FACET Configurations

Our EPIC EMR FACETS configuration helps in implementing and managing the FACETS platform to reduce planned administrative costs, improve business processes and deliver better value for care management solutions.  We have deep expertise across all the modules of FACETS healthcare application. We have integrated the platform with other systems in the client application landscape. We have developed automation and analytics capabilities around FACETS systems to help you in your digital transformation journey and be future ready. Simultaneously, we offer cost-effective managed services on the EPIC EMR FACETS platform to take care of day-to-day administrative tasks.

FACET Configurations we focus on


Perform member assessments, enrollments, health homes billing for Medicaid Health and recovery plan.

Automate member eligibility rules for Medicare Special Needs Plan (SNP) and Medicaid Health and Recovery plan.

Identify all Medicare SNP members who had 90-days assessments and 365-days reassessments.

Extract Member eligibility information from FACETS and generated enrollment files in HIPAA 5010 EDI 834 for Medical, Dental and Vision vendors.

Billing and Payments Reconciliation

Integrate our client’s systems with third party payment system which allows members to set-up recurring payments and make premium payments online seamlessly from member portal.

Process all premium bills to third party payment gateway to accept and process payments to member accounts.

Reconciled member actual deposits from the exchange which includes subsidies for Advanced Premium Tax Credits (APTC) and Cost Sharing Reduction (CSR) against HIPAA EDI 820 policy-based payment notifications.

Claims & Encounters

We Validate and auto adjudicated Professional (837P), Institutional (837I), Dental (837D) and Pharma (NCPDP) claims from various provider networks / vendors and processed response in HIPAA EDI 277/835 form.

We Integrate Clients systems with third party vendor to process EDI 278 pre-authorization requests from providers in real time.

Extract and submitted all post adjudicated Medicaid claims (Medical 298P/299I, Dental 300D, Vision and Pharmacy NCPDP) State’s All Payer Database and improved state acceptance rate by fixing state exceptions – these will be used to calculate capitation rate and to identify the clinical areas for improvement.

Reconciled encounters submissions against state responses and generated discrepancy report

Processed Medicare Advantage members post adjudicated claims data to CMS Risk Adjustment Processing System (RAPS) and CMS Encounter Data Processing System (EDPS) for risk score calculation.

We Collect member information from Charge sheets (part of Medicare charge sheet review) and validated against Clients FACETS system to process linked and unlinked claims accurately.

Risk Adjustment

We analyze Risk Adjustment initiatives by analyzing the encounters and extracting data for chart review.

Performed data aggregation, validation to obtain the suspect list and created reports to analyze the priority of suspect.

Create workflow for analyzing the supplemental codes and submitted to State, CMS, and EDGE as per the respective encounter information.

Analyze the response from government bodies and clear out the errors in the submitted claims to achieve more than 99% accuracy in submission.


We Process member enrollment and claims data to third party system to calculate HEDIS measures for QARR reporting and STAR Rating

Create system to send demographic and claims data for 3M CRG to measure the risk associated to each member to predict future health care utilization and cost (prospective) and explain past health care utilization and cost (retrospective)

Analyze and created HCC gap analysis to determine the members with chronic conditions and need provider’s attention.

Create a member 360 dashboard that can help the business users to understand the complete health profile of members and focus on people with chronic illness.

Create an analytical platform for customer care representatives for tracking the real time member information and provide services to members efficiently.

Create vendor data marts to perform quick analytics on top of huge claims data related to various vendors.

Automation Testing

Regression Testing – automation of FACETS batch jobs

Performance Testing – batch jobs testing and load testing

Reusability of test data, case, and scripts

Collected member information from Charge sheets (part of Medicare charge sheet review) and auto validation against FACETS system to process linked and unlinked claims accurately.

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