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Hosted by Sean Garrett (COO) and Sarah Lesowski (VP), the webinar introduced Orion, a worker portal designed for claims operations staff. It enhances claims inventory management and allows native claims processing within the interface.

1. Core Features:
   • Claims Queuing: Orion enables users to create and manage custom claims queues based on criteria like claim status or user assignment. Claims are routed to users either automatically or manually, enhancing operational flexibility.
   • Task Management: Users can create, assign, and track tasks, including setting reminders and linking external documents, to streamline claims resolution.
   • Real-Time Integration: Updates made in Orion are reflected in PCM, ensuring consistency and accuracy.
   • Configuration Flexibility: Administrators can customize groups, queues, and routing logic to meet organizational needs, including task assignment based on roles or departments.
2. Additional Capabilities:
   • Orion provides detailed reporting and auditing functionality, enabling organizations to track user activity, claim histories, and task progress.
   • The system supports adding multiple EOB codes during claim processing, with enhancements to bulk-edit functionality being considered for the roadmap.
3. Enhancements Discussed:
   • Expanding queue criteria (e.g., benefit contracts, claim aging, adjudicator filters).
   • Improved bulk-edit capabilities for processing multiple claims or EOB codes simultaneously.
   • Additional flexibility in document linking and storage.
4. Audience Engagement: Participants raised questions about functionality, reporting, and usability, leading to clarifications and potential feature additions.The audience requested several additional features and enhancements for the Orion system during the webinar. Here are some of the key requests:
   1. Bulk Editing Capabilities:
      • Ability to bulk edit claims, such as denying or reprocessing claims for a specific provider, payer, or issue.
      • Adding or removing multiple EOB codes across all lines of a multi-line claim or applying changes across multiple claims at once.
   2. Queue Configuration Enhancements:
      • Creating queues based on claim aging, such as defining buckets by the number of days since the claim was received or the date of service.
      • Allowing different users or groups to handle specific aging ranges (e.g., claims aged 1–10 days versus 11–20 days).
      • Adding benefit contract as a queue filter criterion.
   3. Adjudicator Reporting:
      • Filtering claims or generating reports based on which adjudicator worked on a claim, including tracking system-adjudicated claims versus those manually handled by specific users.
      • Viewing and reporting on user activity within Orion, such as claims worked by an individual or group.
   4. Document Linking Flexibility:
      • Clarifying how external documents (e.g., EOBs or other attachments) can be linked to claims in Orion.
      • Ensuring that document linking and storage are user-friendly and not restricted to a single mapped folder.
   5. Task Management Improvements:
      • Enhancing notification functionality for tasks, ensuring users are informed of updates or completions.
      • Streamlining task assignment to groups or individuals for better workload management.
   6. Claim Line-Level Edits:
      • Ability to add EOB codes to all lines of a claim simultaneously rather than line by line.
5. Future Plans:
   • Plexis is considering holding an in-person user conference in 2025 to facilitate networking and learning among PCM users.

The session highlighted Orion’s role in improving efficiency, reducing manual workload, and providing robust tools for claims processing and management.