With Claim Test Pro, you can test claims data efficiently and cost effectively and verify with confidence that correct claim totals are being paid. The solution greatly reduces the need for manual creation of test cases, automates the management and reconciliation of results, tracks and documents test projects and cases and electronically converts system data to applicable testing data sets to create a robust and applicable testing environment.

In addition, Claim Test Pro provides a comprehensive set of testing suites that provide for more diverse testing schemas, enabling testing of a multitude of provider reimbursement scenarios. The solution automates many processes that previously were done manually, helping plans increase administrative efficiencies by reducing the resources needed to manage these initiatives. An added benefit of Claim Test Pro is that it provides management tools that track and report progress.

Plans that do not have a strategy for testing and validating claims data may be at risk. Claim Test Pro can help you:

• Reduce overpayments to providers. Data that has been thoroughly vetted helps ensure that your plan is paying its contracted providers the correct amounts.
• Lower administrative costs. Reducing errors in provider payments reduces manual rework, helping drive down costs.
• Trim test cycle time. Automation can help you save hundreds of hours building and documenting test cases.
• Reduce critical defects introduced to production. The application is virtually self-documenting, automatically summarizing what you have tested and reconciled.

When making and managing system configuration changes, it is critical that payers continually test in order to validate the integrity of the changes and to ensure that new configuration items are production-ready. This task becomes more complex when multiple, simultaneous changes are involved.

The Configuration Migration Utility for Facets helps control, manage and successfully execute configuration promotions. It gives non-healthcare IT personnel the ability to migrate specific aspects of configuration changes from environment to environment in a manner that is controlled, workflow-integrated and audit-capable. With this tool, you can:

• Eliminate wholesale environment copies. Perform targeted component migrations of desired configurations.
• Reduce demand of specialty healthcare IT resources. Decrease the workload on database administrators during change promotions.
• Ensure adherence to change procedures and approval processes. Enforce a rigorous workflow process while distributing the execution work efforts.
• Reduce testing demands and rework. Test only the migrated component instead of re-executing wholesale test cycles.

The Facets Enrollment Toolkit is a set of integrated tools and adapters that streamlines the auto-enrollment process. The toolkit increases the auto-enrollment success rate by intelligently managing the data receipt and correction process for enrollment records. The toolkit’s built-in intelligence also makes it ideal for handling challenges like extremely high volume and inconsistent formatting. These features ensure that data is correct and validated before it is submitted to Facets and the records are consistent in form and content.

With the Facets Enrollment Toolkit, payer organizations can be confident that:

• Data is accurate. Front-end automation in the staging database helps ensure data is correct before it is inserted into the Facets system.
• Less manual intervention is required. The toolkit reduces failures rates, and the error record reader helps identify and resolve issues quickly.
• Customer service improves. Data management flexibility helps improve the intake process and expedite enrollment completion.

Without an intelligent, automated process for designing, configuring, validating, testing and auditing access provisioning, healthcare organizations may run the risk of violating regulatory requirements. The TriZetto Security Management Tool provides a single, centralized repository for Facets security configuration data, automating the management of Facets security data across multiple Facets environments. The tool provides a controlled, managed process for keeping configuration data in sync among environments such as training, development and production.

The Security Management Tool for Facets can help:

• Reduce time required to configure Facets security profiles.
• Streamline administrative tasks and reduce manual errors.
• Increase visibility into access-provisioning actions.
• Ensure traceability.
• Provide audit-ready capabilities for your Facets security management.
• Implement a repeatable process.

Configure and manage claims processing rules and qualifiers.

It can be quite complicated to manage and map complex claims processing rules and qualifiers used by various benefits plans. The Supplemental Mapping Management (SMM) Tool for Facets solves these problems, managing interdependencies within the supplemental mapping and automating the researching, editing and auditing process for configuration data. It also provides much-needed transparency of the current configuration, dependencies and hierarchies while streamlining configuration management tasks.

SMM helps healthcare organizations:

• Reduce the amount of time required to research, review, analyze, load and make configuration changes, without the expense of additional staff.
• Improve configuration accuracy by reducing resource-intensive, error-prone manual editing, researching and mapping of existing configurations.
• Quickly edit, copy or re-order rules that apply to specific criteria instead of scanning all rules individually.

Before adding new functions, changing system configurations or design, it is important to test all changes in a way that keeps health information fully protected. Test Data Generator creates non-production data sets of both transactional and configuration data, allowing healthcare organizations to test possible changes before implementing them. The tool ensures that protected health information (PHI) remains fully secure by stripping the data of personal identifying information and creating key word files with all new identity information. The result is size-controlled data sets of randomized non-production data. 

Using Test Data Generator for Facets, healthcare organizations can:

• Reduce the risk of exposing PHI that occurs when production data is simply copied into non-production data bases for testing.
• Create multiple specialized test databases and control their size and composition.
• Reduce non-targeted environment copies.
• Decrease demands on specialty IT resources.
• Improve security.