Quantum Choice® and Orion® provide configurable core administration, workflow automation, and operational visibility for Medicare Advantage Dual Eligible Special Needs Plans
Medford, OR – July, 2026 – Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs) continue to operate within an evolving regulatory and operational environment while balancing Medicare and Medicaid administration, claims accuracy, member service, and cost management. PLEXIS Healthcare Systems highlights how its Quantum Choice® core administration platform and Orion® operational workspace support these organizations with configurable technology designed to automate administrative processes and improve operational visibility.
Health plans administering complex government-sponsored programs require technology capable of adapting to changing business requirements while supporting efficient claims administration, provider management, enrollment, and customer service operations – including enabling self-service by plan members and providers via a PLEXIS-provided real-time integrated web portal. Quantum Choice supports these needs through configurable business rules, automated claims adjudication, provider administration, enrollment management, premium billing, capitation administration, revenue reconciliation support, and real-time interoperability through web services-based integration capabilities.
Complementing the core platform, Orion provides an integrated operational workspace for customer service, task management, claims inventory management, call tracking, configurable claims routing, dashboards, and operational reporting. Together, Quantum Choice and Orion help organizations improve workflow management while providing greater visibility into day-to-day administrative operations.
“Health plans need technology that can adapt as business and regulatory requirements evolve,” said Sean Garrett, Chief Operating Officer of PLEXIS Healthcare Systems. “Quantum Choice was built to provide highly configurable administration, workflow automation, and operational flexibility that help organizations improve efficiency while supporting the complex requirements of Medicare, Medicaid, and other government-sponsored healthcare programs.”
Additional Quantum Choice capabilities include:
- Configurable benefit administration supporting Medicare and Medicaid products
- Automated rules-based claims adjudication
- Provider contract and fee schedule management – including automated Medicare and Medicaid claim pricing
- Premium billing and capitation administration
- Revenue reconciliation support
- Real-time integration through Quantum Application Interface Services (AIS)
- Workflow and alert notification automation through PLEXIS Alerts
- AI-assisted provider data management and configuration support
As Medicare Advantage enrollment continues to evolve, health plans continue to evaluate administrative platforms that offer configurable business rules, automation, and scalable operational capabilities to support changing business requirements and new line of business growth, while helping reduce manual administrative effort. Quantum Choice was designed to provide the flexibility, automation, and interoperability organizations need to support today’s complex healthcare administration environment.
About PLEXIS Healthcare Systems
PLEXIS Healthcare Systems delivers enterprise-grade core administration and claims processing solutions that power modern healthcare payers and delivery organizations. Recognized as a representative vendor in Gartner’s 2026 “Market Guide for U.S. Healthcare Payer Core Administration”, PLEXIS enables organizations to navigate evolving market demands around automation, integration, and benefit complexity. Through its flagship platform, Quantum Choice®, PLEXIS supports the full spectrum of core administrative functions including claims adjudication, enrollment, premium billing, provider data management, and benefit configuration. Built on a scalable, API-enabled architecture, the platform allows payers to streamline workflows, reduce manual intervention, and adapt to shifting regulatory and product requirements.
PLEXIS solutions are designed to align with the market’s shift toward composable, API-driven ecosystems and real-time data integration, empowering health plans to modernize at their own pace while maintaining operational continuity. With advanced automation, configurable rules-based processing, and seamless interoperability, PLEXIS helps organizations improve efficiency, reduce administrative friction, and deliver accurate outcomes across the claims lifecycle.
More than 100 organizations trust PLEXIS to manage complex benefit structures and process millions of covered lives across all lines of business. By combining deep domain expertise with flexible technology, PLEXIS enables payers to meet today’s operational challenges while building a foundation for future innovation.
Gartner does not endorse any vendor, product or service depicted in its research publications and does not advise technology users to select only those vendors with the highest ratings or other designation. Gartner research publications consist of the opinions of Gartner’s research organization and should not be construed as statements of fact. Gartner disclaims all warranties, expressed or implied, with respect to this research, including any warranties of merchantability or fitness for a particular purpose.
GARTNER is a registered trademark and service mark of Gartner, Inc. and/or its affiliates in the U.S. and internationally and is used herein with permission. All rights reserved.