Processing a Medical Claim in Facets

One of the visitors of this site named MD Harun Rashid wanted to know how to process a medical claim in Facets. So, I am narrating below what are the steps one is supposed to perform to process a medical claim in Facets.

Step 1: Open Test Lab Module of ALM. Suppose the test case is PCP Office Visit.

Test Case description: Process an office visit  professional claim using following data:

PCP ID 111222333444 (Family Practice), POS 11, CPT code 99214, Subscriber ID-111222333, Diagnosis code-ICD10:  E11618, Charges(PCP's Fee)-$100, Unit 1(One Time Visit).

Expected Result: Claim should apply a Copayment of $35 , then process at 100% of the allowable

Step 2: Open Facets Claims Processing application group and scroll down to Medical Claim processing application.

Step 3: In the Indicative page of Medical Claim processing application, enter the following data: Subscriber ID and select a member from the drop down menu, Claim Received Date(suppose Jan 25, 2017), Provider ID and Diagnosis code.

Step 4: Now double click on Line Item page and when you are in Line Item page, enter the following data: Date of service (suppose Jan 20, 2017), POS, CPT code, Charges(suppose $100), Unit(suppose 1), Total charges(Suppose $100).

Step 5: Press F3 on your keyboard to process the claim. Now check the claim pricing.

Step 6: If the claim applies a copay of $35 as expected and then process at 100% of the allowable, save the claim by pressing F4 on your keyboard. Facets will generate a claim ID automatically.

Step7: Open Lab module of ALM and type as follows in actual result edit box:

Claim processed as expected and write the claim ID and pass the test case.