Plexis International Claims Processing & Benefits Administration Software

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)	Remote Access

International benefits administration require an integrated healthcare information system, such as Plexis Claims Manager. For example, 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.

Multi-currency Support for International Claims Adjudication

Multi-currency functionality is required by international organizations that have a single database for processing claims and premium bills from offices with multiple locations and currencies.

Plexis supports the standard Microsoft Windows multi-currency function and uses Microsoft Great Plains Dynamics for the maintenance of currencies and exchange rates.

Plexis Claims Manager's multi-currency claims processing features include:

• Plexis Claims Manager saves international claims in the native currency of the payor.

The payor record has an associated "native" currency type. When the international claim is saved into the database, all money amounts (charges, deductible, coinsurance, net payment, etc.) are saved in the native currency of the payor.

• Plexis Claims Manager pays international claims in the native currency of the payee.

Each provider record has an associated "native" currency type. The system makes payments to the payee (vendor) in their native currency.

• International claims may be entered in any supported currency.

Plexis Claims Manager has a currency exchange rate table that identifies every supported currency. The claim entry screens supports entering monetary amounts (charges, deductible, coinsurance, net payment, etc.) in any of the currencies supported by the exchange rate table.

• Plexis Claims Manager supports multiple exchange rate dates for international claims processing.

Whenever a person enters a claim in a currency other than the native currency of the payor, then the data stored in the database does not match the monies entered on the claim. To translate between the two currencies there must be a fixed exchange rate date. This is the date used to look up into the exchange rate table to determine the exchange rate to use when translating from the currency used to enter the claim to the default currency used.

• Plexis Claims Manager supports the following fixed exchange rate dates for international claims processing:
• The "from" date of service entered on the claim.
• The received date entered on the claim.
• The date the claim was entered into Plexis Claims Manager.
• The date the claim was adjudicated.
• Plexis Claims Manager displays and modifies international claims in any supported currency.

Once Plexis Claims Manager saves an international claim, it can display the claim in any currency supported by the currency exchange rate table. The claim screens have dropdown fields for selecting the desired display currency. This dropdown field defaults to the native currency of the provider.

Importing International Procedure and Diagnosis Codes

International benefits administration and claims processing includes claims that originate from different parts of the world and include a variety of coding. International healthcare claim processing may involve CPT, ICD9, ICD10, French social security codes, and others.

Plexis benefits administration software allows multiple code tables to be loaded into the system for international claims processing.

Remote Access Option 1: Wide Area Network.
In a Wide Area Network, routers are used to route packets of information via dedicated lines between networks. With this mechanism in place, international healthcare organizations' data can be sent from remote locations on dedicated lines to a central office for processing. For example, a WAN may directly connect remote offices in Brazil, the United States and Canada through a large network, based on dedicated lines between those locations. In this way, Plexis Claims Manager can reside at a central location and claim adjudication and benefits administration can be accomplished from remote locations.

Remote Access Option 2: Virtual Private Network.
The function of a Virtual Private Network (VPN) is to allow two computers or networks to talk to each from remote locations. To accomplish this, a VPN uses a computer at each of the two or more points on the various ends of the transport media, such as the Internet. For example, a healthcare organization based in Europe may have offices in France, Germany, Algeria and Thailand. The organization can setup a VPN so it can access any of the 4 network locations at any time through the Internet.

Healthcare organizations can have a unique server located in Europe, equipped with SDSL lines and accessed by users via VPN. Claims data from remote locations could be encrypted and transmitted via VPN to central offices for adjudication.

Remote Access Option 3: Built-in Web Front End
A Web Front End allows a variety of users to access data from remote locations via the Internet, and allows healthcare organizations to limit data access privileges. Plexis WEBWorks is a Web application that connects providers, consumers, employers, administrators and vendors with an integrated database. WEBWorks provides a fast and efficient method of delivering clear, on-demand and up-to-date information from one location to another, and provides seamless integration with the Plexis database. However, WEBWorks does not provide access to the centralized application (Plexis Claims Manager) to perform their daily processes. Options 1 and 2 will be required for remote access to the centralized application.

Plexis International Claims Processing White Paper:

Point-of care-settlement for Cayman General Insurance Partnership, remote access and multi-currency functionality

 Learn More About Plexis Claims Manager

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