- Facets-Manual.pdf has the same contents as Facets Help in about 370 printable pages. Facets has all the capabilities described in the Facets User Manual PDF. Minifac has all the capabilities described in the Facets User Manual PDF except that the dataset is limited to 2,000 observations (responses, ratings, data points).
- 3-5 years test experience. Facets is a must. Subscriber, member and provider modules. Hands on Facets Claims processing experience a must, experience creating test cases, experience reviewing requirements for testability, Quality Center experience preferred.
- Information as the Facets manual, facets.pdf, which is in your Facets folder. Left-click on the next to “Special Topics” to expand the topic list. Then left-click on “Glossary” to display a glossary of Rasch technical words. You may find this useful if you don’t understand the meaning of a word in this Tutorial.
Involved in testing QNXT Member, Provider, Claims Processing, Utilization Management, Accumulators, Contracts and Benefits with proper ICD - 9 and ICD - 10 and HCPCS/CPT codes. Involved in manual claims Adjudication process. Creating, Approving and Modifying PA in both Portal and QNXT.
Project For a National Senior Market Health Insurer
CHALLENGE
The executives of a national Medicare Advantage health plan wanted to adopt a common information systems platform for all of its products in the Medicare-eligible population. The health plan had selected the TriZetto-hosted Facets product as the core claims processing system. The Facets application was already supporting the plan’s Preferred Provider Organization (PPO) and Private Fee-for-Service (PFFS) products; the health plan needed to migrate their HMO product to Facets from the EZ-CAP system to create a single, enterprise-wide information solution.
In order to implement Facets within the HMO product line, the operations leadership of the health plan required functional and technical expertise to work with their end-users and the health plan’s Information Technology (IT) Department.
SERVICES
Advanta staffed the effort with a project manager, who had more than 10 years of Facets implementation experience with a wide range of plan types, along with a project team, throughout the lifecycle. The project manager and the team:
- Elicited and documented business requirements
- Conducted a gap analysis between identified business requirements and system capabilities
- Developed and documented new business processes and workflows to define the “new” operational model
- Developed policies and procedures to support new operational model
- Created desktop and job aides to support future processes and workflows
- Facilitated decision-making around system configuration
- Provided testing support, including user-acceptance testing (UAT)
- Developed and provided staff training on the new operational model and system functionalities
Staffed go-live and post-deployment activities
What Is Facets Claims Processing
RESULT
Facets Claims System
The migration of the HMO business from EZ-CAP to TriZetto Facets was successful and became the foundation for achieving planned operational improvements and cost reductions.