Use the module icons to open a realistic “Configurator” (like Facets build/checklist work).
Each module includes a multi-step checklist: required fields, validations, effective dates, and common pitfalls.
Tip: Pick MRI and toggle Auth Exists.
Then run the journey to see the claim deny vs pay.
System of Record View
Single source of truth
Members
INACTIVE
MemberSarah Johnson
Member IDM-100245
PlanEchoCare Gold PPO
Coverage—
Enrollment creates eligibility, assigns plan/benefits, activates coverage by effective dates.
Providers
IN-NETWORK
ProviderDr. Angela Reed
TypePrimary Care
NetworkIN
Allowed Estimate—
Network + contract terms influence allowed amount and claim pricing.
Claim Setup
CLM-00001
Plan Rules (Simplified)
IN PCP: $25 copay
IN Specialist: $40 copay
Deductible: $500 (Individual)
Coinsurance: 80/20 after deductible (IN)
OON Coinsurance: 60/40 after deductible
MRI: Prior Auth required
Expected Outcome
Allowed Amount$0.00
Decision—
Plan Pays$0.00
Member Owes$0.00
Edits + pricing + deductible + copay/coinsurance.
Payment Artifacts
835 Remit—
EOB—
Premium Billing—
Deductible Remaining$500.00
Facets produces remit/EOB artifacts and tracks accumulators across claims.