Plexis claims processing software helps Independent Physicians Associations (IPAs), Preferred Provider Organizations (PPOs), and Physician Hospital Organizations (PHOs) save money by improving operational efficiencies. Plexis software allows provider-based groups to increase productivity with less staff, access critical data to identify trends, and proactively track accounts receivable with revenue reports to ensure that payment expectations are met.

A Preferred Provider Organization (PPO) is a managed care organization through which customers may patronize a particular network of doctors, hospitals and providers. Customers may also choose outside providers at additional cost. Plexis software supports automated PPO repricing and workflows, incorporating batch EDI or individual claim repricing via the internet (Plexis Direct™).

An Individual (Independent) Practice Associations (IPA) is an aggregated group of prepaid medical practices which allows participating physicians to remain in their independent office settings, seeing both enrollees of the IPA and private-pay patients. Plexis software supports IPA operations with capitation functions, integrated referral and authorization management, AP and AR tracking and reporting, encounter reporting and call sharing. Plexis software also provides IPAs with PCP member management, provider and network contract management and credentialing capabilities.

In addition to a robust benefits administration, claim processing and auto-adjudication software, healthcare IPAs, PPOs, and PHOs also benefit from Plexis EDIWorks™. Plexis EDIWorks™ eliminates a great deal of paper-based processing and improves the efficiency of electronic data interchange by integrating healthcare information directly into the core Plexis database. EDIWorks'™ XML Translator allows provider-based groups to apply their own business rules to the electronic data, creating a seamless flow of information into the database resulting in a constant stream of information into the database.

Plexis Direct™ is a compact direct connectivity solution that offers provider-based groups many advantages.
Plexis Direct™ provides: universal data capture from any practice management system; a secure, automated path to web portals and ASP services; Payer edits, account ID's, knowledge-base, etc.

Plexis WEBWorks™ gives provider-based groups a complete web tool set for controlling online processes, accessing claim and eligibility status*, and monitoring members' coverage and benefits.