee at a meeting conducted at Customers
principal place of business, electronically or by other mutually acceptable
means.
 QCSI Design Obligations:
 
    
    Project Management
 
    
    Project Management responsibilities as identified in Summary
section of the SOW.
    
    Update Gap Table with any newly identified gaps
    
    Lead the Checkpoint Process
    
    Complete Go-Live Strategy Plan for Phase I
 
    
    Business Consulting
 
    
    Lead design configuration of core solution application and
participate with TP and Customer in TP product design.
    
    Finalize and present the Provider Section Business Solution
Blueprint Document.
 
    
    Technical Consulting
 
    
    Finalize and present the Provider Section of the Technical
Solution Blueprint Document.
    
    Provider design and customization of mutually agreed
conversion EDIs, as needed.
    
    Provider Conversion services include but are not limited to:
 §
    
    Data analysis§
    
    Data Conversion Detail Design to include
 §
    
    Data Transformation§
    
    Data Translation§
    
    Custom Solution Processing
 
    
    Provider reports and letters design services. Report
development is limited to mutually agreed upon reports.
 o
    
    Reports and letters detail design and mapping document(s) to include
 §
    
    Report and letters design§
    
    Report and letters custom solutions processing
requirement(s)
 
    
    Design Provider interfaces to/from QNXT to TP applications.
Interface development is limited to interfaces mutually agreed
to in the DPA Technical Solutions Blueprint:
 o
    
    Interface file and format analysiso
    
    Interface Detail Design to include
 §
    
    Data Transformation§
    
    Data Translation§
    
    Custom Solution Processing
 
    
    Assist Customer to develop Validation Criteria to ensure the
data loaded into QNXT is the data the Customer intended
 
    
    Business Process Design
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##### 



SOW PHASE I & II
    
    Implementation Agreement
QCSI and Triple-S
 
    
    Collaborate with Customer to support understanding of future
business processes and descriptions prepared in the DPA to
identify those that will needed further development and identify
interim workflow to be developed.
    
    Collaborate with Customer to review with Customer current
organizational structure, staffing composition and staffing
ratios.
 
    
    Knowledge Transfer
 
    
    Consult with Customer to prepare a knowledge transfer plan
for Customer to take on post go-live Provider maintenance and
support
 
    
    Testing
 
    
    Collaborate with Customer in the design and documentation of
Unit and Integrated Testing Program
 
    
    Training
 
    
    Collaborate with Customer to identify and develop End-User
Training materials
    
    Collaborate with Customer in the creation of a detailed
training plan for the implementation of the core solution
synchronized with the go live strategy.
 Customer Design Obligations:
 
    
    Project Management
 
    
    Participate in Checkpoint Process
    
    All third party products needed for this phase are contracted
and installed in the appropriate environment(s) needed for this
phase
    
    Collaborate with QCSI to complete Go-Live planning for Phase I
 
    
    Business
 
    
    Make available SMEs in the area of Provider to communicate
all Provider business requirements
    
    Provide business requirements and cooperate with QCSI in
designing and documenting CSSBs.
    
    Work in a collaborative fashion with QCSI to provide guidance
and clarification as the business requirements and supporting
design deliverables are being developed to avoid unintended
consequences and to help expedite approvals.
 
    
    Technical
 
    
    Make available SMEs in the area of Provider to communicate
all Provider conversion requirements and to sign-off on the
Provider conversion detail design
    
    Make available SMEs in the area of Provider to communicate
all Provider reports and letters requirements and to sign-off on
the Provider reports and letters detail designs
    
    Make available SMEs in the area of Provider to communicate
all Provider interface requirements and to sign-off on the
Provider interface detail designs
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##### 



SOW PHASE I & II
    
    Implementation Agreement
QCSI and Triple-S
 
    
    Configuration of test environment
    
    Sign off on all CSSBs
    
    Finalized clean data delivered
    
    Develop Validation Criteria to ensure the resultant data set
loaded into QNXT via conversion and/or interface process is
accurate
    
    Complete inventory of all Provider related reports
 
    
    Business Process Design
 
    
    Prepare business process documentation and recommendations to
support:
 o
    
    Future State (planned final
state of business  final phase go live)o
    
    Intermediary (temporary
business processes to support current phase based upon
overall timeline, deliverables and dependencies)
 
    
    Development of deployment strategy
 
    
    Testing
 
    
    Create a detailed testing plan
    
    Prepare unit and integrated testing, including test cases
 
    
    Training
 
    
    Identify and design End-User Training materials
    
    Create a detailed training plan for the implementation of the
core solution synchronized with the go live strategy.
 
    
    Clean Providers Demographic, Credentialing and load it into a
mutually agreed upon format.
    
    Complete Data Analysis
 Design Deliverables/Milestones:
 
    
    Updated Business Solution Blueprint Document
    
    Updated Technical Solution Blueprint Document
    
    Updated Gap Table
    
    Finalized inventory and process documentation of all Provider
related interim and future state business processes
    
    Finalized Provider Testing plan and test cases
    
    Finalized Provider End-User Training Plan
    
    Finalized Go-Live Plan for Phase I
    
    Finalized Knowledge Transfer Plan for Phase I
    
    Finalized Clean Data delivered
 d.
    
    Deliver Phase of LEAP3The parties will complete their respective obligations, established below, and
will work together where collaboration is necessary, during the Provider Deliver
phase of LEAP3 which will begin when the parties have mutually
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##### 



SOW PHASE I & II
    
    Implementation Agreement
QCSI and Triple-S
 agreed to the Finalized Solution Blueprint Document (Provider Section) and shall
be considered complete after the Software and Provider demographic data has been
migrated to Customers production environment.
 During the Provider Deliver phase of LEAP3, validation of the configuration of
the Software according to the Final Solution Blueprint Document (Provider
Section) occurs. QCSIs Action Team will consult with Customer in executing the
use cases required by the test plan. Typically, all configuration choices,
limited reports, processing of multiple transaction types, are validated through
the Validation Activities.Successful completion of the Validation Activities is immediately followed by
the use of the Software in Customers production environment.
 QCSI Deliver Obligations:
 
    
    Project Management
 
    
    PM responsibilities as identified in Summary section in SOW
    
    Leading Checkpoint Process
    
    Leading the implementation of Go-Live Strategy
    
    Consult with Customer in the implementation of the Go-Live
Plan for the use of the Software in Customers production
environment, including:
 o
    
    Production Cut-Over Scheduleo
    
    On-going Job Schedule
 
    
    Business Consulting
 
    
    Guide Customer during the configuration of QNXT based on the
approved design identified in the Final Solution Blueprint
Document (Provider Section).
    
    Assist Customer with Validation Activities as outlined in the
testing plan
    
    Conduct Go-Live Readiness Review
 
    
    Technical Consulting
 
    
    Finalize production environment activities including:
 o
    
    Review server configurationo
    
    Confirm software / schema versionso
    
    Review database maintenance schedules
 
    
    Develop Provider Conversion routine, to include the following
activities:
 o
    
    Develop Provider Conversion
routine to mutually agreed upon detail designo
    
    Unit test Provider
Conversion routineo
    
    Deliver Provider Conversion
routine and supporting documentationo
    
    Support Customer in User
Acceptance testing processing of final delivery of Provider
Conversion routine
 
    
    Develop Provider Interface(s), to include the following
activities:
 o
    
    Develop Provider
Interface(s) to mutually agreed upon detail design(s)
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##### 



SOW PHASE I & II
    
    Implementation Agreement
QCSI and Triple-S
 o
    
    Unit test Provider Interface(s)o
    
    Deliver Provider Interface(s) and supporting documentationo
    
    Support Customer in User
Acceptance testing processing of final delivery of Provider
Interface(s)
 
    
    Develop mutually agreed upon Provider Reports and Letters to
include the following activities:
 o
    
    Develop Provider Reports
and Letters to mutually agreed upon detail design(s)o
    
    Unit test Provider Reports
and Letterso
    
    Deliver Provider Reports
and Letters and supporting documentationo
    
    Support Customer in User
Acceptance testing processing of final delivery of Reports
and Letters
 
    
    Conduct Go-Live Readiness Review
 
    
    Testing
 
    
    Consult Customer with execution of testing plans
 
    
    Training
 
    
    Consult Customer with execution of training plans
 Customer Deliver Obligations:
 
    
    Provide the hardware and software needed to support the production
installation of QNXT products
    
    Configure Provider related reference data including, but not limited
to:
 
    
    Provider Types
    
    Specialties
    
    Zip Codes
 
    
    Configure Provider related structure in QNXT
    
    Execute Validation Activities
    
    Test intermediate and future processes
    
    Support Unit and Integrated testing cycle(s) with appropriate
subject matter experts
    
    Conduct User Acceptance Testing cycle(s)
    
    Complete Provider End-User Training Materials and Execute the
Training
    
    Execute roll-out and training related to BPTs and Interim Processes
    
    Develop and test Desk Level Procedures for Providers processes.
    
    Execute the Go-Live strategy
    
    Implemented Job Schedule
 Deliver Deliverables/Milestones:
 
    
    Testing complete and approved by Customer
    
    PERs mutually agreed upon for delivery for Provider Phase I have
been approved, if applicable
    
    Provider conversion activities complete
    
    Provider configuration activities complete
    
    Provider integration activities complete
    
    Provider reports & letters activities complete
 3
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##### 



SOW PHASE I & II
    
    Implementation Agreement
QCSI and Triple-S
 
    
    Provider Validation Activities complete
    
    Checkpoint Process complete
    
    Implemented operating environment to support the Software Solution
    
    Implemented Job Schedule
    
    Interim and Future State Business Process Transformation documents
complete
    
    Provider End-User Training material complete
    
    Provider End-User Training delivered
    
    Go-Live strategy implemented.
 e.
    
    Realize Phase of LEAP3The parties will complete their respective obligations, established below, and
will work together where collaboration is necessary, during the Realize phase of
LEAP3 which shall begin upon the completion of the Deliver phase of LEAP3 and
shall be considered complete after the Outcome Document is presented to the
Steering Committee as a part of a Checkpoint Process at a meeting conducted at
Customers principal place of business, electronically or by other mutually
acceptable means. This is typically held thirty (30) to ninety (90) days after
the completion of the Deliver phase of LEAP3.
 QCSI Realize Obligations:
 
    
    In collaboration with Customer, evaluate and troubleshoot QNXT for
Providers; QNXT developed conversion, integration, reports and letters
issues.
    
    Coordinate support and lead troubleshooting for QNXT Partner
Products
    
    Work with Customer to monitor and fine-tune both system
configuration and internal processes to achieve outcome measures
    
    Participate in completing measurements for the final Outcome
Document and comparing it to baseline measurements, where applicable
    
    Lead the final Checkpoint Process
    
    Lead post-production QNXT support as per Go-Live Strategy.
 Customer Realize Obligations:
 
    
    Participate in final Checkpoint Process
    
    Monitor and fine tune both system configuration and internal
processes to achieve outcome measures
    
    Calculate or measure appropriate metrics as indicated in the Outcome
Document
    
    Participate in the post-production plan
    
    Collaboration with QCSI to evaluate and troubleshoot QNXT Provider
configuration issues.
    
    Complete measurements for the final Outcome Document and comparing
it to baseline measurements, where applicable
 3
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##### 



SOW PHASE I & II
    
    Implementation Agreement
QCSI and Triple-S
 Realize Deliverables/Milestones:
 
    
    First iteration of Outcome measures complete
    
    Final Checkpoint
 2.
    
    Phase 2  Commercial (including all schedule sub-phases)
 a.
    
    Transition PhaseThe parties will complete their respective obligations, established below, and
will work together where collaboration is necessary, during the Transition phase
although in no event will the Transition phase begin prior to the execution of
this Work Order. The Transition phase shall be considered complete upon the
completion and acceptance of the Transition Deliverables identified below.
 QCSI Transition Obligations:
 
    
    Assign QCSI resources to this Work Order
    
    Lead & conduct detailed Project planning in coordination with
Customer. Detailed Planning will include the development of a mutually
agreed upon integrated Project Schedule and other mutually agreed upon
subsidiary plans needed for the successful implementation of QNXT.
 
    
    Project Scope will be validated and mutually agreed upon
deliverables defined. Project Scope validation includes the
confirmation of deliverables that will be produced by each phase,
the definition of the deliverables and who is responsible for
producing it.
    
    QCSI and Customer Roles & Responsibilities will be mutually
agreed upon and documented with QCSI & Customer resources assigned
to them (Resource Plan) and an Action Team. Structure
representation will be provided.
    
    Detailed Project Schedule:
 o
    
    The Project Schedule shall
include all mutually agreed upon activities required for
implementation of QNXT, including Customer QNXT related
activities, Customer Non-QNXT related dependencies, key
dependencies with PERs and TP dependencies (if applicable).o
    
    Mutually agreed upon
activities in the Project Schedule will be defined, based on
required work effort. Upon mutual agreement, durations will
be assigned to activities of QCSI and Customer. During
Detailed Planning and upon mutual agreement, activity
definitions will be provided the Project Schedule, to clarify
what the execution of the activities will entail and prevent
any misunderstanding of activities to be conducted by
Customer or TP.o
    
    Activities to be conducted
by Customer need to have Customer resources and effort
assigned to them by the Customer.
 3
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##### 



SOW PHASE I & II
    
    Implementation Agreement
QCSI and Triple-S
 o
    
    Dependencies with non-QNXT
activities performed by Customer or other external entities
shall be identified in the integrated Project Schedule.o
    
    Project Schedule shall
incorporate mutually agreed upon interim review points for
Customer and mutually agreed upon time frames for Customer to
review and provide feedback to QCSI.o
    
    Project Schedule shall
include mutually identified and agreed milestones and
Checkpoints in the process.o
    
    Project Schedule shall
incorporate mutually agreed upon and required activities as a
result of planning subsidiary plans described below.
 
    
    Subsidiary Plans: As a minimum, the following mutually agreed
upon subsidiary plans shall be developed:
 o
    
    Communication Plan: The
mutually agreed upon Communication Plan will address mutually
agreed upon Issue Management & Escalating procedures, Action
Items Management, Project Progress and Status reporting and
other communication activities mutually deemed necessary
(e.g., document management procedures, such as document
version control). Format of the progress/status reports will
be mutually agreed upon as part of planning activities to
reflect actual vs. estimated cost & time schedule.o
    
    Risk Management Plan:
Identification of risks, risk response planning and
management of such risks.o
    
    Scope Control: Mutually
agreed upon Process to manage scope changes.o
    
    Updating of Project
Schedule: Process that will be used to capture progress data
and the subsequent update of QNXT and TP dependency
activities included in the integrated Project Schedule.o
    
    QCSI will cooperate with
Customer in developing Acceptance Criteria for the
configuration of QNXT and TP products and will facilitate the
management of Customers acceptance processes.
 
    
    Install QNXT Software Suite for Test Environment
    
    Assigned Technical Consultant will collaborate with Customer to
support its understanding of underlying data requirement for
mutually agreed upon data analysis and conversion tools and format,
    
    Assist Customer to understand the Contract, Benefit and Policy
interpretation process and interpretation tools.
 Customer Transition Obligations:
 
    
    Identify Customers Action Team members as per resource/roles
requirements identified by QCSI.
    
    Collaborate with QCSI and approve detailed Project planning as
described above in Section QCSI Transition Obligations.
 3
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##### 



SOW PHASE I & II
    
    Implementation Agreement
QCSI and Triple-S
 
    
    Mutually identified and agreed Checkpoints in the process
    
    The Customers operating environment prepared for testing-use of the
QNXT Software.
    
    Acceptance Criteria and Management of Acceptance process: Develop;
in coordination with QCSI, Customer will develop the Acceptance
Criteria for the configuration of QNXT and TP products.
    
    Collaborate with QCSI to define interim and final checkpoints and
mutually agree on the associated processes to manage the checkpoints.
    
    Begin Commercial Data Analysis.
    
    Begin the Contract, Benefit and Policy interpretation process and
document interpretations with applicable tools.
 Transition Deliverables/Milestones:
 
    
    QCSI and Customer shall each document their respective members of
the Action Team. QCSI will produce an overall chart representing
Project (organizational) Structure and a document (Resource Plan)
indicating all Roles and Responsibilities for Customer and QCSI with
anticipated resources assigned to roles.
    
    Mutually agreed Detailed Project Schedule as described above in
Section QCSI Transition Obligations.
    
    Mutually agreed Subsidiary Plans and agreed PM procedures as
described above in Section QCSI Transition Obligations.
    
    Environment Ready to Use for Commercial Phase II
 b.
    
    Discover Phase of LEAP3The parties will complete their respective obligations, established below, and
will work together where collaboration is necessary, during the Discover phase
of LEAP3, which shall begin upon the completion of the DPA and shall
be considered complete after the Revised Technical and Business Solution
Blueprint Documents, as they related to Provider, are finalized and presented by
the Action Team in a Checkpoint Process with the Steering Committee at a meeting
conducted at Customers principal place of business, electronically or by other
mutually acceptable means.
 QCSI Discover Obligations:
 
    
    Project Management:
 
    
    Project Management responsibilities as defined in the Summary
section of SOW
    
    Update gap table with newly identified gaps.
    
    Lead the Checkpoint process.
 
    
    Business Consulting
 
    
    Respond to questions from the Customers Action Team Members
regarding the DPA and Post DPA Discovery Documents.
    
    Review Post DPA Discovery Documents
 3
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##### 



SOW PHASE I & II
    
    Implementation Agreement
QCSI and Triple-S
 
    
    Analyze business requirements presented after the discovery
phase of the DPA
    
    Participate as needed to explain Commercial related QNXT
processing.
    
    Work in a collaborative fashion with Customer as the
understanding of the business decisions and deliverables are
being developed to avoid unintended consequences and approvals
would be expedited.
    
    Update Business Solutions Blueprint with new business
requirements identified during the discover phase, as well as
those that were not included in DPA Deliverables by mutual
agreement
    
    Collaborate with Customer to support understanding data
requirement for mutually agreed upon conversion formats, where
applicable.
    
    Assist Customer to understand the Contract, Benefit and
Policy interpretation process and interpretation tools.
 
    
    Technical Consulting
 
    
    Confirm Customers current state data interface points into
process diagrams
    
    Confirm Customers existing network and hardware topology
    
    Update Technical Solutions Blueprint with new business
requirements identified during the discover phase, as well as
those that were, by mutual agreement, not included in DPA
Deliverables Agreement
 
    
    Business Process Design:
 
    
    Collaborate with Customer to support understanding of future
business processes and descriptions prepared in the DPA to
identify those that will needed further development and identify
interim workflow to be developed.
    
    Collaborate with Customer to review with Customer current
organizational structure, staffing composition and staffing
ratios.
 
    
    Review with Customer ITS Home and ITS Host obligations to determine
if new PERs are needed.
 Customer Discover Obligations:
 
    
    Project Management
 
    
    Facilitate the Checkpoint Process to approve proceeding to
the Design phase of LEAP3
    
    Agree, in writing, to modified Project Schedule; business
requirements not identified and documented by QCSI in the DPA;
or technical interfaces, conversion, and mutually agreed upon
reports not documented and scoped by QCSI under the original DPA
project
    
    Mutually identify and agree Checkpoints in the process
 
    
    Business
 
    
    Document and sign off on all new business requirements not
identified during the discover phase
 3
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##### 



SOW PHASE I & II
    
    Implementation Agreement
QCSI and Triple-S
 
    
    Participate as needed to explain commercial related business processes
 
    
    Business Process Design:
 
    
    Review future business processes and descriptions prepared in the DPA
to identify those that will need further development and identify
interim workflows to be developed.
    
    Review current organizational structure, staffing composition and
staffing ratios
    
    Identify any business processes and descriptions that require further
analysis
    
    Confirm current state business processes diagrams and process
descriptions
 
    
    Training and Testing
 
    
    Gathering all additional training and testing documentation, if any.
 
    
    Technical
 
    
    Document and sign off on all actual technical requirements not
identified during the DPA.
    
    Customer sign off on all Provider related interface requirements not
identified during the DPA
    
    Complete inventory of Commercial related reports and letters
    
    Installation of all pre-requisite software and hardware products for
QNXT as identified in the QNXT Installation Guide (or otherwise in the
Documentation).
 Discover Deliverables/Milestones:
 
    
    Modified Project Schedule
    
    Functioning commercial test environment
    
    Business process documentation revised and updated on current state
business processes and data interface points
    
    Clean and load conversion entities into a mutually agreed upon format(s)
including but not limited to:
 
    
    Sponsor demographics, notes, and attributes
    
    Member demographics, relationship data, sponsor affiliation,
eligibility, member condition, PCP, enrollment restriction(s), and
student status
    
    Paid claims history
    
    Open authorization and referral
    
    Open accounts receivable
    
    Accumulator
    
    Open and closed calls
    
    Custom fee schedules
    
    Capitation tables
    
    Premium tables
 
    
    Complete inventory of commercial related reports and letters
 3
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---



##### 



SOW PHASE I & II
    
    Implementation Agreement
QCSI and Triple-S
 
    
    Finalized business and technical requirements not included in DPA
Deliverables but have been mutually agreed upon which will be documented and
delivered in revised blueprint documents.
    
    Updated Gap list with any new identified gaps during the Discover Phase.
    
    Complete review of ITS applications and determination if new PERs are
needed.
 c.
    
    Design Phase of LEAP3
 The parties will complete their respective obligations, established below, and will
work together where collaboration is necessary, during the Design phase of the
LEAP3 Project. The Design phase of the LEAP3 Project shall
begin upon the completion of the Discover phase of LEAP3 and shall be
considered complete after the Solution Blueprint Document has been mutually agreed
upon. The Design phase of the LEAP3 Project is formally concluded in a
Checkpoint Process with the Steering Committee at a meeting conducted at Customers
principal place of business, electronically or by other mutually acceptable means.
 QCSI Design Obligations:
 
    
    Project Management
 
    
    Project Management responsibilities as identified in Summary section
of the SOW.
    
    Update Gap Table with any newly identified gaps
    
    Lead the Checkpoint Process
    
    Complete Go-Live Strategy Plan for Phase II
 
    
    Business Consulting
 
    
    Lead design configuration of core solution application and
participate with TP and Customer in TP product design.
    
    Finalize and present the Business Solution Blueprint Document.
    
    QCSI will assist Customer to understand its Contract, Benefit and
Policy interpretation process and tools.
 
    
    Technical Consulting
 
    
    Finalize and present the Technical Solution Blueprint Document.
    
    Design and customization of mutually agreed upon EDIs, as needed
    
    Commercial Conversion services include but are not limited to:
 o
    
    Data analysiso
    
    Data Conversion Detail Design to include
 
    
    Data Transformation
    
    Data Translation
    
    Custom Solution Processing
 
    
    Design of the infrastructure and interfaces required for the
Commercial implementation between QNXT and the Customer developed
Enterprise Service Bus (ESB) application, in
 3
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---



##### 



SOW PHASE I & II
    
    Implementation Agreement
QCSI and Triple-S
 support of all interface
and daily sync processing. Interface development limited to those
specified in Exhibit B
 o
    
    Interface file and format analysiso
    
    Interface Detail Design to include
 §
    
    Required framework to support the specified interfaces and
daily sync processing between the Customers ESB and QNXT§
    
    Data Transformation§
    
    Data Translation§
    
    Custom Solution Processing
 
    
    Assist Customer to develop Validation Criteria to ensure the data
loaded into to QNXT is the data the Customer intended
 
    
    Business Process Design
 
    
    Collaborate with Customer to support understanding of future business
processes and descriptions prepared in the DPA to identify those that
will needed further development and identify interim workflow to be
developed.
    
    Collaborate with Customer to review with Customer current
organizational structure, staffing composition and staffing ratios.
 
    
    Knowledge Transfer
 
    
    Consult with Customer to prepare a knowledge transfer plan for
Customer to take on post go-live Commercial maintenance and support
 
    
    Testing
 
    
    Collaborate with Customer to design and document Unit and Integrated
Testing Program
 
    
    Training
 
    
    Collaborate with Customer to identify and develop End-User Training
materials
    
    Collaborate with Customer to create a detailed training plan for the
implementation of the core solution synchronized with the go live
strategy.
 
    
    Clean Commercial data and load it into a mutually agreed upon format.
 Customer Design Obligations:
 
    
    Project Management
 
    
    Participate in Checkpoint Process
    
    All third party products needed for this phase are contracted and
installed in the appropriate environment(s)
    
    Collaborate with QCSI to complete Go-Live planning for Phase II
 
    
    Business
 
    
    Make available SMEs to communicate all commercial business
requirements
 3
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---



##### 



SOW PHASE I & II
    
    Implementation Agreement
QCSI and Triple-S
 
    
    Provide business requirements and cooperate with QCSI in designing
and documenting CSSBs.
    
    Work in a collaborative fashion with QCSI to provide guidance and
clarification as the business requirements and supporting design
deliverables are being developed to avoid unintended consequences and to
help expedite approvals.
 
    
    Technical
 
    
    Make available SMEs to communicate all commercial related conversion
requirements and to sign-off on the commercial conversion detail design
    
    Make available SMEs to communicate all commercial related reports and
letters requirements and to sign-off on the commercial reports and
letters detail designs
    
    Make available SMEs to communicate all ESB, interface, and daily sync
requirements and to sign-off on the related detail designs
    
    Configuration of test environment
    
    Sign off on all CSSBs
    
    Finalized clean data delivered
    
    Develop Validation Criteria to ensure the resultant data set loaded
into to QNXT via conversion and/or interface processes is accurate
    
    Complete Data Analysis
    
    Clean and load conversion entities into QNXT supplied format(s) including but not limited to:
 o
    
    Sponsor demographics, notes, and attributeso
    
    Member demographics, relationship data,
sponsor affiliation, eligibility, member condition, PCP, enrollment
restriction(s), and student statuso
    
    Paid claims historyo
    
    Open authorization and referralo
    
    Open accounts receivableo
    
    Accumulatoro
    
    Open and closed callso
    
    Custom fee scheduleso
    
    Capitation tableso
    
    Premium tables
 
    
    Business Process Design
 
    
    Prepare business process documentation and recommendations to support:
 o
    
    Future State (planned final state of business  final phase go live)o
    
    Intermediary (temporary business processes to
support current phase based upon overall timeline, deliverables and
dependencies)
 
    
    Development of deployment strategy
 
    
    Testing
 
    
    Create a detailed testing plan
    
    Prepare unit and integrated testing, including test cases
 3
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---



##### 



SOW PHASE I & II
    
    Implementation Agreement
QCSI and Triple-S
 
    
    Training
 
    
    Identify End-User Training materials
    
    Create a detailed training plan for the implementation of the core
solution synchronized with the go live strategy.
 Design Deliverables/Milestones:
 
    
    Updated Business Solution Blueprint Document
    
    Updated Technical Solution Blueprint Document
    
    Updated Gap Table
    
    Finalized inventory and process documentation of all Commercial related
interim and future state business processes
    
    Finalized Commercial Testing plan and test cases
    
    Finalized Commercial End-User Training Plan
    
    Finalized Go-Live Plan for Phase II
    
    Finalized Knowledge Transfer Plan for Phase II
    
    Finalized Clean Data delivered
 d.
    
    Deliver Phase of LEAP3
 The parties will complete their respective obligations, established below, and will
work together where collaboration is necessary, during the Commercial Deliver phase of
LEAP3 which will begin when the parties have mutually agreed to the Finalized Solution Blueprint Document (Commercial Section) and
shall be considered complete after the Software and Provider demographic data has been
migrated to Customers production environment.During the Commercial Deliver phase of LEAP3, validation of the
configuration of the Software according to the Final Solution Blueprint Document
(Commercial Section) occurs. Typically, all configuration choices, reports, processing
of multiple transaction types, are validated through the Validation Activities.Successful completion of the Validation Activities is immediately followed by the use
of the Software in Customers production environment.QCSI Deliver Obligations:
 
    
    Project Management
 
    
    PM responsibilities as identified in Summary section in SOW
    
    Leading Checkpoint Process
    
    Leading the implementation of Go-Live Strategy
    
    Consult with Customer in the implementation of the Go-Live Plan for
the use of the Software in Customers production environment, including:
 o
    
    Production Cut-Over Scheduleo
    
    On-going Job Schedule
 
    
    Business Consulting
 3
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##### 



SOW PHASE I & II
    
    Implementation Agreement
QCSI and Triple-S
 
    
    Guide Customer during the configuration of QNXT based on the approved
design identified in the Final Solution Blueprint Document (Provider
Section).
    
    Assist Customer with Validation Activities as outlined in the testing plan
    
    Conduct Go-Live Readiness Review
 
    
    Technical Consulting
 
    
    Finalize production environment activities including:
 o
    
    Review server configurationo
    
    Confirm software / schema versionso
    
    Review database maintenance schedules
 
    
    Develop Commercial Conversion routine(s), to include the following activities:
 o
    
    Develop Commercial Conversion routine(s)to mutually agreed upon detail designo
    
    Unit test Commercial Conversion routine(s)o
    
    Deliver Commercial Conversion routine(s) and supporting documentationo
    
    Support Customer in User Acceptance testing
processing of final delivery of Commercial Conversion routine(s)
 
    
    Develop Commercial Interface(s), to include the following activities:
 o
    
    Develop required framework to support the
specified interfaces and daily sync processing between the Customers
ESB and QNXTo
    
    Develop Commercial interface(s) and daily sync routines to mutually agreed upon detail design(s)o
    
    Unit test Commercial interface(s) and daily sync routineso
    
    Deliver Commercial interface(s) and daily sync routines, and supporting documentationo
    
    Support Customer in User Acceptance testing
processing of final delivery of Commercial interface(s) and daily sync
routines
 
    
    Develop mutually agreed upon Commercial Reports and Letters
    
    Conduct Go-Live Readiness Review
 
    
    Testing
 
    
    Consult Customer with execution of testing plans
 
    
    Training
 
    
    Consult Customer with execution of training plans
 
    
    Knowledge Transfer
 
    
    Consult with Customer to prepare a knowledge transfer plan for
Customer to take on post go-live Commercial maintenance and support
 Customer Deliver Obligations:
 
    
    Provide the hardware and software needed to support the production
installation of QNXT products
 3
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---



##### 



SOW PHASE I & II
    
    Implementation Agreement
QCSI and Triple-S
 
    
    Complete QNXT configuration activities to support Commercial business, as
defined in the Solutions Blueprint Document
    
    Deliver finalized intermediate and future state Commercial business process
design documentation and recommendations
    
    Execute Validation Activities
    
    Test intermediate and future processes
    
    Support Unit and Integrated testing cycle(s) with appropriate subject
matter experts
    
    Conduct User Acceptance Testing cycle(s)
    
    Complete End-User Training Materials and Execute the Training
    
    Execute roll-out and training related to BPTs and Interim Processes
    
    Develop and test Desk Level Procedures
    
    Execute the Go-Live strategy
    
    Implemented operating environment to support the Software Solution
    
    Implemented Job Schedule
 Deliver Deliverables/Milestones:
 
    
    Testing complete and approved by Customer
    
    Commercial Phase, mutually agreed upon PERs tested and approved, if
applicable
    
    Commercial conversion activities complete
    
    Commercial integration activities complete
    
    Commercial daily sync activities complete
    
    Commercial reports & letters activities complete
    
    Commercial configuration activities complete
    
    Commercial Validation Activities complete
    
    Checkpoint Process complete
    
    Implemented operating environment to support the Software Solution
    
    Implemented Job Schedule
    
    Interim and Future State Business Process Transformation documents complete
    
    End-User Training material complete
    
    End-User Training delivered
    
    Go-Live Strategy implemented
 e.
    
    Realize Phase of LEAP3The parties will complete their respective obligations, established below, and will
work together where collaboration is necessary, during the Realize phase of
LEAP3 which shall begin upon the completion of the Deliver phase of
LEAP3 and shall be considered complete after the Outcome Document
reflecting attainment of the metrics is presented to the Steering Committee as a part
of a Checkpoint Process at a meeting conducted at Customers principal place of
business, electronically or by other mutually acceptable means. This is typically held
thirty (30) to ninety (90) days after the completion of the Deliver phase of
LEAP3.
 3
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##### 



SOW PHASE I & II
    
    Implementation Agreement
QCSI and Triple-S
 During the ninety (90) days following the completion of the Deliver phase of
LEAP3for the final commercial sub-phase go-live, Project activities focus
on transitioning support from QCSIs Action Team to QCSI Product Support. The parties
will begin the process to measure business objectives as contained Outcome Document.
 QCSI Realize Obligations:
 
    
    In collaboration with Customer evaluate and troubleshoot QNXT
configuration; QNXT developed conversion, integrations and daily sync
    
    Coordinate support and lead troubleshooting for QNXT Partner Products
    
    Work with Customer to monitor fine-tuning both system configuration and
internal processes to achieve outcome measures
    
    Participate in completing measurements for the final Outcome Document and
comparing it to baseline measurements, where applicable
    
    Lead the final Checkpoint Process
    
    Lead post-production QNXT support as per Go-Live Strategy
 Customer Realize Obligations:
 
    
    Participate in final Checkpoint Process
    
    Monitor and fine tune both system configuration and internal processes to
achieve outcome measures
    
    Calculate or measure appropriate metrics as indicated in the Outcome
Document
    
    Participate in the post-production plan
    
    Collaboration with QCSI to evaluate and troubleshoot commercial
configuration.
    
    Complete measurements for the final Outcome Document and comparing it to
baseline measurements, where applicable
 Realize Deliverables/Milestones:
 
    
    Promotion of Project from QNXT Professional Services to QNXT Product
Support following the final commercial sub-phase go-live
    
    First iteration of Outcome measures complete
    
    Final Checkpoint
 III.
    
    Assumptions for all Phases
 
    
    Customer will provide access to essential staff and materials necessary to support QCSI for the duration of Work Order
    
    Customer will provide QCSI resources with onsite working facilities consistent with
those made available to Customer employees and other Customer contractors. Working
facilities shall include, but are not limited to:
 
    
    Building access cards (keys)
    
    Desks
 3
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##### 



SOW PHASE I & II
    
    Implementation Agreement
QCSI and Triple-S
 
    
    Telephones access
    
    Fax/copier access
    
    Internet access
    
    QNXT System access
    
    Meeting room access
 
    
    The following, shall be considered outside of the scope of this Work Order:
 
    
    Conversion services not identified in the DPA Conversion Blue Print including but
not limited to:
 
    
    All conversion discovery, design, development or customization
· Current system data cleanup
    
    Data mapping
    
    Data analysis
 
    
    Integration services not identified in the DPA Integration/Interfaces Blue Print
(Exhibit B) including but not limited to:
 
    
    All integration discovery, design, development or customization activities
    
    Coding and/or testing of custom reports
    
    Data mapping
    
    Data analysis
 
    
    Reporting services not mutually agreed to between the parties.:
 
    
    All report discovery, design, development or customization
    
    Coding and/or testing of custom reports
    
    Data mapping
    
    Data analysis
 
    
    EDI (Electronic Data Interchange) not identified in the DPA EDI/Conversion Blue
Print including but not limited to:
 
    
    All EDI development or customization
    
    Programming and testing of EDI
    
    Data mapping
    
    Data analysis
 
    
    Programming and/or testing of interfaces not identified in the DPA Technical
Blueprint, from the Software to TP applications
    
    Any and all QCSI-sponsored or developed education and training courses
    
    All interpretation and final interpretation matrix coding of Provider Contracts,
Sponsor Contracts, Medical Policies, or Benefit Plans
    
    The parties will collaborate to conduct all Acceptance testing hereunder.
    
    The parties will mutually agree to the Acceptance Criteria for Monthly Progress
Reports/Weekly Progress Reports (although, at a minimum, such reports will contain
tasks completed for the period, hours incurred by consulting resource, and percentage
of the Project completed based on the accepted Project Plan). All Monthly Progress
Reports/Weekly Progress Reports will be considered completed after Acceptance by
Customer. Beginning from the day that QCSI receives notice from Customer that a
particular Monthly Progress Reports/Weekly Progress Reports failed Acceptance, the
parties will collaborate, in the spirit of good faith, to mutually determine what
revisions, if any, to the Monthly Progress Reports/Weekly Progress Reports may be
necessary to enable Acceptance.
    
    The parties will mutually agree to the Acceptance Criteria for all
Deliverables/Milestones. All mutually agreed Deliverables/Milestones will be
considered completed after Acceptance by the Customer. QCSI will provide
 3
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---



##### 



SOW PHASE I & II
    
    Implementation Agreement
QCSI and Triple-S
 drafts of
the Deliverables prior to the applicable, mutually agreed delivery date, and Customer
will review and if applicable approve the Deliverable/Milestone within ten (10)
working days. In the event that QCSI does not provide drafts of the Deliverables
prior to the applicable, mutually agreed delivery date, Customer may not be able to
review and approve the Deliverable/Milestone within ten (10) working days. Once
Detail Planning is completed, Customer and QCSI agree to review the length of this
approval period on a per Deliverable/Milestone basis. Beginning from the day that
QCSI receives notice from Customer that a particular Deliverable/Milestone failed
Acceptance, the parties will collaborate, in the spirit of good faith, to mutually
determine what revisions, if any, to the Deliverable/Milestone may be necessary to
enable Acceptance.
    
    The demonstration by the parties that a Deliverable conform to, or achieves the,
applicable Acceptance Criteria, will result in the Acceptance by Customer of such
Deliverable.
    
    The demonstration by the parties that Acceptance Criteria applicable to a
Milestone conform to, or achieves the, applicable Acceptance Criteria, will result in
the Acceptance by Customer of such Milestone.
    
    The demonstration by the parties that a Monthly Progress Reports/Weekly Progress
Reports conform to, or achieves the, applicable Acceptance Criteria, will result in
the Acceptance by Customer of such Monthly Progress Reports/Weekly Progress Reports.
    
    After Customers sign-off for the use of QNXT in Customers production
environment, the ultimate configuration of the Software in the Customers production
environment is Customers responsibility.
    
    The Milestone Payment will be considered earned, by QCSI, and will be due and
payable to QCSI pursuant to the terms of this Work Order, in the case that QCSIs
failure to achieve the respective Acceptance by Customer of such Milestone by the
applicable milestone date is a result solely of Customers actions, or caused solely
by Customers failure to perform any of its obligations, dependencies, or
responsibilities hereunder.
    
    The Progress Report Payment will be considered earned, by QCSI, and will be due
and payable to QCSI pursuant to the terms of this Work Order, in the case that QCSIs
failure to achieve the respective Acceptance by Customer of such Progress Report by the applicable Progress Report date is a result solely of
Customers actions, or caused solely by Customers failure to perform any of its
obligations, dependencies, or responsibilities hereunder.
    
    Customer grants QCSI all rights and permissions to access Customers third party
hardware, and to access the license(s) of any third party software, that in anyway is
related to QCSIs work hereunder, to the same extent that Customer possesses such
rights and permissions and subject to the terms of any license agreement which exists
in relation to such third party software to which Customer is a party.
    
    Any change to this Work Order or Project Plan may result in the delay of a
Deliverable or Milestone deadline. Material or substantial changes to scope of
effort, or work, may require up to thirty (30) days advanced written notice for
proper staff planning.
 3
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---



##### 



SOW PHASE I & II
    
    Implementation Agreement
QCSI and Triple-S
 IV.
    
    Timeframe, Delivery Dates and Other MilestonesOnly the Professional Services expressly described in this Work Order will be provided. Other
services (i.e. those not specified herein) are outside the scope of this Work Order. For
example, all QCSI classroom or online training will be handled under a separate Work Order,
including but not limited to, fees for training, the specific courses, and course/trainer
scheduling. QCSI will utilize the period immediately following the date of last signature,
through January 31, 2008, to staff for the Services contemplated herein (Ramp-Up Period).No change to this Work Order will be made by Customer or QCSI unless mutually agreed to by
both parties in writing. Any substitution or additional tasks or activities different from
the tasks and activities described in this Work Order has to be approved by Customer in
writing, in which case the substituted or additional work will be counted in the total number
of Professional Service hours utilized under this Work Order. Customer will not be responsible
for any substitution or additional tasks or activities different from the tasks and activities
described in this Work Order performed by a QCSI consultant(s) without Customers written
approval.It is expected that the Professional Services specified in this Work Order will take
approximately thirty-six months to complete, in accordance with the table, Consultant
Staffing Plan, below. The actual time for completion will depend in part on the complexity
encountered and on the input and ability of both Parties to assist in LEAP3.
 Consultant Staffing Plan
 The total estimated hours for this Work Order are 163,560 hours. Please see Below Consultant
Staffing Plan for allocation of work effort hours by TriZetto Professional Services Role.
 Phase 1 & 2
    
    
    Phase 3 & 4
    
    
    TotalExecutive Oversight
    
    
    3,160
    
    
    
    1,040
    
    
    
    4,200QNXT Program Manager
    
    
    5,800
    
    
    
    1,730
    
    
    
    7,530Project Manager (Business)
    
    
    5,800
    
    
    
    1,200
    
    
    
    7,000Project Manager (Technical)
    
    
    
    
    
    
    
    
    
    
    Project Coordinator
    
    
    
    
    
    
    
    
    
    
    Project Architech
    
    
    5,280
    
    
    
    1,730
    
    
    
    7,010Carrier/Program Lead
    
    
    160
    
    
    
    40
    
    
    
    200UM Lead
    
    
    1,557
    
    
    
    
    
    
    
    1,557Benefit Lead
    
    
    4,152
    
    
    
    
    
    
    
    4,152Benefit ConfigurationTeam
    
    
    4,152
    
    
    
    
    
    
    
    4,152Provider Lead
    
    
    2,596
    
    
    
    519
    
    
    
    3,115Provider Contract ConfigurationTeam
    
    
    3,114
    
    
    
    
    
    
    
    3,114UM Lead
    
    
    1,557
    
    
    
    
    
    
    
    1,557Employer/Policy/AR/Premium Lead
    
    
    4,152
    
    
    
    
    
    
    
    4,152Employer/Policy/AR/Premium Config Team
    
    
    4,152
    
    
    
    
    
    
    
    4,152Eligibility Lead
    
    
    3,114
    
    
    
    692
    
    
    
    3,806
 3
 Page 30 of 47




---



##### 



SOW PHASE I & II
    
    Implementation Agreement
QCSI and Triple-S
 Phase 1 & 2
    

    Phase 3 & 4
    

TotalProvider Lead
    
    
    
    
    
    
    
    
    Customer Service Lead
    
    
    1,293
    
    
    346
    
    
    1,639Security Lead
    
    
    80
    
    
    
    
    
    80BPT Lead
    
    
    520
    
    
    
    
    
    520BPT Facilitator
    
    
    1,420
    
    
    
    
    
    1,420BPT Resource
    
    
    
    
    
    
    
    
    Lead Technical Consultant
    
    
    480
    
    
    
    
    
    480Technical Consultant Generalist
    
    
    
    
    
    1,730
    
    
    1,730Technical Consultant Generalist
    
    
    760
    
    
    
    
    
    760Senior Technical Consultant
    
    
    5,720
    
    
    
    
    
    5,720Knowledge Transfer Analyst
    
    
    160
    
    
    
    
    
    160Technical Consultant
    
    
    520
    
    
    
    
    
    520Technical Consultant Generalist
    
    
    
    
    
    
    
    
    Conversion Lead
    
    
    2,320
    
    
    
    
    
    2,320Conversion Analyst
    
    
    2,532
    
    
    
    
    
    2,532Conversion Developer
    
    
    7,108
    
    
    
    
    
    7,108Interface Lead
    
    
    2,320
    
    
    
    
    
    2,320Integration Analyst
    
    
    5,700
    
    
    
    
    
    5,700Integration Developer
    
    
    24,560
    
    
    
    
    
    24,560Reports and Letters Lead
    
    
    
    
    
    
    
    
    Reports and Letters Analyst
    
    
    1,920
    
    
    
    
    
    1,920Reports and Letters Developer
    
    
    
    
    
    
    
    
    Support Analyst
    
    
    480
    
    
    
    
    
    480Support Developer
    
    
    2,112
    
    
    
    
    
    2,112QNXT MyHealthView
    
    
    
    
    
    
    
    
    QNXT Connect
    
    
    1,557
    
    
    
    
    
    1,557AutoQ
    
    
    
    
    
    
    
    
    QNXT ITS
    
    
    3,114
    
    
    
    
    
    3,114MicroDyn - DRG, APC, etc.
    
    
    80
    
    
    
    
    
    80Ingenix - iCES
    
    
    260
    
    
    
    
    
    260Actek
    
    
    170
    
    
    
    
    
    170Test Lead
    
    
    1,697
    
    
    
    
    
    1,697Testing Consultant
    
    
    
    
    
    
    
    
    Document Preparation (Training)
    
    
    
    
    
    
    
    
    Training Lead
    
    
    
    
    
    
    
    
    Training Consultant
    
    
    
    
    
    
    
    
    Post Go-Live Support
    
    
    4,472
    
    
    
    
    
    4,472120,101
    
    
    9,027
    
    
    129,128ADDITIONAL HRSMycroDyn, Ingenix
    
    
    339
    
    
    
    
    
    339MyHealthView
    
    
    1,038
    
    
    
    
    
    1,038Training Lead and Consultant
    
    
    1,600
    
    
    
    
    
    1,600Testing Lead and Consultant
    
    
    2,000
    
    
    
    
    
    2,0001 ITS resource
    
    
    3,114
    
    
    
    
    
    3,1141 Employer/Policy/AR/Premium Config
    
    
    4,152
    
    
    
    
    
    4,1521 Benefit configuration team
    
    
    4,152
    
    
    
    
    
    4,152
 3
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##### 



SOW PHASE I & II
    
    Implementation Agreement
QCSI and Triple-S
 Phase 1 & 2
    

    Phase 3 & 4
    

TotalTechnical
    
    
    
    
    
    6,000
    
    
    6,000Business Configuration
    
    
    
    
    
    9,533
    
    
    9,533Testing
    
    
    
    
    
    634
    
    
    634Post Go Live Support
    
    
    
    
    
    1,870
    
    
    1,870Total Additional Hours
    
    
    16,395
    
    
    18,037
    
    
    34,432GRAND TOTAL
    
    
    136,496
    
    
    27,064
    
    
    163,560
 QCSI realizes that the estimate
contained herein will be insufficient to complete the Work Order, QCSI will notify Customer in
writing, describing reasons for the underestimate. QCSI and Customer will agree on an action
plan to mitigate this impact and if needed determine the estimate of the number of additional
Professional Services hours, by consulting category, necessary to complete the Work Order.
 for cause
 V.
    
    Terms of Compensation to be paid QCSI:
 (A)
    
    Fees for Professional ServicesProfessional Services will be performed on a time and materials basis.Subject to Section 3.1 of the Agreement, the Hourly Services fee rate (the Rate) for this
Work Order shall be one hundred forty dollars ($140.) per hour. The total, estimated Service
fees based upon the terms set forth in this Work Order as of Effective Date of this Work
Order, and calculated by multiplying the Rate by estimated hours by consultant category above
in the Consultant Staffing Plan are twenty two million nine hundred one thousand two hundred
dollars ($22,901,200).The payment terms for this Work Order are as follows (expenses, as set forth in Section 3.3 of
the Agreement, are expressly excluded for the purposes of calculating the quarterly Services
fees):Quarterly Prepayment. Thirty percent (30%) of the estimated quarterly Service fees
(i.e. the total, estimated Service fees based upon the terms set forth in this Work Order,
calculated by multiplying the result of the Rate multiplied by the estimated hours by
consultant category for the applicable quarter during the term of this Work Order by 30%) will
be invoiced, and are due, at the beginning of each quarter, pursuant to the terms of the
Agreement (the Quarterly Prepayment).
 3
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##### 



SOW PHASE I & II
    
    Implementation Agreement
QCSI and Triple-S
 Progress Report Payment. An additional fifty five percent (55%) of the estimated
quarterly Service fees (i.e. the total, estimated Service fees based upon the terms set forth
in this Work Order, calculated by multiplying the result of the Rate multiplied by the
estimated hours by consultant category for the applicable quarter during the term of this Work
Order by 55%) will be invoiced, and are due, upon QCSIs submission of the Monthly Progress
Reports and Weekly Progress Reports, pursuant to the terms of the Agreement, and upon
Customers Acceptance of each applicable Monthly Progress Report (the Progress Report
Payment). For clarity, the Progress Report Payment will be invoiced by QCSI as the Monthly
Progress Reports are delivered (i.e. invoiced monthly).Milestone Payments. The remaining fifteen percent (15%) of the estimated quarterly
Service fees (i.e. the total, estimated Service fees based upon the terms set forth in this
Work Order, calculated by multiplying the result of the Rate multiplied by the estimated hours
by consultant category for the applicable quarter during the term of this Work Order by 15%)
will be invoiced, and are due, in regards to mutually agreed, specific quarterly milestones
(each a Milestone), pursuant to the terms of the Agreement upon Customers Acceptance of
each applicable Milestone (the Milestone Payments). The parties will additionally mutually
agree in regards to Acceptance Criteria for each Milestone, and the process to be used to
determine Customers Acceptance of each Milestone. Milestone Payments will be equally
distributed across the Milestone(s), and the applicable portion of the total Milestone
Payments will be invoiced and paid upon Customers Acceptance of each applicable Milestone,
subject to the terms of the Agreement.If Customer and QCSI do not establish one or more Milestones during a quarter, then the full
Milestone Payment will be invoiced, and will be due, at the end of the applicable quarter,
pursuant to the terms of the Agreement. The parties agree that under no circumstances will
the amount at risk in regards to all quarterly Milestones exceed fifteen percent (15%) of the
quarterly estimated total Service Fees pursuant to this Work Order.True-up. At the end of each quarter, the parties agree to work in good faith to
reconcile the difference between the estimated total Service fees for the applicable quarter
with the actual total Service fees based upon actual hours worked by QCSI consultants in that
same quarter. For example, in the event that the actual total Service fees, calculated by
multiplying the Rate by the actual hours worked by QCSI consultants for the applicable quarter
is greater than sum of the Quarterly Prepayment, the Progress Report Payment, and the
Milestone Payment (subject to Milestone Acceptance as set forth herein), then the Customer
will be invoiced for the balance due to QCSI in excess (the Overage) at the end of the
applicable quarter, and the Overage payment will be due at the end of the applicable quarter,
pursuant to the terms of the Agreement. For greater certainty, the foregoing process may
demonstrate that Customer has overpaid QCSI in a particular quarter, in which case the amount
of such over payment may, at Customers discretion, be applied to the immediately following
Quarterly Prepayment, or refunded to Customer, pursuant to the same terms set forth in Section
(C) titled Unused Prepayment below.An example of calculating the quarterly Service fees is as follows:
 §
    
    The total estimated, quarterly Service fees for QX = $300,000
 3
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##### 



SOW PHASE I & II
    
    Implementation Agreement
QCSI and Triple-S
 §
    
    Quarterly Prepayment:
 o
    
    On the first day of the quarter, Customer will prepay QCSI $90,000
 §
    
    Progress Report Payments:
 o
    
    At the end of month 1, QCSI will invoice for $55,000o
    
    At the end of month 2, QCSI will invoice for $55,000o
    
    At the end of month 3, QCSI will invoice for $55,000
 §
    
    Milestone Payments:
 o
    
    Assume 3 Milestones have been identified for QX. The Milestone Payments are equally
divided among the Milestones, therefore, the Milestone Payments for this QX example are,
and invoiced upon Acceptance, pursuant to the terms of the Agreement:
 o
    
    Milestone 1 (to be completed by month 1) - $15,000o
    
    Milestone 2 (to be completed by month 2) - $15,000o
    
    Milestone 3 (to be completed by month 3) - $15,000
 Notwithstanding anything to the contrary in this Work Order or the Agreement, Customer
acknowledges and agrees that the actualprofessional Service hours worked by each category of
consultant may not coincide directly or uniformly with the Resource Staffing Plan, or the
Consultant Staffing Plan above.QCSI shall provide Customer with periodic reports that disclose the number of hours of
Professional Services utilized (on a weekly and cumulative basis) and the progress of this
Work Order completed to date.(B)
    
    Fees for Out of Pocket, Travel and Related Expenses

Customer shall reimburse QCSI for all expenses incurred by QCSI in connection with this Work
Order in accordance with Section 3.3of the Agreement.(C)
    
    Unused Prepayment

Upon completion or termination of the professional Services specified in this Work Order,
Customer may, at its sole option, elect to have any unused Quarterly Prepayment applied to
additional Professional Services or refunded to Customer. If the Quarterly Prepayment is not
fully utilized within twelve (12) months from the date of receipt by QCSI, and Customer does
not elect to have such unused Quarterly Prepayment refunded within such twelve (12) month
period, such Quarterly Prepayment shall expire and is not refundable.
 VI.
    
    Effective Date of Work Order:This Work Order shall become effective as of the date of last signature below (the Effective Date).VII.
    
    Expiration or Termination Date of Work Order:This Work Order shall terminate upon the completion, in all material respects, of the
professional Services contracted for hereunder (the Expiration Date), unless extended by a
mutually agreed written amendment. Either party may terminate this Work Order prior to the
Expiration Date; provided that the party requesting termination gives the other at least
 3
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##### 



SOW PHASE I & II
    
    Implementation Agreement
QCSI and Triple-S
 thirty (30) days prior written notice. Upon termination, Customer agrees to pay any fees or costs
accrued under this Work Order upon receipt of an invoice from QCSI.
 The Parties hereby cause this Work Order to be executed on and as of the Effective Date.
 QCSI Puerto Rico, Inc.
    
    
    
    Triple-S, Inc.By:
    
    /s/ Jeffrey H. Margols
    
    By:
    
    /s/ Socorro RivasJeffrey H. Margols
    
    
    
    Socorro RivasPrint Name
    
    
    
    Print NameCEO
    
    
    
    President & CEOTitle
    
    
    
    Title12/22/07
    
    
    
    12/21/07Date
    
    
    
    Date
 3
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##### 



SOW PHASE I & II
    
    Implementation Agreement
QCSI and Triple-S
 Third Party Vendors
 1.
    
    McKesson Claim Check2.
    
    Ingenix iCES Facilities Interface3.
    
    Actek4.
    
    Avolent5.
    
    Microdyn
 3
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##### 



SOW PHASE I & II
    
    Implementation Agreement
QCSI and Triple-S
 
 Service
    
    
    
    
    
    
    
    
    
    
    
    
    
    Adapter
    
    Adapter Back
    
    
    
    FormatID
    
    Service
    
    Application Id
    
    Entity
    
    Front End
    
    Back End
    
    Direction
    
    Front End
    
    End
    
    Transformation
    
    Front End
    
    Format Back End1
    
    Receive ID Card File
    
    Flat Card v2007
    
    ID CardNew
    
    Flat Card v2007
    
    QNXT
    
    Outbound
    
    WS
    
    QNXT Adapter
    
    Yes
    
    Flat Card
Id Card
    
    QNXT FORMAT2
    
    Send Member
Information
    
    S.E.R.
    
    Member
    
    S.E.R.
    
    QNXT
    
    Inbound
    
    SQL
    
    QNXT Adapter
    
    Yes
    
    Triple-SMember
    
    QNXT FORMAT3
    
    Send ACH information
    
    S.E.R.
    
    ACH
    
    S.E.R.
    
    QNXT
    
    Inbound
    
    SQL
    
    QNXT Adapter
    
    Yes
    
    Triple-S ACH
    
    QNXT FORMAT4
    
    Eligibiliy Request
Procesing
    
    CLAIMS FOUNDATION
SERVICES
    
    Member
    
    Faciledi
    
    QNXT
    
    Inbound
    
    MQSeries
    
    QNXT Adapter
    
    No
    
    270 Eligibility
Request
    
    270 Eligibility Request5
    
    Eligibiliy Response
Procesing
    
    CLAIMS FOUNDATION
SERVICES
    
    Member
    
    Faciledi
    
    QNXT
    
    Outbound
    
    MQSeries
    
    QNXT Adapter
    
    No
    
    271 Eligibility
Response
    
    271 Eligibility Response6
    
    Claims Submission
Procesing
    
    CLAIMS FOUNDATION
SERVICES
    
    Claims
    
    Faciledi
    
    QNXT
    
    Inbound
    
    MQSeries
    
    QNXT Adapter
    
    No
    
    837 Professional
Claim
    
    837 Professional Claim7
    
    Request Sponsor
Information
    
    SWPRI
    
    Sponsor
    
    SWPRI
    
    QNXT
    
    Outbound
    
    SQL
    
    QNXT Adapter
    
    Yes
    
    Triple-S Sponsor
    
    QNXT FORMAT8
    
    Send Premium Rates
    
    SWPRI
    
    Premium Rates
    
    SWPRI
    
    QNXT
    
    Inbound
    
    SQL
    
    QNXT Adapter
    
    Yes
    
    Triple-S Premium
    
    QNXT FORMAT9
    
    Send Sponsor
Information
    
    SWPRI
    
    Sponsor
    
    SWPRI
    
    QNXT
    
    Inbound
    
    SQL
    
    QNXT Adapter
    
    Yes
    
    Triple-S Sponsor
    
    QNXT FORMAT10
    
    Send Authorization
    
    CCMS
    
    Authorizations
    
    CCMS
    
    QNXT
    
    Inbound
    
    FILE SYSTEM
    
    QNXT Adapter
    
    Yes
    
    CCMS Referral
    
    QNXT FORMAT11
    
    Send Authorization
    
    CCMS
    
    Authorizations
    
    CCMS
    
    QNXT
    
    Inbound
    
    FILE SYSTEM
    
    QNXT Adapter
    
    Yes
    
    CCMS Admission
    
    QNXT FORMAT12
    
    Send Authorization
    
    CCMS
    
    Authorizations
    
    CCMS
    
    QNXT
    
    Inbound
    
    FILE SYSTEM
    
    QNXT Adapter
    
    Yes
    
    CCMS Admission
Review
    
    QNXT FORMAT13
    
    Receive
Authorization
    
    CCMS
    
    Authorizations
    
    CCMS
    
    QNXT
    
    Outbound
    
    FILE SYSTEM
    
    QNXT Adapter
    
    Yes
    
    CCMS Admission
    
    QNXT FORMAT
 3
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##### 



SOW PHASE I & II
    
    Implementation Agreement
QCSI and Triple-S
 Service
    
    
    
    
    
    
    
    
    
    
    
    
    
    Adapter
    
    Adapter Back
    
    
    
    FormatID
    
    Service
    
    Application Id
    
    Entity
    
    Front End
    
    Back End
    
    Direction
    
    Front End
    
    End
    
    Transformation
    
    Front End
    
    Format Back End14
    
    Receive G/L
Transactions
    
    SMARTSTREAM
    
    General Ledger
Transaction
    
    SMARTSTREAM
    
    QNXT
    
    Outbound
    
    FTP
    
    QNXT Adapter
    
    Yes
    
    SmartStream GL
    
    QNXT FORMAT15
    
    Receive Billing
Information
    
    SES GROUPS BILLING
    
    Billing
    
    SES GROUPS BILLING
    
    QNXT
    
    Outbound
    
    SQL
    
    QNXT Adapter
    
    Yes
    
    Triple-S Billing
    
    QNXT FORMAT16
    
    Send Reconciliation
Information
    
    SES GROUPS BILLING
    
    Accounts Receivable
    
    SES GROUPS BILLING
    
    QNXT
    
    Inbound
    
    SQL
    
    QNXT Adapter
    
    Yes
    
    Triple-S AR
    
    QNXT FORMAT17
    
    Receive Payment
Information
    
    ACOM3
    
    Accounts Receivable
    
    ACOM3
    
    QNXT
    
    Outbound
    
    WS
    
    QNXT Adapter
    
    Yes
    
    ACOM3 Payment
    
    QNXT FORMAT18
    
    Receive Member
Information
    
    ACOM3
    
    Member
    
    ACOM3
    
    QNXT
    
    Outbound
    
    WS
    
    QNXT Adapter
    
    Yes
    
    ACOM3 Member
    
    QNXT FORMAT19
    
    Receive A/R
information
    
    ACOM3
    
    Accounts Receivable
    
    ACOM3
    
    QNXT
    
    Outbound
    
    WS
    
    QNXT Adapter
    
    Yes
    
    ACOM3 AR
    
    QNXT FORMAT20
    
    Send Premium Rates
    
    STEPWISE
    
    Premium Rates
    
    STEPWISE
    
    QNXT
    
    Inbound
    
    WS
    
    QNXT Adapter
    
    Yes
    
    QNXT Premium
    
    QNXT FORMAT21
    
    Send Member
Information
    
    REO  OBSTETRICS
REGISTRY
    
    Member
    
    REO  OBSTETRICS
REGISTRY
    
    QNXT
    
    Inbound
    
    WS
    
    QNXT Adapter
    
    Yes
    
    Triple-S Member
    
    QNXT FORMAT22
    
    Receive Provider
Information
    
    REO  OBSTETRICS
REGISTRY
    
    Provider
    
    REO  OBSTETRICS
REGISTRY
    
    QNXT
    
    Outbound
    
    WS
    
    QNXT Adapter
    
    Yes
    
    Triple-S Provider
Group
    
    QNXT FORMAT23
    
    Send Payment
    
    E301-Banks
    
    Accounts Receivable
    
    E301-Banks
    
    QNXT
    
    Inbound
    
    NDM
    
    QNXT Adapter
    
    Yes
    
    Triple-S AR
    
    QNXT FORMAT24
    
    Send Authorization
    
    E307-FHCHS
    
    Authorizations
    
    E307-FHCHS
    
    QNXT
    
    Inbound
    
    FTP
    
    QNXT Adapter
    
    Yes
    
    FHCHS Authorization
    
    QNXT FORMAT25
    
    Send COB information
    
    E405-IKON
    
    COB
    
    E405-IKON
    
    QNXT
    
    Inbound
    
    FTP
    
    QNXT Adapter
    
    Yes
    
    IKON COB
    
    QNXT FORMAT26
    
    Send Enrollment
Error Information
    
    E502-ASES
    
    Member
    
    E502-ASES
    
    QNXT
    
    Inbound
    
    FTP
    
    QNXT Adapter
    
    Yes
    
    ASES Error File
    
    QNXT FORMATASES Member27
    
    Send Query Response
    
    E502-ASES
    
    Member
    
    E502-ASES
    
    QNXT
    
    Inbound
    
    FTP
    
    QNXT Adapter
    
    Yes
    
    Eligibility
    
    QNXT FORMAT
 3
 Page 2 of 47




---



##### 



SOW PHASE I & II
    
    Implementation Agreement
QCSI and Triple-S
 Service
    
    
    
    
    
    
    
    
    
    
    
    
    
    Adapter
    
    Adapter Back
    
    
    
    FormatID
    
    Service
    
    Application Id
    
    Entity
    
    Front End
    
    Back End
    
    Direction
    
    Front End
    
    End
    
    Transformation
    
    Front End
    
    Format Back End28
    
    Send Member
Enrollment
    
    E502-ASES
    
    Member
    
    E502-ASES
    
    QNXT
    
    Inbound
    
    FTP
    
    QNXT Adapter
    
    Yes
    
    ASES Enrollment
    
    QNXT FORMAT29
    
    Send Payment
Information
    
    E502-ASES
    
    Accounts Receivable
    
    E502-ASES
    
    QNXT
    
    Inbound
    
    FTP
    
    QNXT Adapter
    
    Yes
    
    P820 Payment Detail
    
    QNXT FORMAT30
    
    Send Member
Enrollment
    
    E105  Electronic
Enrollment
    
    Member
    
    E105  Electronic
Enrollment
    
    QNXT
    
    Inbound
    
    FTP
    
    QNXT Adapter
    
    No
    
    P834 Member
Enrollment
    
    834 Member Enrollment31
    
    Receive Enrollment
Acknowlegde
    
    E105  Electronic
Enrollment
    
    Functional
Acknowledge
    
    E105  Electronic
Enrollment
    
    QNXT
    
    Outbound
    
    FTP
    
    QNXT Adapter
    
    Yes
    
    Triple-S Enrollment
Acknowledge
    
    QNXT FORMAT32
    
    Send Member
Enrollment
    
    E105  Electronic
Enrollment
    
    Member
    
    E105  Electronic
Enrollment
    
    QNXT
    
    Inbound
    
    FTP
    
    QNXT Adapter
    
    Yes
    
    Hewitt
    
    QNXT FORMAT33
    
    Receive Enrollment
Response
    
    E105  Electronic
Enrollment
    
    Member
    
    E105  Electronic
Enrollment
    
    QNXT
    
    Outbound
    
    FILE SYSTEM
    
    QNXT Adapter
    
    Yes
    
    Triple-S Enrollment
Response
    
    QNXT FORMAT34
    
    Send Member
Enrollment
    
    E105  Electronic
Enrollment
    
    Member
    
    E105  Electronic
Enrollment
    
    QNXT
    
    Inbound
    
    NDM
    
    QNXT Adapter
    
    Yes
    
    P6001
    
    QNXT FORMAT35
    
    Send Member
Enrollment
    
    E105  Electronic
Enrollment
    
    Member
    
    E105  Electronic
Enrollment
    
    QNXT
    
    Inbound
    
    NDM
    
    QNXT Adapter
    
    Yes
    
    Zimmer
    
    QNXT FORMAT36
    
    Send Member
Enrollment
    
    E105  Electronic
Enrollment
    
    Member
    
    E105  Electronic
Enrollment
    
    QNXT
    
    Inbound
    
    NDM
    
    QNXT Adapter
    
    Yes
    
    Cingular
    
    QNXT FORMAT37
    
    Send ACH information
    
    E401-APPLICA
    
    ACH
    
    E401-APPLICA
    
    QNXT
    
    Inbound
    
    FTP
    
    QNXT Adapter
    
    Yes
    
    Triple-S ACH
    
    QNXT FORMAT38
    
    Send Claims
    
    E401-APPLICA
    
    Claims
    
    E401-APPLICA
    
    QNXT
    
    Inbound
    
    FTP
    
    QNXT Adapter
    
    Yes
    
    Triple-S Dental
Claim
    
    QNXT FORMAT
 3
 Page 3 of 47




---



##### 



SOW PHASE I & II
    
    Implementation Agreement
QCSI and Triple-S
 Service
    
    
    
    
    
    
    
    
    
    
    
    
    
    Adapter
    
    Adapter Back
    
    
    
    FormatID
    
    Service
    
    Application Id
    
    Entity
    
    Front End
    
    Back End
    
    Direction
    
    Front End
    
    End
    
    Transformation
    
    Front End
    
    Format Back End39
    
    Send Claims
    
    E401-APPLICA
    
    Claims
    
    E401-APPLICA
    
    QNXT
    
    Inbound
    
    FTP
    
    QNXT Adapter
    
    Yes
    
    Triple-S
Institutional Claim
    
    QNXT FORMAT40
    
    Send Claims
    
    E401-APPLICA
    
    Claims
    
    E401-APPLICA
    
    QNXT
    
    Inbound
    
    FTP
    
    QNXT Adapter
    
    Yes
    
    Triple-S Host Claim
    
    QNXT FORMAT41
    
    Send Claims
    
    E401-APPLICA
    
    Claims
    
    E401-APPLICA
    
    QNXT
    
    Inbound
    
    FTP
    
    QNXT Adapter
    
    Yes
    
    Triple-S Claim
    
    QNXT FORMAT42
    
    Send Authorization
    
    E401-APPLICA
    
    Authorizations
    
    E401-APPLICA
    
    QNXT
    
    Inbound
    
    FTP
    
    QNXT Adapter
    
    Yes
    
    Triple-S Referral
    
    QNXT FORMAT43
    
    Send Claims
    
    E401-APPLICA
    
    Claims
    
    E401-APPLICA
    
    QNXT
    
    Inbound
    
    FTP
    
    QNXT Adapter
    
    Yes
    
    Triple-S
Reinsburstment
    
    QNXT FORMAT44
    
    Send Payment
Information
    
    EXXX-ELA Payment
    
    Accounts Receivable
    
    EXXX-ELA Payment
    
    QNXT
    
    Inbound
    
    FTP
    
    QNXT Adapter
    
    Yes
    
    Triple-S ACH
    
    QNXT FORMAT45
    
    Send Paid Claims
    
    E314-MC21
    
    Claims
    
    E314-MC21
    
    QNXT
    
    Inbound
    
    FTP
    
    QNXT Adapter
    
    Yes
    
    NCPDP
    
    QNXT FORMAT46
    
    Request Provider
Information
    
    WEB PORTAL
    
    Provider
    
    WEB PORTAL
    
    QNXT
    
    Outbound
    
    SQL
    
    QNXT Adapter
    
    Yes
    
    Triple-S Provider
    
    QNXT FORMAT47
    
    Request Member
Information
    
    WEB PORTAL
    
    Member
    
    WEB PORTAL
    
    QNXT
    
    Outbound
    
    SQL
    
    QNXT Adapter
    
    Yes
    
    Triple-S Member
    
    QNXT FORMAT48
    
    Request Sponsor
Information
    
    WEB PORTAL
    
    Sponsor
    
    WEB PORTAL
    
    QNXT
    
    Outbound
    
    SQL
    
    QNXT Adapter
    
    Yes
    
    Triple-S Sponsor
    
    QNXT FORMAT49
    
    Request Claims
History Information
    
    WEB PORTAL
    
    Claims
    
    WEB PORTAL
    
    QNXT
    
    Outbound
    
    SQL
    
    QNXT Adapter
    
    Yes
    
    Triple-S Claim
    
    QNXT FORMAT50
    
    Request A/R
information
    
    WEB PORTAL
    
    Accounts Receivable
    
    WEB PORTAL
    
    QNXT
    
    Outbound
    
    SQL
    
    QNXT Adapter
    
    Yes
    
    Triple-S AR
    
    QNXT FORMAT51
    
    Request
Authorization
Information
    
    WEB PORTAL
    
    Authorizations
    
    WEB PORTAL
    
    QNXT
    
    Outbound
    
    SQL
    
    QNXT Adapter
    
    Yes
    
    Triple-S
Authorization
    
    QNXT FORMAT52
    
    Send Payment
Information
    
    WEB PORTAL
    
    Accounts Receivable
    
    WEB PORTAL
    
    QNXT
    
    Inbound
    
    COM
    
    QNXT Adapter
    
    Yes
    
    Triple-S Payment
    
    QNXT FORMAT
 3
 Page 4 of 47




---



##### 



SOW PHASE I & II
    
    Implementation Agreement
QCSI and Triple-S
 Service
    
    
    
    
    
    
    
    
    
    
    
    
    
    Adapter
    
    Adapter Back
    
    
    
    FormatID
    
    Service
    
    Application Id
    
    Entity
    
    Front End
    
    Back End
    
    Direction
    
    Front End
    
    End
    
    Transformation
    
    Front End
    
    Format Back End53
    
    Send Member
Information
    
    WEB PORTAL
    
    Member
    
    WEB PORTAL
    
    QNXT
    
    Inbound
    
    COM
    
    QNXT Adapter
    
    Yes
    
    Triple-S Member
    
    QNXT FORMAT54
    
    Send Sponsor
Information
    
    WEB PORTAL
    
    Sponsor
    
    WEB PORTAL
    
    QNXT
    
    Inbound
    
    COM
    
    QNXT Adapter
    
    Yes
    
    Triple-S Sponsor
    
    QNXT FORMAT55
    
    Receive Claims
    
    CLAIMS PAYMENT v2007
    
    Claims
    
    CLAIMS PAYMENT v2007
    
    QNXT
    
    Outbound
    
    WS
    
    QNXT Adapter
    
    Yes
    
    Triple-S Claim
    
    QNXT FORMAT56
    
    Send Paid Claims
    
    CLAIMS PAYMENT v2007
    
    Claims
    
    CLAIMS PAYMENT v2007
    
    QNXT
    
    Inbound
    
    WS
    
    QNXT Adapter
    
    Yes
    
    Triple-S Claim
    
    QNXT FORMAT57
    
    Request Provider
Information
    
    CLAIMS PAYMENT v2007
    
    Provider
    
    CLAIMS PAYMENT v2007
    
    QNXT
    
    Outbound
    
    WS
    
    QNXT Adapter
    
    Yes
    
    Triple-S Provider
    
    QNXT FORMAT58
    
    Send Paid Claims
    
    E409-WHI
    
    Claims
    
    E409-WHI
    
    QNXT
    
    Inbound
    
    FTP
    
    QNXT Adapter
    
    Yes
    
    NCPDP
    
    QNXT FORMAT59
    
    Receive Provider
Information
    
    E315-Mckesson
    
    Provider
    
    E315-Mckesson
    
    QNXT
    
    Outbound
    
    FTP
    
    QNXT Adapter
    
    Yes
    
    Mckesson Provider
    
    QNXT FORMAT60
    
    Receive Provider
Information
    
    E314-MC21
    
    Provider
    
    E314-MC21
    
    QNXT
    
    Outbound
    
    FTP
    
    QNXT Adapter
    
    Yes
    
    MC21 Provider
    
    QNXT FORMAT61
    
    Receive Provider
Information
    
    E401-APPLICA
    
    Provider
    
    E401-APPLICA
    
    QNXT
    
    Outbound
    
    FTP
    
    QNXT Adapter
    
    Yes
    
    APPLICA Provider
    
    QNXT FORMAT62
    
    Receive Provider
Information
    
    E503-BCBSA
    
    Provider
    
    E503-BCBSA
    
    QNXT
    
    Outbound
    
    FTP
    
    QNXT Adapter
    
    Yes
    
    Provider Directory
Format
    
    QNXT FORMAT63
    
    Receive Billing
Information
    
    EXXX-ELA Billing
    
    Billing
    
    EXXX-ELA Billing
    
    QNXT
    
    Outbound
    
    FTP
    
    QNXT Adapter
    
    Yes
    
    Billing Bayamon
    
    QNXT FORMAT64
    
    Receive Billing
Information
    
    EXXX-ELA Billing
    
    Billing
    
    EXXX-ELA Billing
    
    QNXT
    
    Outbound
    
    FTP
    
    QNXT Adapter
    
    Yes
    
    Billing Hacienda
    
    QNXT FORMAT65
    
    Receive Billing
Information
    
    EXXX-ELA Billing
    
    Billing
    
    EXXX-ELA Billing
    
    QNXT
    
    Outbound
    
    FTP
    
    QNXT Adapter
    
    Yes
    
    Billing Policia
    
    QNXT FORMAT
 3
 Page 5 of 47




---



##### 



SOW PHASE I & II
    
    Implementation Agreement
QCSI and Triple-S
 Service
    
    
    
    
    
    
    
    
    
    
    
    
    
    Adapter
    
    Adapter Back
    
    
    
    FormatID
    
    Service
    
    Application Id
    
    Entity
    
    Front End
    
    Back End
    
    Direction
    
    Front End
    
    End
    
    Transformation
    
    Front End
    
    Format Back End66
    
    Receive Billing
Information
    
    EXXX-ELA Billing
    
    Billing
    
    EXXX-ELA Billing
    
    QNXT
    
    Outbound
    
    FTP
    
    QNXT Adapter
    
    Yes
    
    Billing San Juan
    
    QNXT FORMAT67
    
    Receive A/R
information
    
    EXXX-Coupons
    
    Accounts Receivable
    
    EXXX-Coupons
    
    QNXT
    
    Outbound
    
    FTP
    
    QNXT Adapter
    
    Yes
    
    Coupons
    
    QNXT FORMAT68
    
    Receive A/R
information
    
    EXXX-GBCS
    
    Accounts Receivable
    
    EXXX-GBCS
    
    QNXT
    
    Outbound
    
    FTP
    
    QNXT Adapter
    
    Yes
    
    GBCS AR
    
    QNXT FORMAT69
    
    Receive Premium
Payment Information
    
    EXXX-GA Life
    
    Accounts Receivable
    
    EXXX-GA Life
    
    QNXT
    
    Outbound
    
    FTP
    
    QNXT Adapter
    
    Yes
    
    Triple-S Premium
Payment
    
    QNXT FORMAT70
    
    Receive Medicare
Advantage Query
    
    E502-ASES
    
    Member
    
    E502-ASES
    
    QNXT
    
    Outbound
    
    FTP
    
    QNXT Adapter
    
    Yes
    
    ASES Member
Eligibility
    
    QNXT FORMAT71
    
    Send ITS Home Claims
    
    E503-BCBSA
    
    Claims
    
    E503-BCBSA
    
    QNXT
    
    Inbound
    
    NDM
    
    QNXT Adapter
    
    No
    
    ITS Submission
    
    ITS Submission72
    
    Receive ITS Home
Claims
    
    E503-BCBSA
    
    Claims
    
    E503-BCBSA
    
    QNXT
    
    Outbound
    
    NDM
    
    QNXT Adapter
    
    No
    
    ITS Disposition
    
    ITS Disposition73
    
    Receive Provider
Information
    
    CCMS
    
    Provider
    
    CCMS
    
    QNXT
    
    Outbound
    
    FILE SYSTEM
    
    QNXT Adapter
    
    Yes
    
    CCMS Provider
    
    QNXT FORMAT74
    
    Receive Provider
Groups
    
    CCMS
    
    Provider
    
    CCMS
    
    QNXT
    
    Outbound
    
    FILE SYSTEM
    
    QNXT Adapter
    
    Yes
    
    CCMS Provider
Practice Groups
    
    QNXT FORMAT75
    
    Receive IPA
    
    CCMS
    
    Provider
    
    CCMS
    
    QNXT
    
    Outbound
    
    FILE SYSTEM
    
    QNXT Adapter
    
    Yes
    
    CCMS Provider
Practice Groups
    
    QNXT FORMAT76
    
    Receive Facility
    
    CCMS
    
    Provider
    
    CCMS
    
    QNXT
    
    Outbound
    
    FILE SYSTEM
    
    QNXT Adapter
    
    Yes
    
    CCMS Facility
    
    QNXT FORMAT77
    
    Request Member
Authentication
    
    IVR
    
    Member
    
    IVR
    
    QNXT
    
    Outbound
    
    SQL
    
    QNXT Adapter
    
    Yes
    
    Triple-S Member
    
    QNXT FORMAT78
    
    Receive ELA Renewal
Transaction
    
    IVR
    
    Member
    
    IVR
    
    QNXT
    
    Outbound
    
    SQL
    
    QNXT Adapter
    
    No
    
    Triple-S Member
    
    QNXT FORMAT
 3
 Page 6 of 47




---



##### 



SOW PHASE I & II
    
    Implementation Agreement
QCSI and Triple-S
 Service
    
    
    
    
    
    
    
    
    
    
    
    
    
    Adapter
    
    Adapter Back
    
    
    
    FormatID
    
    Service
    
    Application Id
    
    Entity
    
    Front End
    
    Back End
    
    Direction
    
    Front End
    
    End
    
    Transformation
    
    Front End
    
    Format Back End79
    
    Request Premium
Rates Information
    
    IVR
    
    Premium Rates
    
    IVR
    
    QNXT
    
    Outbound
    
    SQL
    
    QNXT Adapter
    
    Yes
    
    Triple-S Premium
    
    QNXT FORMAT80
    
    Request Member
Information
    
    IVR
    
    Member
    
    IVR
    
    QNXT
    
    Outbound
    
    SQL
    
    QNXT Adapter
    
    Yes
    
    Triple-S Member
    
    QNXT FORMAT81
    
    Request ID Card
    
    IVR
    
    ID Card New
    
    IVR
    
    QNXT
    
    Inbound
    
    SQL
    
    QNXT Adapter
    
    Yes
    
    Triple-S ID Card
    
    QNXT FORMAT82
    
    Request A/R
Information
    
    IVR
    
    Accounts Receivable
    
    IVR
    
    QNXT
    
    Outbound
    
    SQL
    
    QNXT Adapter
    
    Yes
    
    Triple-S AR
    
    QNXT FORMAT83
    
    Request Member
Eligibility
    
    IVR
    
    Member
    
    IVR
    
    QNXT
    
    Outbound
    
    SQL
    
    QNXT Adapter
    
    No
    
    Triple-S Member
    
    QNXT FORMAT84
    
    Request Claims
History Information
    
    IVR
    
    Claims
    
    IVR
    
    QNXT
    
    Outbound
    
    SQL
    
    QNXT Adapter
    
    Yes
    
    Triple-S Claim
    
    QNXT FORMAT85
    
    Request Coupon Book
replacement
    
    IVR
    
    Member
    
    IVR
    
    QNXT
    
    Outbound
    
    SQL
    
    QNXT Adapter
    
    Yes
    
    Triple-S Member
    
    QNXT FORMAT86
    
    Request ID Card
    
    IVR
    
    ID Card New
    
    IVR
    
    QNXT
    
    Outbound
    
    SQL
    
    QNXT Adapter
    
    Yes
    
    Triple-S ID Card
    
    QNXT FORMAT87
    
    Receive Premium
Payment
    
    IVR
    
    Accounts Receivable
    
    IVR
    
    QNXT
    
    Outbound
    
    SQL
    
    QNXT Adapter
    
    Yes
    
    Triple-S AR
    
    QNXT FORMAT88
    
    Request Claims
Status(last 5)
    
    IVR
    
    Claims
    
    IVR
    
    QNXT
    
    Outbound
    
    SQL
    
    QNXT Adapter
    
    Yes
    
    Triple-S Claim
    
    QNXT FORMAT89
    
    Request
Authorization
Information
    
    IVR
    
    Authorizations
    
    IVR
    
    QNXT
    
    Outbound
    
    SQL
    
    QNXT Adapter
    
    Yes
    
    Triple-S
Authorization
    
    QNXT FORMAT90
    
    Request Member
Upfront Deductible
Status
    
    IVR
    
    Member
    
    IVR
    
    QNXT
    
    Outbound
    
    SQL
    
    QNXT Adapter
    
    Yes
    
    Triple-S Member
    
    QNXT FORMAT91
    
    Request Audit Trail
    
    IVR
    
    Member
    
    IVR
    
    QNXT
    
    Outbound
    
    SQL
    
    QNXT Adapter
    
    Yes
    
    Triple-S Member
    
    QNXT FORMAT92
    
    Request Provider
Eligibility
    
    IVR
    
    Provider
    
    IVR
    
    QNXT
    
    Outbound
    
    SQL
    
    QNXT Adapter
    
    Yes
    
    Triple-S Provider
    
    QNXT FORMAT
 3
 Page 7 of 47




---



##### 



SOW PHASE I & II
    
    Implementation Agreement
QCSI and Triple-S


Service
    
    
    
    
    
    
    
    
    
    
    
    
    
    Adapter
    
    Adapter Back
    
    
    
    FormatID
    
    Service
    
    Application Id
    
    Entity
    
    Front End
    
    Back End
    
    Direction
    
    Front End
    
    End
    
    Transformation
    
    Front End
    
    Format Back End93
    
    Receive Member
Information
    
    IVR
    
    Member
    
    IVR
    
    QNXT
    
    Outbound
    
    SQL
    
    QNXT Adapter
    
    Yes
    
    Triple-S Member
    
    QNXT FORMAT94
    
    Request Special
Coverage
(Catastrophic)
information
    
    IVR
    
    Member
    
    IVR
    
    QNXT
    
    Outbound
    
    SQL
    
    QNXT Adapter
    
    Yes
    
    Triple-S Member
    
    QNXT FORMAT95
    
    Request Provider
Authentication
    
    IVR
    
    Provider
    
    IVR
    
    QNXT
    
    Outbound
    
    SQL
    
    QNXT Adapter
    
    Yes
    
    Triple-S Provider
    
    QNXT FORMAT96
    
    Receive
Authorization
Request
    
    IVR
    
    Authorizations
    
    IVR
    
    QNXT
    
    Outbound
    
    SQL
    
    QNXT Adapter
    
    Yes
    
    Triple-S
Authorization
    
    QNXT FORMAT97
    
    Request Claim Status
    
    IVR
    
    Claims
    
    IVR
    
    QNXT
    
    Outbound
    
    SQL
    
    QNXT Adapter
    
    Yes
    
    Triple-S Claim
    
    QNXT FORMAT98
    
    Request Payment
Information
    
    IVR
    
    Claims
    
    IVR
    
    QNXT
    
    Outbound
    
    SQL
    
    QNXT Adapter
    
    Yes
    
    Triple-S Claim
    
    QNXT FORMAT99
    
    Request Claims
Payment Schedule
    
    IVR
    
    Claims
    
    IVR
    
    QNXT
    
    Outbound
    
    SQL
    
    QNXT Adapter
    
    Yes
    
    Triple-S Claim
    
    QNXT FORMAT100
    
    Request Fee
Schedule
Information
    
    IVR
    
    Fee Schedule
    
    IVR
    
    QNXT
    
    Outbound
    
    SQL
    
    QNXT Adapter
    
    Yes
    
    Triple-S Fee
Schedule
    
    QNXT FORMAT101
    
    Request RTP
    
    IVR
    
    Claims
    
    IVR
    
    QNXT
    
    Outbound
    
    SQL
    
    QNXT Adapter
    
    Yes
    
    Triple-S Claim
    
    QNXT FORMAT102
    
    Receive
Authorization
Request  Dummy
    
    IVR
    
    Authorizations
    
    IVR
    
    QNXT
    
    Outbound
    
    SQL
    
    QNXT Adapter
    
    Yes
    
    Triple-S
Authorization
    
    QNXT FORMAT103
    
    Request Upfront
Deductible Status
    
    IVR
    
    Member
    
    IVR
    
    QNXT
    
    Outbound
    
    SQL
    
    QNXT Adapter
    
    Yes
    
    Triple-S Member
Accumulator
    
    QNXT FORMAT104
    
    Request Provider
Information
    
    IVR
    
    Provider
    
    IVR
    
    QNXT
    
    Outbound
    
    SQL
    
    QNXT Adapter
    
    Yes
    
    Triple-S Provider
    
    QNXT FORMAT105
    
    Request Medicare -
Payments Already
Paid
    
    IVR
    
    Claims
    
    IVR
    
    QNXT
    
    Outbound
    
    SQL
    
    QNXT Adapter
    
    Yes
    
    Triple-S Claim
    
    QNXT FORMAT106
    
    Request RTP
    
    IVR
    
    Claims
    
    IVR
    
    QNXT
    
    Outbound
    
    SQL
    
    QNXT Adapter
    
    Yes
    
    Triple-S Claim
    
    QNXT FORMAT
 3
 Page 8 of 47




---



##### 



SOW PHASE I & II
    
    Implementation Agreement
QCSI and Triple-S
 Service
    
    
    
    
    
    
    
    
    
    
    
    
    
    Adapter
    
    Adapter Back
    
    
    
    FormatID
    
    Service
    
    Application Id
    
    Entity
    
    Front End
    
    Back End
    
    Direction
    
    Front End
    
    End
    
    Transformation
    
    Front End
    
    Format Back End107
    
    Request Sponsor
Authentication
    
    IVR
    
    Sponsor
    
    IVR
    
    QNXT
    
    Outbound
    
    SQL
    
    QNXT Adapter
    
    Yes
    
    Triple-S Sponsor
    
    QNXT FORMAT108
    
    Request Sponsor
Information
    
    IVR
    
    Sponsor
    
    IVR
    
    QNXT
    
    Outbound
    
    SQL
    
    QNXT Adapter
    
    Yes
    
    Triple-S Sponsor
    
    QNXT FORMAT109
    
    Send Fee Schedule
    
    CIMA
    
    Fee Schedule
    
    CIMA
    
    QNXT
    
    Inbound
    
    WS
    
    QNXT Adapter
    
    Yes
    
    Triple-S Fee
Schedule
    
    QNXT FORMAT110
    
    Request Fee Schedule
    
    CIMA
    
    Fee Schedule
    
    CIMA
    
    QNXT
    
    Outbound
    
    WS
    
    QNXT Adapter
    
    Yes
    
    Triple-S Fee
Schedule
    
    QNXT FORMAT111
    
    Send Benefits
Information
    
    CIMA
    
    Benefit
    
    CIMA
    
    QNXT
    
    Inbound
    
    WS
    
    QNXT Adapter
    
    Yes
    
    Triple-S Benefits
    
    QNXT FORMAT112
    
    Request Benefits
Information
    
    CIMA
    
    Benefit
    
    CIMA
    
    QNXT
    
    Outbound
    
    WS
    
    QNXT Adapter
    
    Yes
    
    Triple-S Benefits
    
    QNXT FORMAT113
    
    Send PDF
    
    CIMA
    
    Benefit
    
    CIMA
    
    QNXT
    
    Inbound
    
    WS
    
    QNXT Adapter
    
    Yes
    
    Triple-S PDF
    
    QNXT FORMAT114
    
    Request PDF
Information
    
    CIMA
    
    Benefit
    
    CIMA
    
    QNXT
    
    Outbound
    
    WS
    
    QNXT Adapter
    
    Yes
    
    Triple-S PDF
    
    QNXT FORMAT115
    
    Send RTP
    
    CIMA
    
    Claims
    
    CIMA
    
    QNXT
    
    Inbound
    
    WS
    
    QNXT Adapter
    
    Yes
    
    Triple-S Claim
    
    QNXT FORMAT116
    
    Request RTP
    
    CIMA
    
    Claims
    
    CIMA
    
    QNXT
    
    Outbound
    
    WS
    
    QNXT Adapter
    
    Yes
    
    Triple-S Claim
    
    QNXT FORMAT117
    
    Send Special
Coverage
Information
    
    CCMS
    
    Member
    
    CCMS
    
    QNXT
    
    Inbound
    
    FILE SYSTEM
    
    QNXT Adapter
    
    Yes
    
    Triple-S Special
Coverage
    
    QNXT FORMAT118
    
    Request Member
Information
    
    WEB PORTAL
    
    Member
    
    WEB PORTAL
    
    QNXT
    
    Outbound
    
    COM
    
    QNXT Adapter
    
    Yes
    
    Triple-S Member
    
    QNXT FORMAT119
    
    Receive Provider
Information
    
    Providers MF
    
    Provider
    
    Mainframe
    
    QNXT
    
    Outbound
    
    FTP
    
    QNXT Adapter
    
    Yes
    
    Triple-S Provider
    
    QNXT FORMAT120
    
    Receive Provider
Information
    
    Cactus
    
    Provider
    
    Cactus
    
    QNXT
    
    Outbound
    
    SQL
    
    QNXT Adapter
    
    Yes
    
    Cactus Provider
    
    QNXT FORMAT121
    
    Receive Provider
Information
    
    Providers MF
    
    Provider
    
    Mainframe
    
    QNXT
    
    Outbound
    
    FTP
    
    QNXT Adapter
    
    Yes
    
    Triple-S Provider
Group
    
    QNXT FORMAT
 3
 Page 9 of 47




---



##### 



SOW PHASE I & II
    
    Implementation Agreement
QCSI and Triple-S
 Service
    
    
    
    
    
    
    
    
    
    
    
    
    
    Adapter
    
    Adapter Back
    
    
    
    FormatID
    
    Service
    
    Application Id
    
    Entity
    
    Front End
    
    Back End
    
    Direction
    
    Front End
    
    End
    
    Transformation
    
    Front End
    
    Format Back End122
    
    Receive Provider
Information
    
    Cactus
    
    Provider
    
    Cactus
    
    QNXT
    
    Outbound
    
    SQL
    
    QNXT Adapter
    
    Yes
    
    Cactus Provider
Groups
    
    QNXT FORMAT123
    
    Receive Provider
Information
    
    Providers MF
    
    Provider
    
    Mainframe
    
    QNXT
    
    Outbound
    
    FTP
    
    QNXT Adapter
    
    Yes
    
    Triple-S IPA
    
    QNXT FORMAT124
    
    Receive Provider
Information
    
    Cactus
    
    Provider
    
    Cactus
    
    QNXT
    
    Outbound
    
    SQL
    
    QNXT Adapter
    
    Yes
    
    Cactus IPA
    
    QNXT FORMAT125
    
    Receive Provider
Information
    
    Providers MF
    
    Provider
    
    Mainframe
    
    QNXT
    
    Outbound
    
    FTP
    
    QNXT Adapter
    
    Yes
    
    Triple-S Provider MA
    
    QNXT FORMAT126
    
    Receive Provider
Information
    
    Cactus
    
    Provider
    
    Cactus
    
    QNXT
    
    Outbound
    
    SQL
    
    QNXT Adapter
    
    Yes
    
    Cactus Provider MA
    
    QNXT FORMAT127
    
    Send Credentialing
Data
    
    Cactus
    
    Provider
    
    Cactus
    
    QNXT
    
    Inbound
    
    SQL
    
    QNXT Adapter
    
    Yes
    
    Cactus Credentialing
    
    QNXT FORMAT128
    
    Send Acummulators
Information
    
    Transaction Driven
    
    Member
    
    Transaction Driven
    
    QNXT
    
    Inbound
    
    MQSeries
    
    QNXT Adapter
    
    Yes
    
    Triple-S Member
Accumulator
    
    QNXT FORMAT129
    
    Receive
Acummulators
Information
    
    Transaction Driven
    
    Member
    
    Transaction Driven
    
    QNXT
    
    Outbound
    
    MQSeries
    
    QNXT Adapter
    
    Yes
    
    Triple-S Member
Accumulator
    
    QNXT FORMAT130
    
    Request Provider
Information
    
    IPA WEB
    
    Provider
    
    IPA WEB
    
    QNXT
    
    Outbound
    
    SQL
    
    QNXT Adapter
    
    Yes
    
    Triple-S Provider
    
    QNXT FORMAT131
    
    Request Member
Information
    
    IPA WEB
    
    Member
    
    IPA WEB
    
    QNXT
    
    Outbound
    
    SQL
    
    QNXT Adapter
    
    Yes
    
    Triple-S Member
    
    QNXT FORMAT132
    
    Send Claims
Adjustments
    
    IPA WEB
    
    Claims
    
    IPA WEB
    
    QNXT
    
    Inbound
    
    SQL
    
    QNXT Adapter
    
    Yes
    
    Triple-S Claim
Adjustment
    
    QNXT FORMAT
 3
 Page 10 of 47