The Competitive Advantage of our Proven Product Features

  • Payers in the field of delegated risk stay in control of the information that various users are authorized to view with PLEXIS’ smart portal solutions.
  • Process Claims on a familiar Windows interface with hot keys.
  • Load legacy data far more quickly with the PLEXIS GFFI.
  • For Business Activity Monitoring (BAM), PLEXIS Alerts sends automated, intelligent alerts to a variety of user-defined media devices including a cell phone or pager.
  • Linked Accumulators automatically track contingent benefits.
  • Configure filters to eliminate Duplicate Claims.
  • Conduct Encounter Reporting in compliance with CMS protocol.
  • Automate sequestration payments, interest, and penalties with our Withhold tool.
  • Customize result/EOB codes and control their action (deny/pend/approve), and further customize forms for reporting purposes.
  • Effective from and through dates allow users to proactively implement changes before they take effect.
  • Accounting abilities are included with AP/AR.

Payer Benefits

  • Meet cost containment objectives by investing in affordable core administrative processing technology for the greatest ROI.
  • Automate complex benefit calculations and drive high auto-adjudication rates with PLEXIS’ rules-based .NET system.
  • Support multiple lines of business on one platform, eliminating data silos so that key data is shared among appropriate agencies. For example, state healthcare organizations can support multiple programs such as Medicaid, SCHIP, and Public Employees Insurance plans—all under one enterprise-wide solution with nearly unlimited scalability through the deployment of RAIS (Random Array of Inexpensive Servers).
  • Simplify regulatory compliance with HIPAA-ready EDI (electronic data interchange), developed to include ICD-10, HCFA 1500, and UB04.
  • Flexible configuration capabilities drive outcomes with an agile, dependable software solution.
  • Deploy the most comprehensive benefit administration platform on the market with the assurance of proven reusability to ensure success throughout ongoing changes in healthcare policy and technology.