Plexis Healthcare Systems Announces Plexis Claims Manager Upgrade

Plexis Healthcare Systems today announced the release of Plexis Claims Manager Version 5.1.1. The new version provides added functionality in several areas, including adjudication processing, referrals, automatic generation of member IDs, payment contract assignments, and general features that accelerate automated processes.

(PRWEB) June 13, 2005 -- Plexis Healthcare Systems today announced the release of Plexis Claims Manager Version 5.1.1. The new version provides added functionality in several areas, including adjudication processing, referrals, automatic generation of member IDs, payment contract assignments, and general features that accelerate automated processes.

“The Plexis engineering team is constantly working to enhance our software products to meet the changing needs of the industry and improve our client’s productivity,” explained Susan Drobkiewicz, PCM Product Manager. “This new version of PCM combines the functionality and time-saving features that will help healthcare organizations cut administrative costs and succeed in an increasingly competitive environment,” said Drobkiewicz

Adjudication processing has had many enhancements made in the areas of performance optimization and an expanded selection of new rules. Rules have been added to support extended eligibility processes, which may be particularly important to TPAs, who often administer benefit plans based on “per episode type” rather than being based on a benefit contract/policy. In addition, adjudication processing has been improved with a new rule selection for extending member eligibility after a policy has lapsed or been terminated, and a new adjudication rule to modify coordination of benefits (COB) calculation.

Member information has been expanded with referral form options for filtering records. These filters include the ability to sort by effective date, to avoid making conflicting appointments. Additional filters, such as date ranges and “referred to” providers, may also be applied by users.

Plexis Claims Manager allows clients to select a rule to auto-generate member identifications. PCM Version 5.1.1 includes a new rule for auto generating member IDs with a new “Dependent Counter” system. This is one of the many member ID generation rules provided by PCM, which is especially important to health plans complying with HIPAA rules for privacy, which can no longer use a member’s SSN as a health plan identifier.

The new version also expands the provider form to expose additional medical group and provider network assignment information, as well as expands the provider search form with additional provider network-related search criteria.

In addition to the enhancements described above, PCM 5.1.1 has updated many screens to allow users to “drill up” or “drill down” into a field to find related components.

To receive more information about Plexis Claims Manager, please contact the Plexis Sales Department at 877-475-3947.

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