Comprehensive TriZetto Facets™ Support for Healthcare Efficiency

How One U.S. Health Plan Rapidly Expanded in ACA and Medicaid Using Facets

Challenge: Leveraging Technology to Expand Product Lines and Serve More Members

Health plans face limited options for growth: increasing membership, expanding into new geographic markets, and participating in governmental programs like Medicaid and Medicare. Achieving this requires robust technology to manage benefit configurations, claims systems, and data. Without the right technology and expertise, growth is stifled.

A client approached us during their transition from a legacy claims system to TriZetto Facets™, seeking assistance with their ACA (Affordable Care Act) expansion, which had been delayed. Their goal was to enter multiple states with new product lines to grow their business rapidly. However, they faced significant challenges:

• No team experience with Facets.
• Lack of formal testing and documentation processes.
• Inadequate project tracking system, limiting executive visibility.

Solution: Configure Facets to Expand into ACA and Medicaid Lines of Business

Alivia assembled a highly skilled team capable of navigating complex functionalities to avoid slowing down progress. We developed a project plan with five fundamental steps:

1. Requirements: Gather detailed requirements for the ACA and Medicaid expansion.
2. Design: Create a design plan to configure Facets for the new product lines.
3. Build: Implement the design within the Facets system.
4. Test: Conduct thorough testing to ensure all configurations worked as intended.
5. Deploy: Successfully roll out the configurations, enabling the client to enter new markets.

Alivia’s Role: General Contractor, Mentor, and Software Engineer

Throughout the process, we acted as general contractors, mentors, and engineers. We:

• Created detailed project plans and timelines.
• Facilitated DHCP (Dynamic Host Configuration Protocol) setup by collecting and documenting necessary information.
• Configured Medicaid by grouping age-based fee schedules logically and aligning them with taxonomy codes.
• Developed 500 qualifier groups for Facets to create claim agreements.
• Mentored the client’s team across all levels and set up comprehensive documentation processes.

Outcome: Successful Market Expansion

The client rapidly implemented new product lines and expanded into new markets. As a result, they transitioned from a third-party administrator (TPA) to a fully qualified health insurance provider (QHP). This project underscored Alivia’s capability to deliver turnkey, end-to-end solutions for configuring Facets to support business growth.

Seamless TriZetto Facets™ Support for Enhanced Health Plan Administration

• System Integration: Optimize your Facets environment with seamless integrations to enhance workflow efficiency and data accuracy.
• Custom Development: Tailor Facets to meet your specific needs with bespoke solutions that enhance functionality and user experience.
• Regulatory Compliance: Stay compliant with industry regulations through timely updates and modifications.
• Data Migration: Ensure smooth transitions with our reliable data migration services, maintaining data integrity and minimizing downtime.
• Training & Support: Empower your team with comprehensive training and ongoing support for optimal use of Facets.

Specialized Services for Comprehensive Strategy and Operations

Strategy

• Readiness Assessments: Evaluate your preparedness for system upgrades or new implementations.
• Requirements Analysis: Define system requirements to align with operational goals.
• Product Fit Analysis: Recommend the best product solutions tailored to your needs.
• Solution Architecture: Design robust architectures to ensure system efficiency and scalability.

Implementation

• Configuration: Customize your system settings to match business processes and workflows.
• Integration: Integrate with existing systems for enhanced interoperability and data flow.
• Testing: Validate system functionality through thorough testing.
• Go-Live Support: Support the transition to live operations with minimal disruptions.

Operations

• Upgrades and New Releases: Implement system upgrades to leverage new features.
• Usage Efficiency: Optimize system usage to enhance productivity.
• Service Level Agreements (SLA): Manage SLAs for consistent service delivery.
• Reporting & Analytics: Utilize analytics to monitor performance and make data-driven decisions.

Our Unique Expertise in TriZetto Facets™

At Alivia, we possess deep-rooted expertise in TriZetto Facets™, allowing us to support the operational requirements with unparalleled proficiency. We live and breathe IT solutions for health plans, ensuring our clients benefit from top-tier service and innovation.

Why Choose Us for TriZetto Facets™ Support?

• Industry Expertise: Benefit from our extensive experience in health plan administration systems.
• Customized Solutions: Receive solutions tailored to your specific operational needs.
• Proactive Approach: Experience proactive support that anticipates and resolves issues.
• Client-Centric Service: Enjoy a partnership that prioritizes your success with dedicated account managers and responsive support teams.