Problem Statement

Provider records must be accurate for claims to adjudicate and enrollment to report correctly, and reviewing them by hand across a QA'd list of providers is slow and easy to backlog. Stale or invalid User Warning Messages in Facets, specifically codes 00016 and 00018, can misfire during processing, so each practitioner, provider group, or facility has to be opened, checked against the QA list, and the offending line items removed, then logged so the action is auditable. Left in place, these messages create noise and incorrect handling that the QA process exists to prevent.

Automation Solution

This automation opens each provider in Facets, reviews User Warning Messages, and removes line items with specific codes based on the quality assurance list.