Facets Partner Solutions

  • Claims Editing and Auditing

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    Optum™ Claims Editing System

    The OPTUM™ Claims Editing System, an integrated partner product, is a powerful adjunct to the Facets enterprise core administration system. The Claims Editing System is a transparent open-architecture and rules-based application that provides a commercial and Medicare-compliant KnowledgeBase of edits and utilizes date-sensitive processing to adjudicate both professional and facility claims. The application includes full customization capabilities for software auditing logic as well as data relationships and has disclosure statements embedded in the solution. The results for payers are streamlined claims-processing workflows, reduced reimbursement errors and improved payment integrity.  

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    McKesson

    McKesson’s ClaimXten™ is an integrated partner product that provides an advanced claims auditing solution for applying complex payment and medical policies, and complex provider contract terms to the adjudication process. The ClaimsXten™- Facets™ Connector helps to increase administrative efficiency and enables customers the flexibility to process each claim under the specific terms and conditions of each benefit plan. ClaimsXten™ combines the McKesson Total Payment™ software and rules engine, a comprehensive library of McKesson clinical rule content, and a services team of medical claims experts to provide your organization with more medical and administrative savings opportunities. 

    Claims Grouping and Pricing

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    OPTUM™

    The OPTUM™ Prospective Payment Systems (PPS)* software application, an integrated partner product, maps, groups and prices facility claims to ensure appropriate reimbursement. OPTUM™’s ECMPro™ application integrates with TriZetto®’s NetworX Suite® solution to manage grouping, pricing, editing and mapping for Federal (DRG, APC, ASC, IRF, SNF, CAH, LTCH, IPF, Physician) Prospective Payment Systems (PPS) and more than 20 state and payer specific PPS. Facility (inpatient and outpatient) and professional Medicare PPS, and a number of Medicaid PPS are integrated with NetworX Pricer® to support auto-adjudicated claims processing. Users can also apply the supported Medicare and/or Medicaid PPS to their commercial business processing. The integrated solutions streamline claims-processing workflows to reduce reimbursement errors and improve payment integrity.


    Healthcare Account and Funds Management

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    Alegeus Healthcare Solutions

     

     

    Subrogation and Claim Recovery Services

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    The Phia Group

    The Phia Group is a provider of services designed to control costs and protect plan assets; including subrogation & overpayment recovery, document drafting, compliance and consultation. The Phia Group’s mission is to reduce the cost of health benefit plans through the use of innovative technologies, legal expertise, and focused, flexible customer service.