Sophisticated claims adjudication software on a powerful payer platform
Growing numbers of healthcare payers are seeking to centralize and modernize their claims processing environment. Manual processes and legacy administrative systems are costly and inaccurate. Healthcare payer organizations are increasingly aware that leveraging automated claims adjudication software is the single greatest step they can take to process claims with sufficient speed and accuracy so you can reduce or eliminate duplication errors for an accelerated ROI.
The critical components of modern claims adjudication software include:
- A rules-based engine to automate all workflows for claims adjudication, auto-adjudication, benefit administration, enrollments, eligibilities, premium billing, and more
- A flexible API integration offering complete interoperability to connect all your enterprise-wide systems.
- Agile technology built on service-oriented architecture to deliver scalable, enhanced transaction processing
- Automated batch readjudication capabilities to streamline workflows for claim reprocessing projects
A claims adjudication solution ready for expanding healthcare markets
The best claims adjudication software must come from an established healthcare IT company that serves the needs of a number of leading healthcare markets. For example, if your organization currently specializes in medical claims adjudication, then your claims adjudication solution should also be able to cover the intricacies of dental claims adjudication in case your organization takes on an opportunity for expansion in years to come. Likewise, payers must consider only EDI-ready claims adjudication software with the full data integration to process electronic claim submissions in real-time.
PLEXIS Healthcare Systems deploys mission-critical claims adjudication solutions
PLEXIS’ comprehensive enterprise platform is the premier claims adjudication and benefit administration software solution on the market. Serving a large number and variety of healthcare payers for the past 20 years, PLEXIS simplifies and automates claims processing operations. PLEXIS’ agile, flexible technology is eminently configurable to empower you to manage all aspects of claims onboarding and integration.
Learn more about our rules-based core administration + claims management solution, our suite of readily-configured business apps, and the cutting-edge services we offer as part of our full-service platform solution.
