You can enter detailed information capture demographics and meet the growing

You can enter detailed information capture

This preview shows page 18 - 20 out of 42 pages.

You can enter detailed information, capture demographics and meet thegrowing demand for information. Groups, subscribers and members can beentered and updated online and/or via batch programs.Tracking Group and Membership InformationWith Facetsyou can track group, member and family information such aspre-existing conditions, eligibility events, coordination of benefits, theprimary care physician, salary, classes, handicapped/student data andhome/mailing address. You can also establish and edit information such asparent group name, group and subgroup information, rate and billing data andlink subscribers to groups for employer-related business. You can identifyrelated entities, such as Utilization Review firms, claims payors, PPOs andbrokers that provide services to the currently selected group and anyone whois responsible for a member who is legally unable to make decisions forhimself. Based on this information, Facetscalculates and determinesbenefits, plan eligibility, premium and rating in conjunction with data andparameters established in the member’s Plan.EligibilityYou can easily monitor the subscriber and member’s eligibility to receivebenefits. Facetsmaintains a history of eligibility for all subscribers and theirfamilies, so you have up-to-date information at your fingertips which will tellyou the subscriber’s plan, date of enrollment, if family members are includedin the plan, whether coverage is COBRA or if the subscriber has beenterminated and reinstated. Facets also provides member ID cards and rostersfor PCPs and standard reports to analyze membership.
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Facets Product OverviewDecember 1997Page 15Maintaining AccumulatorsFacetsautomatically tracks paid claim limits, individual plan limits, COBand deductible amounts accumulated to date by a member or subscriber.These accumulators are used to properly apply the plan and product limitsduring claims processing.One-stop Enrollment and Quick MemberThe Enrollment application provides “one-stop” entry when enrolling newsubscribers and members. Enrollment presents the complete data capturefeatures of Subscriber/Family in two panels, allowing users to choose buttonsand menu options to open dialog boxes and panels to enter information. Thefields and buttons are strategically placed in a logical order for quick andefficient use. Common information is reused and, once saved, thisinformation is available in all other applicable Facets applications.If you need to perform utilization reviews or other functions, yet are notresponsible for maintaining member eligibility, then FacetsQuick Memberapplication can be the solution. Use the Quick Member application to quicklyenter and view participating members in a health plan. By creating anabbreviated member record, you can maintain a limited amount ofdemographic information about a member. This is particularly useful whenyou receive an inquiry or request for a referral or pre-authorization from a
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