PLEXIS Webinar – Enhanced Claims Inventory Management – March 8, 2024

Orion for PCM Webinar – Questions Raised by Attendees – PLEXIS Responses – 03082024

“PLEXIS Webinar – Enhanced Claims Inventory Management” was hosted by Sean Garrett, COO of PLEXIS Healthcare Systems, and Sarah Lesowski, who covered the product overview. The focus of the webinar was on enhanced claims inventory management through the use of Orion, a new add-on capability for use with your PCM system, designed to support health plans, TPAs, and managed care organizations.

Key points from the webinar included:

  1. Introduction and Context: Sean Garrett introduced the topic and mentioned the intent to answer attendee questions post-webinar. He emphasized the role of PLEXIS in offering solutions to improve the operational efficiency of claims processing for their diverse client base, which included claims examiners and adjusters. The discussion centered around a new front-end alternative UI designed to cater specifically to the needs of claims examiners.
  2. Role-Specific Enhancements: The new system, Orion, was introduced as a role-specific solution aimed at front office workers, particularly claims examiners. It focused on managing an inventory of claims, which included finalizing pended claims through an efficient and effective process. This approach aimed to minimize operational costs, improve auto adjudication rates, and enhance satisfaction among providers and members.
  3. Product Overview by Sarah Lesowski: Sarah delved into the technical aspects of Orion, including its setup, administration, and configuration of queues for claims management. She explained how Orion facilitated the distribution and management of claims among analysts and groups, leveraging criteria-based filtering for efficient claims routing. The system allowed for manual and automated claim selection, enhancing the flexibility and efficiency of the claims processing workflow.
  4. Demonstration and Features: The demonstration showcased Orion’s capabilities in managing queues, assigning tasks, and handling claims through a user-friendly interface. It highlighted the system’s ability to integrate with PCM (PLEXIS Claims Manager) for seamless claims processing, offering insights into adjudication details, payment details, and task management. Sarah emphasized the configurability of the system, its support for task assignments, and the ability to attach documents to tasks for comprehensive claims management.
  5. Closing Remarks: The webinar concluded with Sean Garrett inviting feedback from clients and expressing an interest in exploring the use of AI to further enhance claims processing efficiency. He underscored the PLEXIS commitment to supporting their clients in managing a growing volume of claims without necessarily increasing staff, thereby improving stakeholder satisfaction and operational efficiency.

Overall, the webinar introduced Orion as a transformative tool designed to streamline claims processing through improved inventory management, task assignment, and a user-friendly interface, highlighting the PLEXIS commitment to innovation and client support in the healthcare claims management sector.