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Empower Accountability

EFFECTIVELY MANAGE SHARED RISK

Support new HMO offerings that incorporate shared financial risk and accountability for authorizations and UM processes.

ENABLE DIVISION OF FINANCIAL RESPONSIBILITY


Easily administer the wide variety of risk sharing arrangements being built into today’s HMO products.

Facets Assigned Risk Module supports Health Maintenance Organization (HMO) products under an assigned risk or division of financial responsibility model, where providers agree to assume risk for certain services while the health plan assumes risk for claims that do not fall under those defined services. The Facets Assigned Risk Module enables plans to configure business rules in order to structure provider reimbursements based on accountability and authorization for each service.

Capabilities include:

  • Health Plans to enter into a wider variety of risk sharing arrangements with provider groups, IPAs and facilities.
  • Ability to configure business rules including service area determination, claims processing, encounter processing and utilization management features.
  • Encounter processing for capitated services and the ability to define the entity responsible for credentialing and quality management for provider contract.

FACETS MODULAR ADD-ONS

Facets® Workflow

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

Facets® Accumulator Synchronization

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

Facets® CDH Suite™

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

Facets for Blue Cross Blue Shield Plans

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

Facets® Open Access Solution

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

Facets® Disability Module

Administer and reimburse long- and short-term disability benefits

Facets® Assigned Risk Module

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

Facets® Dental

Increase efficiency with dental-based claims processing and adjudication.

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CONTACT US

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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