Facets Healthcare Application



Facetscan be termed as a One-Stop Service Center for healthcare payer organizations. Itis an integrated health care payer administration solution, designed to handlethe complex requirements of managed health plans. The role of facets in health insurance is of great importance.
Newregulatory requirements such as ACA as well as ongoing Medicare and Medicaidupdates demand flexibility in payer’s technology and processes. TriZetto hasdeveloped Facets to provide solutions tothese complex requirements. Facets is scalable,serving both large and smaller plans. Facets claims processing tool has given new directions to health insurance industry.

Master Facets hands-on from basic to advanced level concepts with real-time examples. Our training will help you gain in-depth knowledge of claims processing and automating tasks using Facets workflow application through hands-on sessions. By the end of the training, you’ll become an expert in applying this knowledge in real-world. Master Facets hands-on from basic to advanced level concepts with real-time examples. Our training will help you gain in-depth knowledge of claims processing and automating tasks using Facets workflow application through hands-on sessions. By the end of the training, you’ll become an expert in applying this knowledge in real-world. The Facets Core Administration platform, trusted by more than 75 healthcare organizations, consists of a rich set of modules that allow payer organizations to meet their business requirements while positioning them for growth and change. Healthcare FACETS System Facets (Trizetto Claims processing system) provides several functionality which is supported under the application group or you can call modules.It helps the organizations to perform their day to day operational work by utilizing any or all of the application groups.

TheFacets system automates and streamlines critical business functions across theenterprise, including member enrollment, premium billing, claims processing andcustomer service, helping payers decrease administrative spending whileimproving both healthcare and business outcomes.
Thecurrent version of Facets is 5.0 and Facets is organized in Application groupsand the main Application groups are asfollows:
1.Accounting application group
3.Billing application group
5.Claims Processing application group
7.Commission application group
9.Customer Service application group
11.Dental Provider Agreement application group
13.ITS Application Support application group
15.Medical Plan application group
Healthcare
17.Pricing Profile application group
19.Subscriber/Member application group

Facets Healthcare Tables

20.Utilization Management application group
Agile Health Technologies’ FACETS Center of Excellence in blended-shore model is enabling our customers to leverage full potential and benefit of FACETS system, while reducing operational cost by 30% or more and enhancing overall operational efficiency.

Facets Healthcare Claims

Agile Health Technologies Inc. is a healthcare information technology company offering specialized business and technology solutions and services in product areas such as FACETS and QNXT for our Health Plan clients.

FACETS, one of the flagship products of Trizetto, is an excellent Health Plan core administration solution. However, like any enterprise product, from implementation to operation and production support, it requires configurations, customizations, extensions and interfaces to meet the client-specific business requirements. With constant changes in business rules, government mandates, technological advances etc., there is a constant need to upgrade and changes to the enterprise application without impacting the core systems.

FACETS Healthcare – At Agile, our highly skilled FACETS experts are helping our clients in utilizing the fullest potential of the FACETS system through seamless integration, configuration, extensions, upgrades and testing through our blended-shore FACETS Center of Excellence. Whether it is Plan / Product configuration, Provider Networks or Fee Schedule, NetworX Pricing, ExternalClaims and Accumulator updates, Workflow management integrating external applications like Claims Xtend; our
Center of Excellence is the best and most cost-effective alternative to OEM resources. We are your partner in your healthcare business operation using FACETS.

Through our blended-shore FACETS Center of Excellence, we offer: • FACETS Implementation and Upgrades • Configuration, process and workflow management • Application Integration and external interfaces • Real time integration and FXI services • Enhancements and Extensions • Testing Services • Production support and batch operation
Healthcare
• Developed the integration and SOA components for a large health plan using FACETS.• Implemented the complete FACETS batch processing and error handling process using Tidal for a health plan in west coast.• Implemented the complete FEP program in FACETS• Implemented Prime PBM with real time accumulator update to and from FACETS.• Complete plan / product benefit testing for a large health plan• Automated the Fee Schedule load process for a large health plan• Implemented letter server for a health plan in west coast• Automated the billing receipt and premium reconciliation process• Developed customized small and large group rating system and automated rate upload to FACETS

FACETS Healthcare Technology, We located in Naperville, IL and Bangalore, India; provides the perfect mix of onshore – offsite team composition managed through our robust RMO and project delivery which is managed by the PMO process. This “follow the sun”
model of delivery brings in –
• Reduces implementation and operational cost for our clients
• Enables 24-hour support
• Faster delivery
• High quality due to both onshore and offsite quality inspections
• Ability to expand and contract staffing based on current needs

FacetsFacets

We are a Hi-TRUST accessed and Hi-Tech Associates security certified and HIPAA compliant organization.

The agile healthcare technology company, our Center of Excellence is providing best in class Outsourcing services in the following areas –

Provider and Network Management – We at Agile help our Clients manage their annual Provider and network assignment along with the agreements. We help set up the agreements and conduct user acceptance testing on their behalf.
Configuration and Benefits Management – Every year Health Plans roll out new products and changes. We help our Clients in configuration and benefits validation using our proprietary benefit testing Tool BenefitPro or Client specific tools.
Pricing and Agreements – We specialize in Managing provider pricing and Network configuration. We configure agreements and pricing and validate the pricing using custom reports and Claim Processing.
Enrolment and Billing – Our Services include Validation of new enrolment process and systems, annual rate validation and specimen billing validation. Billing reconciliation and Broker Commission processing
Claims Analytics and Recovery – We assist Clients in their analytics by providing ad hoc reporting and data presentation. We also help in their overpayment recovery process and corrections. We also perform validation for Configuration changes, Productions Incidents and new changes.

Facets Healthcare Application

Our Outsourcing model employs a flexible resource plan, duration and schedule based on clients need. Our model offers the unique blend of Knowledge and flexibility which can assist Clients in their operation and increase savings.

• Product Benefit configuration and testing • NetworX Pricing configuration and FEE Schedule loading • Automated Enrollment • Claims and EXCD configuration and testing • ITS Claims Processing • Utilization Management • Formatted outputs, ID cards, Letters and Invoice generation • External claims and accumulator updates • Accumulator Synchronization Process • Billing Receipt automation • Group rating systems automation and rate upload • PBM Integration both real time and batch • Integrating external applications such as Claims Xtend, ClearCoverage, Care Advance etc. • Medicare Management / EAM implementation • FACETS Consumer Directed Health (CDH) • EDI processing – 834, 835, 837, 820, 270/271, 276/277 transactions • HIPAA Gateway implementation
For more details, email us at sales@agilehealthtech.com