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Product Briefs
Quantum Choice combines a user-configurable rules-based processing engine, .NET platform and distributed architecture to deliver a powerful new benefits management solution. Its state-of-the-art technology optimizes your current business processes and allows for seamless integration with web-based tools; flexible design and user-configurable rules make it easy to add new products.
With rapidly evolving government healthcare landscapes, payer organizations anticipate changes on the horizon for programs, products and technologies. Quantum Choice is a COTS product that is closely aligned with the MITA 2.0 initiative to deliver the processing and architectural agility required to rise to tomorrow’s challenges.
Plexis Claims Manager is an integrated healthcare information system providing complete benefit administration, claim processing, and reporting features. Tailored to reduce administrative costs and increase productivity, Plexis Claims Manager is designed to provide a solid return on technology investments.
Plexis LCSConnect is a powerful electronic gateway that combines EDI, an XML-based translator, and data conversion interface with a powerful rules engine that conforms to your organization’s processes. These components work together to send and receive X12 and other data formats to and from Plexis LCS for smooth electronic transmission.
Plexis Alerts’ enhanced business activity monitoring (BAM) technology enables Plexis clients to identify and respond to business issues, enterprise-wide, by automatically sending alerts or notifications according to pre-defined means, when user-specified events related to an operational management function (e.g., claims, premium, capitation, etc.) occurs. Plexis Alerts notifies clients of important issues such as impending changes in client age, past due accounts and claims billed at over a predetermined amount. It also monitors IT functions alerting appropriate personnel of computer server problems and many other issues.
Combining the power and flexibility of Plexis Claims Manager with Plexis Direct allows claims to be adjudicated in about the same time as a credit card transaction.
Quantum EDI is an advanced, full-featured electronic gateway that combines EDI, an XML-based translator, and data conversion interface with a powerful validation engine that conforms to your organization’s information flow. These components work together to move X12 and other electronic data formats to and from Plexis Quantum Choice with smooth efficiency.
EDIWorks is a powerful electronic gateway that combines EDI, an XML-based translator, and data conversion interface with a powerful rules engine that conforms to your organization’s processes. These components work together to send and receive X12 and other data formats to and from Plexis Claims Manager for smooth electronic transmission.
WEBWorks provides an easy-to-use healthcare web portal that allows providers, health plans, vendors and TPAs to instantly communicate and share data. WEBWorks allows access to third party healthcare information system data, connecting claim adjudication data with other vendor information, such as data from a pharmacy benefit manager (PBM).
Plexis provides the tools to automate the administration of Medicare Advantage benefits according to CMS requirements. From capturing enrollment data and sending via EDI to CMS, executing RAPS encounter data extracts, and administering dual eligibility, the Plexis software solution handles Medicare’s interfaces and requirements, accelerates processing time and accuracy, and provides customer service representatives with the information necessary to improve customer satisfaction.
