Plexis Eligibility Importer

Streamlines data conversion and file imports for membership and eligibility data

For many TPAs, importing eligibility files can be cumbersome, time-consuming and costly, especially if their clients are unable to submit electronic enrollment data. While EDI enrollment standards (X12 834 transactions) exist, not all employer groups can send HIPAA-compliant 834 files. Instead, TPAs have to grapple with manual enrollment updates or client files in proprietary formats that require custom data conversions.

Plexis Flat File Eligibility Importer solves the data conversion and eligibility import problem by providing for converting flat files into the Plexis Claims Manager application from a common format - a Microsoft Excel spreadsheet.

Import Wizard Makes Conversion and Imports Fast and Easy

Plexis designed the new Eligibility Importer with a process wizard and drop down menus so it is easy for your staff to set up and run right out of the box. User selectable options allow you to display data in .xls spreadsheets, where it is easy to identify and fix data problems. In addition, a file mapper makes it easy to review and edit the user-configurable parsing map.

After scrubbing data to meet the pre-defined format, the Import Wizard allows you to bring in data from many different sources, and still have only one EDI import routine to maintain. The wizard streamlines the import of generic files and allows for the application of your own over-ride and pass-through values.

Plexis Eligibility Importer improves workflow by:

• Validating existing members and eligibility records
• Creating new members and eligibility records in Plexis Claims Manager
• Updating existing member and eligibility records

Plexis Flat File Importer provides the tools for TPAs to translate employer groups' proprietary member enrollment data formats so they can be imported directly into Plexis Claims Manager. The Flat File Importer also allows TPAs to set up spreadsheets for employer groups that include qualified drop-down menus so submitted data meets your specific criteria.