Plexis EDI Healthcare Software: EDIWorks

Electronic data interchange (EDI) standards provide a shared language that enables healthcare organizations to interact electronically. Plexis EDIWorks offers significant benefits over traditional paper-based claim processing, including improved accuracy, efficiency, speed, and lower investment in claims processing and health information systems.

Plexis EDIWorks software is customizable to provide a dependable, efficient and flexible electronic gateway that, in conjunction with PCM, makes it easy for healthcare organizations to send, receive, process and store electronic data from any source, and verify accuracy.

Plexis EDIWorks interfaces directly with our Plexis Claims Manager program for a seamless electronic data interchange solution that significantly reduces administrative costs associated with claims processing.

Plexis EDIWorks Includes 3 Powerful Features:

• Healthcare EDI interface built with a X12 translator *
• Sophisticated rules engine for faster EDI implementation
• Customizable to meet an organization's proprietary requirements

These three features work together to translate, extract, transfer and load X12 and other data formats to communicate with Plexis Claims Manager for seamless electronic data transmission.

Claredi Certified EDI

Plexis EDIWorks has been certified to meet Claredi standards. EDIWorks supports major X12 formats and automatically integrates X12 data formats into Plexis Claims Manager.**

Configurable Rules Eliminate Manual Data Entry

Plexis EDIWorks includes a rules engine that allows our knowledgeable Plexis EDI staff to map, scrub, translate and validate data and set specific business rules to your organization's unique needs. By supporting proprietary business rules, verifying the integrity of imported data and providing crosswalk functionality, EDIWorks saves time and reduces administrative costs associated with paper-based claims processing.

How the Plexis EDIWorks Program Works:

• X12 data is translated into XML, and then travels through the EDIWorks rules engine. Legacy and proprietary data must also be translated into XML prior to entering the data conversion process.
• XML data travels through the rules engine, where rules are applied before the data is stored in the Plexis Claims Manager database. ***
• The flexible structure of XML makes it easy to export data to a variety of formats.

 View the Plexis EDIWorks Product Brief (PDF File)...

 Learn More About Eligibility Importer

*	Please contact our sales team to learn what formats are supported
**	Not all situational X12 segments are supported
***	X12 mapping, segments and fields are compatible with Plexis Claims Manager

Software for Health Insurance Co. • Software for Managed Care Orgs • Software for PPOs, PHOs, IPAs • Software for PACE Orgs • Software for TPAs