Facets Claims Processing System Manual

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Facets Claims Processing System Manual

Facets (Trizetto Claims processing system) provides several functionality which is supported under the application group or you can call modules.It helps the organizations to perform their day to day operational work by utilizing any or all of the application groups. Facets is a registered.
Business Analysis in Healthcare Domain with Facets Training: Facets is a Trizetto's tool which is used. Back to Internet-Only Manuals (IOMs) 100-04 Publication # 100-04. Medicare Claims Processing Manual. Processing Hospice Claims (PDF) Chapter 11 Crosswalk (PDF). Step 2: Open Facets Claims Processing application group and scroll down to Dental Claims processing application. Step 3: In the Indicative page of Medical Claims processing application, enter the following data: Subscriber ID and select a member from the drop down menu, Claim Received Date(suppose Jan 25, 2017), Provider ID and Diagnosis code.
In response to MD HarunRashid's request, I am again giving an example of Dental Claim which is similarto Real Life Scenario. The test case name is Oral Surgery. These are the steps that you are supposed to perform to process a dental claim in Facets under medicalplan.
Step 1: Open Test Lab Module ofALM, you will see the following test case in test lab module of ALM/QC.
Test Case description:Process a claim for Oral Surgeryservices using following data: INN Provider 333444555777 (Dental Surgeon), POS11, HCPCS D7240, Subscriber ID-100200300, Diagnosis code ICD10: k08499,Charges (PCP's Fee) $350, Unit 1(One Time Visit).

Expected Result: Claim should apply aCopayment of $50 , then process at 80% of the allowable.
Step 2: Open Facets ClaimsProcessing application group and scroll down to Dental Claims processingapplication.
Step 3: In the Indicative pageof Medical Claims processing application, enter the following data: SubscriberID and select a member from the drop down menu, Claim Received Date(suppose Jan25, 2017), Provider ID and Diagnosis code.
Step 4: Now double click onLine Item page and when you are in Line Item page, enter the following data:Date of service (suppose Jan 20, 2017), POS, HCPCS code, Charges(suppose $350),Unit(suppose 1), Total charges(Suppose $350).
Step 5: Press F3 on yourkeyboard to process the claim. Now check the claim pricing.
Step 6: If the claim applies acopayment of $50 as expected and then process at 80% of the allowable, save theclaim by pressing F4 on your keyboard. Facets will generate a claim IDautomatically. Suppose the claim ID is 000011112222
Step7: Open Lab module of ALM,take required screenshots and type as follows in actual result edit box:

Claim processed asexpected and write the claim ID and pass the test case.

Facets Claims Processing Training

Expected Result: Claim should apply aCopayment of $50 , then process at 80% of the allowable.
Step 2: Open Facets ClaimsProcessing application group and scroll down to Dental Claims processingapplication.
Step 3: In the Indicative pageof Medical Claims processing application, enter the following data: SubscriberID and select a member from the drop down menu, Claim Received Date(suppose Jan25, 2017), Provider ID and Diagnosis code.
Step 4: Now double click onLine Item page and when you are in Line Item page, enter the following data:Date of service (suppose Jan 20, 2017), POS, HCPCS code, Charges(suppose $350),Unit(suppose 1), Total charges(Suppose $350).
Step 5: Press F3 on yourkeyboard to process the claim. Now check the claim pricing.
Step 6: If the claim applies acopayment of $50 as expected and then process at 80% of the allowable, save theclaim by pressing F4 on your keyboard. Facets will generate a claim IDautomatically. Suppose the claim ID is 000011112222
Step7: Open Lab module of ALM,take required screenshots and type as follows in actual result edit box:
Claim processed asexpected and write the claim ID and pass the test case.

Facets Claims Processing TrainingFacets Claims Processing SystemNote: HCPCS stands forHealthcare Common Procedure Coding System.