Plexis Claims Processing Software for PACE and Long Term Care Organizations

Programs of All-inclusive Care for the Elderly (known as PACE) provide continuous care and services offering individuals eligible for nursing home care the option of continuing to live in the community. Because these health care costs are traditionally paid for through the Medicare and Medicaid programs and out of people's pockets - access to a comprehensive system of care that encompasses preventive, primary, acute and long term care is usually not possible. An important component of the PACE model is the combining of dollars from different funding streams in order to deliver a comprehensive set of services focused on the health and well-being of the individual. It is essential that PACE software used to process PACE claims and administer PACE benefits provide the flexibility and functionality to support the coordination of benefits from various funding streams.

Plexis Healthcare Systems benefits administration and claim processing software serves several PACE organizations across the United States. In fact, Plexis claims systems provide automated claims processing, benefits administration and encounter reporting for the nation's largest PACE organizations. Plexis' award-winning Plexis Claims Manager healthcare software provides the tools and flexibility to automate PACE claims processing and benefit administration.

Examples of Plexis claims processing and benefits administration functionality specific to PACE claims and long term care benefits include:

• Ability to load National Drug Code (NDC) pharmacy codes
• ASC Fee Schedule Generator
• CMS Inpatient Fee Schedule Generator
• DRG Fee Schedule Generator
• Fee Schedule Importer
• Fee schedule modifier importer
• National Correct coding code loader - uses Medicare definition of the 140,000 pairs of codes which are mutually exclusive (can not be together), looks for unbundling of claim items, looks for modifiers which are not allowable for certain procedures, looks for codes which are not allowed based on gender.
• ID card extraction tool for creation of member ID cards

Plexis Claims Manager's advanced reporting capabilities provide the claims processing and benefits administration information long term care organizations require to reduce costs, improve productivity, make better decisions, and expand into markets such as Medicare Advantage. Plexis long term care software and PACE reporting functionality features:

• More than 100 standard claims processing reports
• Allow you to create your own custom reports
• Queries in Excel
• Queries in Access
• Open database - makes it easy to control your claims processing and benefits administration data

 Learn More About Plexis Support for PACE Organizations and Long Term Care Benefits Administration