PLEXIS Portals App

Claims Editing

Accelerate adjudication and increase payment integrity with PLEXIS’ claim editing capabilities

Batch or real-time, your claims will be edited for incorrect and potentially fraudulent billing

Through strategic partnerships, PLEXIS enables streamlined, automated claim editing during adjudication, reducing claim errors and denials and meeting claims cost containment objectives. The result is an increase to auto-adjudication rates, claims payment accuracy, greater regulatory compliance, and a reduction in expenses and manual intervention.

Seamless, automated claims editing

Seamless to the end user, PLEXIS’ claims editing capability sends out adjudicated claims to our partners whose engines maintain thousands of claim editing rules. These solutions are fully-customizable to meet specific billing guidelines for institutional and professional claims, significantly reducing FWA (fraud, waste, and abuse) , as well as incorporating NCCI data rules. Users have the flexibility to configure responses to different types of edits, allowing them to create more efficient workflows.

Ensure compliance and stay current with evolving CMS coding mandates by leveraging PLEXIS’ partnering solutions.