PLEXIS LCS: Logical Claims Solutions

Your Trusted Payer Platform

PLEXIS has over two decades of experience crafting innovative payer solutions for customers across diverse business lines. The PLEXIS Logical Claims Solutions (LCS) platform ignites growth and efficiencies for worldwide payer organizations including but not limited to:

  • Third party administrators (TPAs)
  • Tribal groups
  • Employer groups
  • Dental Networks and more

PLEXIS LCS provides complete benefit administration, claim processing, premium billing, authorization, reporting features, and more.

LCS delivers unmatched speed-to-value

LCS is an essential core administration and claims management platform, empowering the business of healthcare. LCS’ user-friendly interface requires minimal training time and can be seamlessly integrated into your current technology ecosystem. LCS implementations are often completed in less than ninety days, and with a price point below most competitors, LCS is a long-term payer solution that provides unmatched speed-to-value.

LCS at a Glance

  • Auto-adjudication
  • ICD-10
  • Standard reports
  • Worker’s compensation capabilities
  • Flexible portal solutions
  • EDI functionality
  • Referrals and Authorizations
  • Rules-based claims processing
  • Contract Administration
  • Customer service-ready
  • Easy customer correspondence
  • Enrollment
  • Dental processing
  • Unreported liability tracking
  • Network management
  • Premium billing: health, life, & disability
  • Provider contracts
  • Claim repricing-ready
  • Complex accumulator capabilities
  • Streamlined interface for secure banking transactions
  • Easy to manage, multi-level security
  • Proactive LCS users group provides a unique networking opportunity

LCS’s integrated features & benefits

  • Benefit plans automatically track deductible, coinsurance, maximums, and plan limitations. In and out of network benefits are tracked in one plan.
  • EDI ready: exchange data electronically, eliminating expensive manual input and increasing productivity and efficiency
  • Cost & risk management: Predictive modeling of client’s data saves money through early intervention
  • User-defined budget tables enable tracking for spent and available funds
  • Drive outcomes with an agile COTS software solution based on flexible configuration capabilities
  • LCS tracks member demographics, including Medical Health Record number, eligibility status, etc.
  • Supports data conversion from legacy systems into LCS to enable faster implementations
  • Reference data loaders automatically load procedure/diagnosis codes, UB04, NCCI data, etc.
  • Extensive reporting capabilities include plan cost modeling, census, and reinsurance
  • Customize result/EOB codes and control their action (deny/pend/approve), and further customize forms for reporting purposes
  • Proactively implement changes before they take effect using effective from and through dates Passport connectivity services empower client success by connecting your ecosystem of diverse applications