Announcing ReClaim™ for PLEXIS Claims Manager ™
With almost two decades of market experience, PLEXIS understands payers’ needs for a readjudication tool that is easy to deploy yet includes the advanced functionalities to cover every aspect of batch readjudication. PLEXIS ReClaim™ finds pended claims and lines and automatically re-adjudicates them. It finds closed claim lines and negates them or optionally adds copies of the original lines and adjudicates the new lines.
PLEXIS ReClaim has the advanced configurability to deliver the following business values:
- Increase adjudication efficiency by minimizing manual intervention
- Streamline workflows for claim reprocessing projects
- Reduce technical requests to your IT group with our batch-friendly search tool
- Deliver better data quality with faster response times
The three principal functions of ReClaim are to search, change, and process:
- Search: claim, member, provider
- Change: delete, adjust, correct
- Process: test, process, undo
PLEXIS ReClaim™ will list the claim lines that meet the parameters that you have set, allowing you to exclude any claim line from processing. A test run of the claim processing can be done on one of the claim lines, allowing you to verify your outcome within PLEXIS Claims Manager and “undo” the changes if needed. As ReClaim processes the claim lines a status will be displayed on the screen, letting you know which claim line have completed and the outcome. Projects can be saved and reused in PLEXIS ReClaim which will save the query criteria, processing settings, and the identified claims for future use.