Facets is an enterprise-wide core solution that automates claims processing, billing, care management and network management workflow. But getting the most out of Facets requires configuring it to best meet the needs of your organization, testing processes before they go live and ensuring full security. Our suite of optimization solutions for Facets gives your IT staff the tools they need to fine-tune Facets for your environment.
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:
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:
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:
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:
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:
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: