Facets

Facets QA Tutorial L I N K

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