AUGUST 2009 – FACETS EDITION BCBSRI is dedicated to providing excellent service to our members and providers. As we convert our business and processes over to the new Facets® system and begin processing claims in Facets and our existing legacy system, we will be striving to further enhance the service we provide. Back to Internet-Only Manuals (IOMs) 100-04 Publication # 100-04. Medicare Claims Processing Manual. Processing Hospice Claims (PDF) Chapter 11 Crosswalk (PDF).
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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.
Google chrome for mac os x 10.5 8 free download. 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
Facets Claims Processing User Guide
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
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.
Google chrome for mac os x 10.5 8 free download. 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
Facets Claims Processing User Guide
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
RESULT
Facets Claims Processing System Manual Pdf
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.
