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Real-time ITS solutions for claims processing and member liability estimation for BCBS plans. 

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:

  • Reduces costly manual processes.
  • Delivers quality interactions.
  • Enables your organization to manage both “Host” and “Home” claims faster, more easily and more economically.
  • Improves provider and member experience through accurate and consistent inter-plan communication.
  • Fosters more accurate patient information and real-time liability calculations.
  • Enables your organization to meet the Blue Cross and Blue Shield Association (BCBSA) Home Plan member liability estimation requirement.

FACETS MODULAR ADD-ONS

Facets Workflow™

Real-time delivery of claims and customer service items, reducing bottlenecks and automating work.

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Facets Accumulator Synchronization™

Near real-time accumulator synchronization between Facets and third-party vendors.

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Facets CDH Suite™

Supports the administration of flexible spending accounts, health reimbursement arrangements, and health savings accounts.

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Facets for Blue Cross Blue Shield Plans

Real-time ITS solutions for claims processing and member liability estimation for BCBS plans.

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Facets® Open Access Solution™

Data publishing and web services that extend and integrate with the Facets system in real-time with third-party applications.

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Facets™ Disability Module

Administer and reimburse long- and short-term disability benefits

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Facets™ Assigned Risk Module

Supports HMO products for capitated entities to share financial risk and claims, along with UM processing responsibilities.

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Solution Summary
TriZetto® Facets™ for Blue Cross and Blue...

Real-time ITS solution for claims processing and member...

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At Cognizant, we are here to provide you with more information about our TriZetto Healthcare Products software and service solutions and answer any questions you may have.

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