Dental Provider Agreement Application Group in Facets

TriZetto's  Facets is an epoch-making tool for claims processing and other activities related to claims processing. Facets is playing a very vital role in the health insurance industry. This is why it is so popular with healthcare payers. Claims processing and providers are inter-related. Every healthcare payer has a network of participating providers. After treatment is done, the participating providers submit claims to healthcare payers for payment. 

Participating providers are those physicians and allied health providers who have entered into a provider agreement with the healthcare payers. The provider agreement of the Participating providers is a very useful legal document for the providers' obligations, terms and conditions.

As a network provider, the provider has to agree to  a negotiated rate. Any amount above the negotiated rate is a contractual write-off and not billable to the member. The provider can bill the member any applicable deductible, co-pay, co-insurance and non-covered service, but not any amount above the negotiated rate for a covered service.

The Dental Provider Agreement application group in Facets has different applications to serve these purposes for dental providers. The applications of this group is used to establish or edit an agreement between participation dental providers. During the  dental claims processing, claims processing application of facets internally visits the contractual rules maintained in the applications of Dental Provider Agreement application group.  The applications in the Dental Provider Agreement application group are:

1. Agreement, Dental

2. Category Discounts

3. Prompt Payment Discount