Add On Software

WEBWorks

Plexis LCS Software for TPAs,
Self-Insured Employers Claims Processing & Benefits Administration Features and Functionality

Complete TPA Processing Functionality

Supports Medical, dental, vision, Worker's Comp, short term disability, and long term disability. Plexis LCS includes everything TPAs require for claims processing and benefits administration:

Premium billing and payments
Reporting capabilities
Plan Cost Modeling
Flexible software handles most benefit plan designs

Familiar Windows Platform

Easy-to-use claims data entry and system navigation. Integrates into your existing office platform; reduces training time and increases claims processing efficiency.

Plexis LCS claims processing and benefits administration software capabilities include premium billing and payments, reporting and plan cost modeling for healthcare TPAs and self-funded groups. The Plexis LCS claims system also automatically tracks eligibility status, plan deductibles, co-insurance, maximums and limits, and provides real-time benefit calculations.

Single, Fully-Integrated Database

Process and manage your health claims in one database, make changes throughout the system with a single mouse click, and reduce benefit administration and claims processing costs by eliminating multiple database maintenance expenses.

Automated Benefit Administration

Plexis LCS claims software provides TPAs and self-insured employers with the automation to track and manage benefit plans. From the time that benefit plan data is entered, deductibles, coinsurance, maximums, in and out of network benefits, and plan limitations are tracked.

Billing

Complete premium billing and disbursement including commission payments.
Monthly billing reports for client fees, premiums and commissions can be produced based on a variety of rate tier structures.
Automatic billing adjustments are generated based on the individual clients' billing parameters.
Reconciliation of monthly billing provides for disbursement of collected fees and balance forward billing.

Claim Processing

Familiar Windows-based technology with single-screen keyboard entry for all coverage types. Eligibility status and plan deductibles, coinsurance, maximums and limits are tracked by the system, with benefits being calculated on a real-time basis. Hot keys allow operators easy access to detailed member information including claim history, benefit accumulators and notes.

Eligibility

Plexis LCS provides an integrated file system that allows for single entry and maintenance of eligibility. Once a member is entered, family members can be added through a single screen.

Dental Claims Processing

Plexis LCS provides TPAs and self-funded employers with the automated tools required for processing dental claims.

Automated Correspondence

Plexis LCS for TPAs and Self-Funded organizations allows for letters to be generated for a variety of needs from within multiple areas in the system. An interface with Microsoft Word allows users to create document templates that can include specific data elements from the Plexis LCS system. When a letter is created, system data is then automatically inserted into the document. Letters can be printed either at the time of generation or at a later date.

Customer Service

Quick access to all member information including eligibility, plan accumulators and history facilitates member and provider phone inquiries. Complete customer service note tracking provides details of customer service activity.

Electronic Data Interchange (EDI)

TPA and Self-Insured Organizations' electronic claims can be received from any source and easily downloaded into the Plexis LCS system. Once downloaded, valid claims are categorized into those ready for release, missing a matching provider, or claims with errors/invalid coding. Electronic transmissions can be viewed by the operator as a simulated claim form (HCFA1500 and UB92) to aid in claim review. Claims are released with a single mouse click, increasing productivity, or edited with the claim processing function. All electronic claim information is stored for future retrieval and audit purposes.

Reporting

In addition to over 50 standard paid claims analysis reports, the system also includes:

Plan Cost Modeling
Specific and Aggregate
Census and Membership
Management reporting such as: Operator Productivity, Claim Lag Report (IBNR) and Claim Turnaround Analysis
1099 reporting

Security

System security can be set at the operator level. Security levels can be set to deny access to an area of the system or allow access to certain functions within an area. Dollar limits can be set by operator so that claims exceeding the dollar amount will automatically be pended for supervisory review. Data modifications are logged by user using Automatic Record Tracking (ART).

Web Software for TPAs

Plexis LCS offers WEBWorks, a web-based portal that provides TPAs and Self-Insured organizations with real-time transaction capabilities. WEBWorks allows on-line transactions such as eligibility inquiries and claims submissions, as well as access to provider data and medical resources.

WEBWorks provides healthcare TPA and Self-Insured organizations with the ability to offer a web-based interface to customers and gain an advantage among consumers and vendors in a competitive market.