Facets Partner Solutions

  • Claims Editing and Auditing

    OPTUM™  Logo

    Optum™ Claims Editing System

    The OPTUM™ Claims Editing System, an integrated partner product, is a powerful adjunct to the Facets enterprise core administration system. The Claims Editing System is a transparent open-architecture and rules-based application that provides a commercial and Medicare-compliant KnowledgeBase of edits and utilizes date-sensitive processing to adjudicate both professional and facility claims. The application includes full customization capabilities for software auditing logic as well as data relationships and has disclosure statements embedded in the solution. The results for payers are streamlined claims-processing workflows, reduced reimbursement errors and improved payment integrity.  

    McKesson Logo


    McKesson’s ClaimXten™ is an integrated partner product that provides an advanced claims auditing solution for applying complex payment and medical policies, and complex provider contract terms to the adjudication process. The ClaimsXten™- Facets™ Connector helps to increase administrative efficiency and enables customers the flexibility to process each claim under the specific terms and conditions of each benefit plan. ClaimsXten™ combines the McKesson Total Payment™ software and rules engine, a comprehensive library of McKesson clinical rule content, and a services team of medical claims experts to provide your organization with more medical and administrative savings opportunities. 

    Claims Grouping and Pricing

    OPTUM™  Logo


    The OPTUM™ Prospective Payment Systems (PPS)* software application, an integrated partner product, maps, groups and prices facility claims to ensure appropriate reimbursement. OPTUM™’s ECMPro™ application integrates with TriZetto®’s NetworX Suite® solution to manage grouping, pricing, editing and mapping for Federal (DRG, APC, ASC, IRF, SNF, CAH, LTCH, IPF, Physician) Prospective Payment Systems (PPS) and more than 20 state and payer specific PPS. Facility (inpatient and outpatient) and professional Medicare PPS, and a number of Medicaid PPS are integrated with NetworX Pricer® to support auto-adjudicated claims processing. Users can also apply the supported Medicare and/or Medicaid PPS to their commercial business processing. The integrated solutions streamline claims-processing workflows to reduce reimbursement errors and improve payment integrity.

    Healthcare Account and Funds Management

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    Alegeus Healthcare Solutions



    Healthcare Payments Technology


    Zelis Payments

    Zelis™ Payments is a leading healthcare payments technology company dedicated to delivering value via exceptional client experiences. Our solutions facilitate regulatory compliance and streamline the transfer of healthcare payments and data. Through our proprietary integration with Cognizant’s TriZetto® QNXT, Facets, or QicLink , Zelis Payment’s technology becomes a part of your daily workflow to create a seamless payment process, which improves accuracy and reduces process complexity for significantly improved cost control. To ensure provider satisfaction and reduce noise, we employ a unique, provider-centric enrollment and support model, which encourages electronic adoption and network retention.

    Outbound Printing and Fulfillment



    RedCard delivers reliable, client branded, enhanced design and production of critical customer communications including healthcare checks, Explanation of Payments (EOPs), Explanation of Benefits (EOBs), Healthcare (ID) cards, enrollment-related correspondence, and letters delivered in the mail or via the Web. RedCard enables clients, through an integrated set of Web-based self-service management tools, the ability to redesign its member and provider communication utilizing the latest four-color technology. Based upon client-specific needs, it will also enhance communication time frames using its industry first, healthcare episode-based claim bundling option. This integrated system creates new cost savings while changing the frequency, look, and feel of the communications, allowing for fewer customer service calls and an overall better experience.

    Subrogation and Claim Recovery Services

    The Phia Group logo

    The Phia Group

    The Phia Group is a provider of services designed to control costs and protect plan assets; including subrogation & overpayment recovery, document drafting, compliance and consultation. The Phia Group’s mission is to reduce the cost of health benefit plans through the use of innovative technologies, legal expertise, and focused, flexible customer service.