The flow of claims processing, including manual re-processing of failed submissions. Proposal pengadaan alat musik gamelan. Claim Prioritization & Processing Multiple Claims Approval & Payment Systems App 1 Accept/Decline. Sterling File Gateway system logs. Sybase Facets performance analytics. Once data collection was set up and the Splunk platform was extracting. Your premier platform for all things nursing assistant - videos, practice exams, study tools, and more! 99 saturn sl2 car manual facets claims user manual priority downloads yamaha waverunner 800xlt manual health claims processing in the us - tm floyd & basic elctrical manual facets claims processing and ajudication system adventist pathfinder staff manual facets claims user manual compiled pdf, doc, ppt rand ts1a claims processing system. Isuzu worldwide epc keygen software.
- What Is Facets System
- What Is Facets Claims Processing
- Facets Claims Processing User Guide
- Facets Claims Processing System Manual Instructions
- What Is Facets Claims Processing System
Facets Testing explained
FacetsTesting is not one of the testing types. But it is purely and most of the time,a type of manual testing which is done on Facets tool that is being used forclaims processing and other healthcare insurance company day to day activitiesare done.
Theseare Typical healthcare manual testing/ tester roles and responsibilitiesespecially in FACETS application in healthcare industry.
·Participatedin requirements meetings to understand the requirements from business people.
·PreparedTest cases and Test scripts from the requirements and Functional, Technicalspecifications.
·Validatedmember eligibility and eligibility inquiry in the facets application to thelegacy application in order to confirm the migration successful or not.
·Experiencein Medical, Pharmacy Plan changes from one plan to other plan with in Group,subgroup, class combinations.
·Experiencewith COB (coordination of benefits) application with in facets, testing ofclaims status for selected subscribers.
·Writingtest cases and test scripts in MS Excel Manually and uploading in Qualitycenter.
·Wellexperienced in benefit coding of different products for various plans of BCBSsuch as Blue preferred, Blue exchange etc.
·Calculatingco-pay, coinsurance, adding single tier, multi tier for different products within a plan.
·Comparingplan and product details in medical module, and reviewing the benefit summaryand feeding them into pivot tables with appropriate co-pay and coinsurance andvalid comments for various codes of vision, maternity etc.
·Testdata entry into FACETS4.7 application in the test environment for creatinggroups, subscribers and family members.
·Experiencein creating new groups, subgroups, subscribers as and when needed which islater used as a test data for testing purpose.
·Experiencein System testing and UAT testing of the facets core application and custommodules as needed.
·Claimsvalidation in Facets application which includes claims pending status, memberstatus, etc.
·Creatingtest cases, test scripts for various modules, and uploading them into qualitycenter.
·Traceabilitymatrix of test cases to corresponding requirements.
·Runningthe test cases and it scripts and executing them thoroughly with pass/failstatus.
·Enteringdefects for failed test cases and assign the defects to appropriate developers.
·Regressiontesting of the application once the defects are fixed and passing the testcases.
Insimple words, Facets testing is not really much different than other types oftesting except the fact that the domian knowledge in healthcare industry is amust and familiarity on facets tool is necessary.
Majorapplications with in the Facets testing that you need to learn /know beforeinterview is, Claims processing, hospital, claims, physician claims, membersubscriber inquiry etc.
facets testing facets healthcare facetstesting interview questions what is facets testing
What Is Facets System
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).
What Is Facets Claims Processing
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.
Facets Claims Processing User Guide
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:
Facets Claims Processing System Manual Instructions
Claim processed asexpected and write the claim ID and pass the test case.
What Is Facets Claims Processing System
Note: HCPCS stands forHealthcare Common Procedure Coding System.