Integration / EDI
Configurability and ecosystem enablement have become the most critical capabilities in next-generation core administrative processing solutions (CAPS). To address a rapidly evolving market and the associated uncertainties, PLEXIS next-generation CAPS platform are scalable, extensible, and adaptable.
Real-time and batch EDI, provided by PLEXIS, is the solution for comprehensive end-to-end processing. Simplify, empower, and visualize the management of your full EDI transaction lifecycles. PLEXIS real-time and batch EDI reduces data entry needs and maximizes strategic, scalable, and sustainable communication with trading partners.
AIS web services, provided by PLEXIS, enable rapid deployment of systems integration for optimum enterprise interoperability. This extends to real time electronic systems integration (ESI) with Quantum Choice core (processing) services such as claims adjudication, enabling real time claim editing and pricing with external systems. Additionally, support for the most commonly used HIPAA EDI transactions enables expedient clearinghouse connectivity, and increased speed-to-value.
PLEXIS Integrative EDI technology provides powerful solutions for healthcare payers
- Automate inbound and outbound processing of X12 5010 and proprietary formats, including claims (837s), enrollments (834s), remittance (835s), finalized authorizations (278, proprietary), and more.
- Leverage isolated configuration layers (transform and business rules) to meet your specialized business needs for full-spectrum, end-to-end processing.
- Increase automation for claim lifecycle from receipt of claim through payment and encounter reporting.
- Manage many-to-many trading partner agreements through our Trading Partner Manager client. Supports generation of TA1 and 999 responses for X12 5010 document types. Apply reusable processing rules to multiple trading partner agreements, or specialize processing for specific trading partners.
- Configured for your business needs. The transform layer allows common processing tools to be applied to X12 5010 and proprietary formats. The configuration layer supports specialized processing of your inbound and outbound transactions targeting claims system configuration.
- Customize your EDI processing to automate workflows beyond standard EDI processing. Our modular application supports development of customized enhancements to meet your specialized needs, including mapping, scrubbing, translating, and validating your data
- Meet compliance requirements for HIPAA, utilizing code sets such as NPI, ANSI, Standard Health Care Codes, CPT/HCPCS, ICD-10, etc.
- Reap the benefits of standard processing and specialized processing within a single product, limiting administrative costs through decreased manual intervention and support calls while increasing the data throughput for your business.