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