Pharmacy Claims – Implementation

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This topic contains 0 replies, has 1 voice, and was last updated by prakash prakash 3 years, 9 months ago.

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  • #584 Score: 0
    prakash
    prakash
    Participant

    Does the latest version of Facets support Pharmacy Claims . Does the latest 5.30 version have this functionality . Currently we are at 5.0 and are looking to upgrade . Is shadow accumulator also a part of this functionality

    #597 Score: 0
    rajanimallaiah
    rajanimallaiah
    Participant

    Hello Prakash,

    Its a good question focusing on Facets functionality.

    To reply to that, we have seen a lot of modifications to Facets application off late with “real-time” updates being main focus. For instance, having the real time accumulator synchronization implemented as part of the previous build.

    However, the latest build(version 5.40) do not handle Pharmacy claims adjudication as such and as far as shadow accumulator functionality, the application do provide a place holder for Shadow accumulator processed by any external vendor. But this value is not applied in any Facets logic.

    So I believe there is lot of scope in implementing the Pharmacy Claims adjudication process in Facets. Currently this is being taken care by TPA. Facets will receive files from TPA and only the accumulator value is being loaded into Facets.

    Hope this was helpful. Will keep you posted once we come across any information.

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