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.
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.