Problem Statement

When a provider contract is updated retroactively, or a configuration setup error is found and corrected, claims that already adjudicated under the old terms may now pay differently. Before acting on that, the plan needs to know the scope and dollar impact: how many Facets claims are affected and how the allowed, deductible, copay, and coinsurance amounts would change. Pulling that together manually means identifying the affected claims and recalculating each one, slow analysis that delays the plan's view of its exposure and which claims need reprocessing.

Automation Solution

This automation reports the financial impact (allowed, deductible, copay, and coinsurance) of retroactive contract updates and setup errors on affected Facets claims, providing a snapshot of how those claims would pay once the configuration changes are applied.