Plexis Health Claims Software for Managed Care Organizations (MCOs)

Plexis Claims Manager is a powerful managed care software package that provides 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 to reduce administrative costs. Plexis Claims Manager's managed care software capabilities include the provision of capitation and premium reconciliation reports, which makes it easy for MCOs to identify correct payments for its members.

MCOs typically have direct contracts with providers, and managed care software must be flexible to allow for a wide range of provider contracts. Plexis Claims Manager's payment contracting component makes it easy for the many different combinations of date-sensitive fee schedules associated with these contracts to be loaded into the system.

Plexis Claims Manager provides referral/authorization and a medical management component to facilitate case management and utilization management/utilization review (UM/UR) functions required by MCOs.

Plexis EDIWorks provides extensive healthcare EDI functionality, including enrollment and eligibility, submission/receipt of electronic claim files, and HIPAA standard or custom/proprietary encounter reporting.

Plexis WEBWorks is a web-based claim and referral system providing a managed care web portal that MCOs can use for customer service, facilitating daily transactions, and allowing providers to look up a member's eligibility and check claim status in seconds.

Plexis benefits administration software streamlines the essential elements of managed care claim processing and reporting:

• Premium Billing
• Enrollment
• Claim Processing
• Capitation Processing
• Customer Service
• Case Management
• Performing and Responding to Audits
• Encounter Reporting
• HEDI/NCQA Reporting

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