Medicare Prospective Pricing

PLEXIS offers several powerful solutions to integrate and automate the complexities of inpatient/outpatient Medicare prospective pricing for claims. PLEXIS’ business integration apps tie PLEXIS platforms to Medicare pricing solutions such as AMP$ and Visium in real time to simplify adjudication while saving time and improving accuracy.

By leveraging PLEXIS’ prospective pricing capabilities, healthcare payers centralize and simplify the adjudication process by having claims priced per Medicare guidelines in real time. With access to embedded regulatory content, payers can analyze data and conduct reporting for their clients.

Configurable Medicare grouper and pricer routines

Payers can provide reliable, high-speed processing of healthcare claims by utilizing expert grouping content for denials management and for budgetary and management purposes. Administrators can choose the classification and reimbursement methodologies (and % thereof) they need to accurately group, edit, and calculate the expected reimbursement of individual claims, enabling them to remain compliant, accurate, and timely in their claims turnaround.