As a claims processing tool, Facets is
playing a very vital role in the health insurance industry. This is why it is so
popular with healthcare payers. One of the great features of Facets is its
different application groups. One of them is Dental Plan application group.
The
Dental Plan group of applications
holds information about the dental plans offered and administered by healthcare
payer organizations. Each application in this group holds details of an integral
dental plan component.
The
applications available in this group are:
1.
Administrative Information
2.
Administrative Rules, Dental
3.
Area & Industry Rate Factors
4.
Alternate Funding Rules
5.
Automatic Action Criteria
6.
Benefit Summary
7.
Billing Component
8.
Class/Plan Definition
9.
COB Rules
10.
Component Prefix Descriptions
11.
Conversion Factor Definition, Dental
12.
Covering Provider Set application
13.
Deductible Rules
14.
Dental Category Payment
15.
Dental Category Related Parameters
16.
Dental Category Rule Definition
17.
Dental Category Waiting Period
18.
Dental Procedure/Category Conversion
19.
Dental Utilization Edits
20.
Duplicate Claim Rules, Dental
21.
EOB Information
22.
Group Administration Rules
23.
In Area ZIP Codes
24.
Limit Rules
25.
Network Set
26.
Other Party Liability
27.
Plan Descriptions
28.
Premium Rate Table
29.
Procedure Definition, Dental
30.
Procedure Payment, Dental
31.
Procedure Pricing, Dental
32.
Processing Control Agent
33.
Product
34.
R&C/Schedule, Dental
35.
Trend Rate Factors
36.
Unit Value Pricing Definition, Dental
37.
User Warning Messages
38.
Volume Calculation
39.
Volume Reduction Calculation
40.
Warning Messages
41.
Zip Code Area Definition
Therefore, many Koreans also join a private health insurance that covers what the national health insurance does not cover, such as deductibles (which can get high, since it’s a percentage of the NHIC-set cost rather than an absolute amount,) lost wages, etc.
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