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Blue Cross and Blue Shield plans communicate and share data with each other via the nationwide ITS network. But getting a core administrative system to seamlessly share data via ITS can be a challenge. Data input errors, unacceptable time lags, inconsistency and even compliance issues can erode productivity and customer loyalty.
TriZetto's ITS solutions for Facets enable Blues plans to better support real-time claims processing and member liability estimation using the ITS structure. Designed to meet the specific business needs of Blue Cross and Blue Shield organizations, the Facets ITS subsystem allows you to send, receive and manage data regarding claims, providers, membership and fee-for-service/capitation billing.
In the process, it:
Real-time delivery of claims and customer service items, reducing bottlenecks and automating work.
Near real-time accumulator synchronization between Facets and third-party vendors.
Supports the administration of flexible spending accounts, health reimbursement arrangements, and health savings accounts.
Real-time ITS solutions for claims processing and member liability estimation for BCBS plans.
Data publishing and web services that extend and integrate with the Facets system in real-time with third-party applications.
Administer and reimburse long- and short-term disability benefits
Supports HMO products for capitated entities to share financial risk and claims, along with UM processing responsibilities.
Increase efficiency with dental-based claims processing and adjudication.