The Comprehensive Solution to Enhance and Optimize Business Operations in PACE Managed Care Organizations

Cutting-edge platforms from PLEXIS Healthcare Systems are engineered to transform how PACE managed care organizations operate – ensuring that they can focus on what matters most — providing outstanding care to their clients while maintaining high degrees of operational efficiency and compliance.

Click the image below to download our “Quantum Choice PACE/Managed Care Support” brochure and learn more about how PACE business processes are elevated, enhanced, and optimized with these capabilities:

Download our Quantum Choice PACE/Managed Care Support brochure to learn more about how PACE business processes are elevated, enhanced, and optimized with these capabilities.

Automated Claim Processing

  • To include auto-adjudication of claims and use of EDI for automated receipt and loading of claims supporting real-time application of Medicare edits and pricing.

Comprehensive Provider Data Management

  • Adept at tracking providers and managing corresponding contract, vendor, practice office, and network affiliation details.

Capitation : Revenue Reconciliation (A/R), Provider Payments (A/P)

  • A/R: Revenue reconciliation to ensure awareness of potential revenue inaccuracy.

  • A/P: Capitation processing to support risk-sharing arrangements with specific providers.

Integration with Critical Systems

  • The ability to interface your core admin system with other critical systems (i.e., EHR and UM/UR), creates a unified and streamlined ecosystem for key healthcare data records and transactions.

 

PLEXIS technology empowers PACE organizations to:

  • Enhance provider networks.
  • Lower utilization rates and close care gaps with coordinated care.
  • Simplify inpatient and outpatient prospective pricing.
  • Integrate business intelligence + business analytics (BI/BA) to deliver actionable insights, predict outcomes, and reduce risk.
  • Closely and effectively manage your capitation contracts and arrangements.
  • Coordinate mass reprocessing of claims due to retroactive changes.
  • Automate complex benefit calculations to drive high auto-adjudication rates augmented by automated audits and responsive reporting to meet cost containment objectives.
  • Simplify electronic workflows.
  • Connect and communicate with members, providers, and all essential stakeholders with PLEXIS real-time portals.
  • Achieve efficient fraud, waste, and abuse (FWA) detection with automated claim editing supported by automated alerts, reporting, and workflows. 
  • Enhance transparency to accommodate ever-evolving compliance requirements.