Healthcare and Facets training

Concepts

Advanced Health care - Basics

Advanced Health care - Payer business

Facets Overview

Facets - Group, Class/Plan Product

Facets - Membership

Facets - Provider

Facets - Claims processing

Facets - Billing & Finance

Facets - Utilization Management

Facets data model

Facets implementation - Requirement Analysis

Total
 Healthcare and Facets training
Sessions
Introduction to healthcare insurance
Evolution of healthcare - Managed Care Organizations
Evolution of Healthcare - Managed Healthcare for Specialty Services
Provider Organizations and Networks
Utilization Management, Healthcare quality assessment and Improvement
Managed healthcare - Operations
Facets - A niche healthcare product overview
Group & Individual policies
Class/Plan and product relationship & overview : Benefits summary
Classification of Groups by size, billing and sponsorship
Working session - Facets front end and backend tables
Subscriber/Membership module overview
Member enrollment - Various ways
FET & MEET process - overview
Discuss various types of members - Medicare, Medicaid and Commercial
Member - PCP relationship
Member Plan termination, Change of enrollment and coordination of benefits
Plan Renewals
Provider module overview - Various types of providers
Provider network relationship
Compensation methods
Claims processing overview
Workflow in Facets
Types of claims
Claims pricing & payment - EOB & EOP
Common tables - review
Billing module overview
Modes of billing and various billing methods
Generating bills and delinquency definition
Finance and accounting
Premium payments and reciept processing
Modes of payment
UM overview
Authorizations and referrals
Case Management and Healthcare assessment
Overview and recap
Requirements - Understanding
Requirements - Discussion forum
Total
Duration (in Hours)
1

1
1
1
1
0.5
0.5
0.5
0.5

1
1
1

1
1
1
30