model is enabling our customers to leverage full potential and benefit of
FACETS system, while reducing operational cost by 30% or more and
enhancing overall operational efficiency.
FACETS, one of the flagship products of Trizetto,is an excellent Health Plan core administration solution. However, like any enterprise product, from implementation to operation and production support, it requires configurations, customizations, extensions and interfaces to meet the client specific business requirements. With constant changes in business rules, government mandates, technological advances etc., there is a constant need to upgrade and changes to the enterprise applicationwithout impacting the core systems.
At Agile, our highly skilled FACETS experts are helping our clients in utilizing the fullest potential of the FACETS system through seamless integration,configuration, extensions, upgrades and testing through our blended-shore FACETS Center of Excellence. Whether it is Plan / Product configuration, Provider Networks or Fee Schedule, NetworX Pricing, ExternalClaims and Accumulator updates, Workflow managementor integrating external applications like Claims Xtend; our
Center of Excellence is the best and most cost-effective alternative to OEM resources. We are your partner in your
healthcare business operation using FACETS.
• FACETS Implementation and Upgrades
• Configuration, process and workflow management
• Application Integration and external interfaces
• Real time integration and FXI services
• Enhancements and Extensions
• Testing Services
• Production support and batch operation
• Implemented the complete FACETS batch processing and error handling process using Tidal for a health plan in west coast.
• Implemented the complete FEP program in FACETS
• Implemented Prime PBM with real time accumulator update to and from FACETS.
• Complete plan / product benefit testing for a large health plan
• Automated the Fee Schedule load process for a large health plan
• Implemented letter server for a health plan in west coast
• Automated the billing receipt and premium reconciliation process
• Developed customized small and large group rating system and automated rate upload to FACETS
model of delivery brings in –
• Reduces implementation and operational cost for our clients
• Enables 24-hour support
• Faster delivery
• High quality due to both onshore and offsite quality inspections
• Ability to expand and contract staffing based on current needs
We are a HiTRUST accessed and HiTech Associates security certified and HIPAA compliant organization.
• Provider and Network Management – We at Agile help our Clients manage their annual Provider and network assignment along
with the agreements . We help setup the agreements and conduct user acceptance testing on their behalf.
• Configuration and Benefit Management – Every year Health Plans roll out new products and changes. We help our Clients in configuration and benefits validation using our proprietary benefit testing Tool BenefitProTM or Client specific tools.
• Pricing and Agreements – We specialize in Managing provider pricing and NetworX configuration. We configure agreements and pricing and validate the pricing using custom reports and Claim Processing.
• Enrolment and Billing – Our Services include Validation of new enrolment process and systems, annual rate validation and specimen billing validation. Billing reconciliation and Broker Commission processing
• Claims Analytics and Recovery – We assist Clients in their analytics by providing ad hoc reporting and data presentation . We also help in their overpayment recovery process and corrections. We also perform validation for Configuration changes , Productions Incidents and new changes .
Our Outsourcing model employs a flexible resource plan, duration and schedule based on clients need. Our model offers the unique blend of Knowledge and flexibility which can assist Clients in their operation and increase savings .
• NetworX Pricing configuration and FEE Schedule loading
• Automated Enrollment
• Claims and EXCD configuration and testing
• ITS Claims Processing
• Utilization Management
• Formatted outputs, ID cards, Letters and Invoice generation
• External claims and accumulator updates
• Accumulator Synchronization Process
• Billing Receipt automation
• Group rating systems automation and rate upload
• PBM Integration both real time and batch
• Integrating external applications such as Claims Xtend, ClearCoverage, Care Advance etc.
• Medicare Management / EAM implementation
• FACETS Consumer Directed Health (CDH)
• EDI processing – 834, 835, 837, 820, 270/271, 276/277 transactions
• HIPAA Gateway implementation