Facets
can be termed as a One-Stop Service Center for healthcare payer organizations. It
is an integrated health care payer administration solution, designed to handle
the complex requirements of managed health plans. The role of facets in health insurance is of great importance.
New
regulatory requirements such as ACA as well as ongoing Medicare and Medicaid
updates demand flexibility in payer’s technology and processes. TriZetto has
developed Facets to provide solutions to
these complex requirements. Facets is scalable,
serving both large and smaller plans. Facets claims processing tool has given new directions to health insurance industry.
The
Facets system automates and streamlines critical business functions across the
enterprise, including member enrollment, premium billing, claims processing and
customer service, helping payers decrease administrative spending while
improving both healthcare and business outcomes.
The
current version of Facets is 5.0 and Facets is organized in Application groups
and the main Application groups are as
follows:
1.
Accounting application group
2.
Application Support application group
3.
Billing application group
4.
Capitation/Risk Allocation application group
5.
Claims Processing application group
6.
Claims Processing + ITS application group
7.
Commission application group
8.
Criteria Maintenance application group
9.
Customer Service application group
10. Dental Plan application group
11.
Dental Provider Agreement application group
12.FSA
Plan application group
13.
ITS Application Support application group
14.
ITS Plan application group
15.
Medical Plan application group
16.
NetworX application group
17.
Pricing Profile application group
18.
Provider application group
19.
Subscriber/Member application group
20.
Utilization Management application group
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