Product Components

Health plan is the marketing name of a set of health care benefits or features. But there is a product at the bottom of every health plan. A product consists of several product components. These components are known as prefixes in Facets. The most important product component is Benefit Summary.

Insurance companies send benefit summary to policy holders. In Facets, users can access to Benefit Summary application of Facets from Actions menu of Facets. They can also use shortcut F6 to access to benefit summary information of product.

More update is coming soon.......

How to Login Facets?

Facets login means you are going to connect to some SQL Server. It depends on user's role in the company. Security system is very very strong. So, unauthorized user can never ever login to Facets application.
Generally, you will see Facets icon on your desktop. Most of the time , Facets is housed in Virtual Desktop. Double click on the Facets icon on your desktop, it will direct you what to do next. Let us suppose we want to login "Facets Medical Claims Processing + ITS" application in Testing Environment. Here Testing Environment means front end facets will be connected with"testing environment Server Name_SIT_facets.pzb".
When users will work in Facets in this environment, all data will come from this database and if user saves any data , the data will be stored in this database. When users process a claim and save it by pressing F4 button, facets will generate a claim ID automatically and claim id will be stored in this database. Later on, anybody can open that claim and review.
Sometimes, your company will give you user name and password to login facets as per your role in the company.
For Back End login, you must have access to the company's database. It varies company to company. Actually, for back end login, you will login to some version of SQL server. Facets is housed in SQL Server. If company grants you access to their database, you can access to database without any user name and password. Some company may give you user name and password to access their database.

How to Login Facets System in Earlier Versions

Facets login in earlier versions was a  little bit different as it is now. I am mentioning the steps that users followed in earlier versions.

Step 1: Click the Start button on your Taskbar to open the Start menu.

Step 2: Click on Facets Client in the Start menu. As per your company's configuration, a Facets window with File and Help menu will open on your screen.

Step 3: Click on File Menu

Step 4: Click on Open Database and select a database/product in which you have access, suppose abc.pzb

Step 5: Double click on abc.pzb. The Logon dialog box will be displayed as follows

Step 6. Enter your User Id and Password, then click OK button. Product Navigation window opens displaying three sections: Applications, Application Groups, and Open Forms.

Note: Both your User Id and Password are case sensitive.

Step 7: Select the application group you want by double clicking on its name in the Application Groups list box.

Step 8. Select the application you want by double-clicking on its name in the Applications list box

Facets Application Navigation Screen

When you log on to Facets, the Facets Application Navigation Screen will be displayed. This is called home page of Facets. From the ‘home page’, users will be able to move to all other sections of the Facets system. The home page is divided into two areas.

Ø  Application Tree

Ø  Display Area

Application Tree:

The Application Tree on the left of the screen is a list of all the possible application groups within Facets . If you double click on any application group, the applications of the application group will be displayed. It may be mentioned that only the applications required to perform your role in the system will be displayed. This is based upon your user profile and security levels.

Display Area:

When a user double click on an application of  an application group an application, the fields appear in the Display Area on the right.

Utilization Management Application Group

The Utilization Management group of applications automates the processing of pre-authorizing health care treatment prior to delivery, allows inquiries about multiple reviews without opening the reviews themselves, and tracks case management activity for each episode of care. The applications in this group are:

1. Case Management

2. Prospective UM

3. Provider Case Fees

4. UM Inquiry

5. UM Logging

Subscriber/Member Applications Group

The Subscriber/Member group of applications holds information about the individuals and employer groups who participate in insurance companies'health plans. These individuals are called either members or subscribers. The applications in this group are:

1. Area

2. COB Carrier

3. Eligibility Inquiry

4. Enrollment

5. Family Accumulator

6. Group

7. Institutions for Medicare Risk

8. Mass PCP Changes

9. Mass Plan Change

10. Member Accumulator

11. Member Notes

12. Parent Group

13. Quick Member

14. Quick PCP

15. Rating Inquiry

16. Related Entity

17. Responsible Person

18. Subgroup

19. Subscriber Notes

20. Subscriber/Family

Provider Applications Group

The Provider group of applications holds information about the providers who contract to deliver health care services to eligible enrollees. Facets distinguishes each provider as either a practitioner, facility, IPA, or provider group. The applications in this group are:

1. Common Practitioner

2. Facility

3. IPA

4. Network

5. Network Area

6. Network Group

7. Practitioner

8. Provider Group

9. Provider Notes

10. Provider Related Entity

11. Quick Facility

12. Quick Practitioner

13. Quick Provider Group

Pricing Profile Applications Group

The Pricing Profile group of applications establishes the pricing contracts agreed upon between practitioners, facilities, networks, and MCOs. The applications in this group are:

1. Conversion Factor Profile, Dental

2. Conversion Factor Profile, Medical

3. DRG Profile

4. Fee Schedule Profile, Dental

5. Fee Schedule Profile, Medical

6. Room Type Profile

Medical Provider Agreement Application Group

The Medical Provider Agreement applications group is used to establish or edit an agreement between participating providers. The applications in the Medical Provider Agreement application group are:

1. Agreement, Medical

2. Auto Room Type

3. DRG Rules

4. Exclusions

5. Procedures

6. Prompt Payment Discount

7. Stoploss

Medical Plan Application Group

The Medical Plan group of applications holds information about the health plans that are offered and administered. Each application in this group holds details of an integral plan

component:

1. Administrative Information

2. Administrative Rules, Medical

3. Alternate Funding Rules

4. Area & Industry Rate Factors

5. Automatic Action Criteria

6. Benefit Summary

7. Billing Component

8. Claim Interest Rates

9. Claim/UM Matching Parameters

10. Class/Plan Definition

11. Clinical Editing Admin Rules

12. COB Rules

13. Component Prefix Descriptions

14. Conversion Factor Definition, Medical

15. Covering Provider Set

16. Deductible Rules

17. Duplicate Claim Rules, Medical

18. Duplicate UM Rules

19. EOB Information

20. Group Administration Rules

21. HCFA AAPCC Rate Table

22. HCFA Rate Factors

23. In Area Zip Codes

24. Limit Rules

25. Network Set

26. Other Party Liability

27. Plan Descriptions

28. Premium Rate Table

29. Processing Control Agent

30. Product

31. R&C/Schedule, Medical

32. RBRVS Zip Code Area

33. Service Code Conversion

34. Service Conversion Description

35. Service Definition

36. Service ID Descriptions

37. Service Payment

38. Service Pricing

39. Service Related Parameters

40. Service Rule Definition

41. Service/Procedure Conversion

42. Service/Revenue Code Conversion

43. Supplemental Procedure Conversion

44. Supplemental Revenue Code Conversion

45. Trend Rate Factors

46. UM Service Group

47. Unit Value Pricing Definition, Medical

48. User Warning Messages

49. Volume Calculation

50. Volume Reduction Calculation

51. Warning Messages

52. Zip Code Area Definition

Dental Provider Agreement Application Group

The Dental Provider Agreement applications group is used to establish or edit an agreement between participating providers. The applications in the Dental Provider Agreement applications group are:

1. Agreement, Dental

2. Category Discounts

3. Prompt Payment Discount

Dental Plan Application Group

The Dental Plan group of applications holds information about the dental plans offered and administered by healthcare payers. Each application in this group holds details of an integral dental plan component. The applications available in this group are:

1. Administrative Information

2. Administrative Rules, Dental

3. Area & Industry Rate Factors

4. Alternate Funding Rules

5. Automatic Action Criteria

6. Benefit Summary

7. Billing Component

8. Class/Plan Definition

9. COB Rules

10. Component Prefix Descriptions

11. Conversion Factor Definition, Dental

12. Covering Provider Set application

13. Deductible Rules

14. Dental Category Payment

15. Dental Category Related Parameters

16. Dental Category Rule Definition

17. Dental Category Waiting Period

18. Dental Procedure/Category Conversion

19. Dental Utilization Edits

20. Duplicate Claim Rules, Dental

21. EOB Information

22. Group Administration Rules

23. In Area ZIP Codes

24. Limit Rules

25. Network Set

26. Other Party Liability

27. Plan Descriptions

28. Premium Rate Table

29. Procedure Definition, Dental

30. Procedure Payment, Dental

31. Procedure Pricing, Dental

32. Processing Control Agent

33. Product

34. R&C/Schedule, Dental

35. Trend Rate Factors

36. Unit Value Pricing Definition, Dental

37. User Warning Messages

38. Volume Calculation

39. Volume Reduction Calculation

40. Warning Messages

41. Zip Code Area Definition

Customer Service Application Group

The Customer Service group of applications allows healthcare payers to administer appeals, record correspondence such as inquiries between the MCO and its clients or state regulatory agents, and channel inquiries about practitioners and facilities. The applications in this group are:

1. Appeals

2. Appeals Contact

3. Appeals Reviewer

4. Channeling

5. Customer Service

Criteria Maintenance Application Group

The Criteria Maintenance group of applications lets healthcare payers set up the evaluation criteria that they need during utilization review, clinical editing, and capitation processing to help them make authorization decisions based on established medical criteria. The applications in this group are:

1. AE Criteria by Diagnosis

2. AE Criteria by Procedure

3. Alternate Criteria Definition

4. Clinical Editing Criteria

5. Clinical Organ/Disease Panels

6. CPT-4 to ICD-10 Conversion

7. CT/SC/DI Criteria

8. Diagnosis Criteria M&R

9. Diagnosis Edit Criteria

10. Length of Stay by Diagnosis

11. Length of Stay by Procedure

12. Length of Stay Conversion

13. Medical Admission Criteria

14. Optimal Recovery Guidelines

15. Procedure Criteria M&R

16. Procedure Edit Criteria

17. Same Day/Follow-Up Procedures

18. SSO Waiver Criteria

19. Surgical Admission Criteria

20. Surgical Indications M&R

Commission Application Group

The Commission application group allows healthcare payers to define and maintain commission information for agents and brokers who sell plans to policyholders. Healthcare payers  can identify commission entities, enter detailed commission entity information, define commission payment methods, assignments, schedules and agreements, establish affiliations between commission entities and related insurance carriers, and enter manually calculated commission adjustments, such as advances, payments and bonuses. The applications available in this group are:

1. Affiliated Carrier

2. Commission Adjustments

3. Commission Arrangement

4. Commission Entity

5. Commission Inquiry

6. Commission Schedule

7. Commission Summary

8. Common Commission Entity

9. Entity Type Definition

Claims Processing Application Group

The Claims Processing applications group enables you to record, process, track and run inquiries on hospital and medical claims. The applications available in this group are:

1. Claims Inquiry

2. Dental Claim Line-Item History

3. Dental Claims Electronic Log

4. Dental Claims Logging

5. Dental Claims Processing

6. External Claims Editing

7. Hospital Claims Electronic Logging

8. Hospital Claims Logging

9. Hospital Claims Pre-Pricing

10. Hospital Claims Processing

11. Medical Claims Electronic Logging

12. Medical Claims Logging

13. Medical Claims Pre-Pricing

14. Medical Claims Processing

15. Payment Drag Override Processing

16. Pended Claims Release Parameters

Capitation/Risk Allocation Application Group

Use the Capitation/Risk Allocation group of applications to establish and control the information necessary to process claims for members with capitated service agreements and then direct payments and/or allocate funds to the appropriate service providers. The applications available in this group are:

1. Average Member Premium

2. Batch Control Parameters

3. Capitation Inquiry

4. Capitation Pool Description

5. Capitation Schedule Definition

6. Claim/Encounter Mapping

7. Cycle Description

8. Fund Definition

9. Lifestyle Rate Factor

10. Manual Capitation Adjustment

11. Supplemental Capitation Rates

Billing Application Group

Use the Billing group of applications to apply billing to different billing types. Facets allows healthcare payers to set up the billing entity, assign the entity to a group, define and calculate fees, define discounts and discretionary items, create a summary for the entity, and create statements and reports for subscriber-based billing and self-administered billing.

The applications available in this group are:

1. Batch Receipts

2. Bill Adjustments

3. Billing Carriers

4. Billing Entity

5. Billing Group

6. Billing Message Definition

7. Billing Profile

8. Billing Summary

9. Delinquency Definition

10. Discount Calculation

11. Discount Definition

12. Discretionary Billing Items

13. Fee Calculation

14. Fee Definition

15. Receipt History

16. Receipt Processing

17. Self-Billed Processing

Application Support Group

The Application Support group of applications serves as a central library for all the codes and standard information that is entered into Facets on a regular basis. Each application maintains a specific type of information that displays as field selections throughout many application groups, such as Customer Service, Provider, Subscriber/Family, and Utilization Management. Applications included in the Application Support group of applications are the following:

1. Accumulator Descriptions

2. Bank Data

3. Clinical Procedure Code Ranges

4. Component Description

5. Confinement Service Setup

6. Dental Category Description

7. Dental Procedure Descriptions

8. Dental Utilization Code Descriptions

9. Diagnosis Codes

10. Explanation Codes

11. Hospital Bill Code Definition

12. Hospital Frequency Code Definition

13. ICD  Procedure Codes

14. MDC Code Description

15. Place of Service Description, Medical

16. Place of Service Description, Dental

17. Procedure Codes

18. Product Category Definition

19. Report Category Description

20. Revenue Codes

21. System Codes

22. Tooth Chart Code Descriptions

23. User Warning Messages Description

24. User-Defined Codes

25. Audit Information (Audit Information is available via a Transfer)

Accounting Application Group

The Accounting group of applications forms the foundation for claims and capitation check processing. These applications allow healthcare payers to establish separate lines of business to associate with specific plans and claims or capitation payors. They may also maintain information about the corporate bank accounts from which claims or capitation payments are drawn. Applications included in the Accounting group of application are the following:

1. Accounting Description

2. Accounting Period

3. Bank Account

4. Check Numbering Process

5. GL Account Mapping

6. Line of Business

7. Payment

8. Payment Reductions

9. Payor

Facets Application Groups

Facets is an integrated health care payers' administration solution. The Facets system gives them a platform for fostering collaboration and building connections among members, employers, brokers and providers. Facets is a wonderful tool to handle the complex and challenging requirements of managed health plans. In order to perform the desired functions efficiently,  Facets is organized into application groups and each group consists of several applications. In 2.81 version of Facets, there were 16 application groups, they are as follows:

1. Accounting application group

2. Application Support application group

3. Billing application group

4. Capitation/Risk Allocation application group

5. Claims Processing application group

6. Commission application group

7. Criteria Maintenance application group

8. Customer Service application group

9. Dental Plan application group

10. Dental Provider Agreement application group

11. Medical Plan application group

12. Medical Provider Agreement application group

13. Pricing Profile application group

14. Provider application group

15. Subscriber/Member application group

16. Utilization Management application group

In 5.0 version of Facets, there are more than 30 application groups, some of which are:

1.  Claims Processing + ITS application group

2. ITS Plan application group

3. NetworX application group

4. Vision Plan application group
5. Workflow Group Configuration