The Comprehensive Solution to Enhance and Optimize Business Operations in PACE Managed Care Organizations

Cutting-edge platforms from PLEXIS Healthcare Systems are engineered to transform how PACE managed care organizations operate – ensuring that they can focus on what matters most — providing outstanding care to their clients while maintaining high degrees of operational efficiency and compliance.  PLEXIS empowers startup PACE plans with reliable claims administration and partnered TPA services, helping to ensure efficient operations, rapid implementation, and full regulatory compliance from day one.

Click the image below to download our “Quantum Choice PACE/Managed Care Support” brochure and learn more about how PACE business processes are elevated, enhanced, and optimized with these capabilities:

Download our Quantum Choice PACE/Managed Care Support brochure to learn more about how PACE business processes are elevated, enhanced, and optimized with these capabilities.

Thank you for visiting our booth at the NPA 2024 Annual Conference.

It was a real pleasure to attend the conference this year and learn of the new regulatory and process developments within the PACE group space. Sean Garrett, our COO, attended the conference and mentioned that there is “…a lot of excitement and growth happening within PACE, and PLEXIS is proud to continue our 20+ years supporting PACE organizations, large and small.”

If you weren’t able to attend and would like a “Fast Facts” sheet outlining PLEXIS support for PACE organizations, you can download the document by clicking this link: PLEXIS Support of PACE – Fast Facts 2024

Automated Claim Processing

  • To include auto-adjudication of claims and use of EDI for automated receipt and loading of claims supporting real-time application of Medicare edits and pricing.

Comprehensive Provider Data Management

  • Adept at tracking providers and managing corresponding contract, vendor, practice office, and network affiliation details.

Capitation : Revenue Reconciliation (A/R), Provider Payments (A/P)

  • A/R: Revenue reconciliation to ensure awareness of potential revenue inaccuracy.

  • A/P: Capitation processing to support risk-sharing arrangements with specific providers.

Integration with Critical Systems

  • The ability to interface your core admin system with other critical systems (i.e., EHR and UM/UR), creates a unified and streamlined ecosystem for key healthcare data records and transactions.

 

PLEXIS technology empowers PACE organizations to:

  • Enhance provider networks.
  • Lower utilization rates and close care gaps with coordinated care.
  • Simplify inpatient and outpatient prospective pricing.
  • Integrate business intelligence + business analytics (BI/BA) to deliver actionable insights, predict outcomes, and reduce risk.
  • Closely and effectively manage your capitation contracts and arrangements.
  • Coordinate mass reprocessing of claims due to retroactive changes.
  • Automate complex benefit calculations to drive high auto-adjudication rates augmented by automated audits and responsive reporting to meet cost containment objectives.
  • Simplify electronic workflows.
  • Connect and communicate with members, providers, and all essential stakeholders with PLEXIS real-time portals.
  • Achieve efficient fraud, waste, and abuse (FWA) detection with automated claim editing supported by automated alerts, reporting, and workflows. 
  • Enhance transparency to accommodate ever-evolving compliance requirements.