Dental Claims Processing Solutions

With an automated, rules-based system that which optimizes productivity and significantly reduces costs, Plexis Quantum Choice™ provides extensive dental claim processing capabilities. Rules-based technology offers health insurers, TPAs and managed care organizations the dental benefit administration flexibility required to achieve growth and provide superior service.

Government Healthcare Solutions

A few years ago, as healthcare spending was growing faster than government infrastructures could manage, Plexis recognized a unique opportunity. As a team of talented professionals, and as concerned citizens, we resolved to develop an efficient solution that could restore responsible control to government healthcare officials. Today that challenge, more significant than ever, has been met with determination and dedication. Plexis is proud to present the new standard of agility, flexibility, rapid deployment and overall cost efficiency in a true COTS based, MITA aligned, SOA platform.

Health Insurance Companies

Plexis benefit administration software provides health insurance companies with a claims system that reduces costs by focusing on health plan results instead of health plan claims processing. Administrative costs drop when premium billing, capitation, commissions and claim adjudication become automated. This automation frees staff, who can make informed decisions based on documented trends and actual expenses. Plexis health plan administration software includes standard and ad-hoc reporting capabilities that provide decision-making information for every area of health plan management.

International Claims Processing

Globalization has created many challenges and opportunities for international healthcare organizations. For example, many international organizations process a wide variety of medical claims and healthcare benefits that originate from different countries. Plexis healthcare information system supports three key areas necessary to international claims processing and benefits administration:

1. Multi-currency Support
2. Importing International Code Tables
3. Web-based Automated Claim submission/adjudication (via Plexis Direct™)

International benefits administration require an integrated healthcare information system, such as Plexis Claims Manager. An integrated benefits administration system allows an international subscriber's demographic information to be maintained and easily accessed within the system to facilitate claims processing and auto adjudication.

Managed Care Organizations

Plexis offers powerful managed care software packages that provide managed care organizations (MCOs) with technology tools to streamline business processes and increase revenues. Plexis benefits administration and claims processing software optimize productivity for managed care organizations (MCOs) by automating essential operations. Managed care software capabilities include the provision of capitation and premium reconciliation reports, enabling MCOs to identify correct payments for their members.

IPAs, Medical Groups, PPOs and PHOs

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.

Third Party Administrator

A Third Party Administrator (TPA) is an organization that performs benefit administration and claims processing services for other organizations, like self-funded employer groups. However, TPAs may contract with insurance companies and managed care health plans to perform these same services on their behalf.

Plexis claims processing and benefit administration software helps Third Party Administrators (TPAs) reduce their workload and costs and add value to their client services. Our rule-based claim processing systems typically create very high auto-adjudication rates, which means that only a small percentage of all claims processed require manual intervention.