The PLEXIS Solution for CHS

Easy to configure, agile enough to address demanding daily business requirements, and flexible enough to capitalize on new growth opportunities, the PLEXIS suite of solutions delivers:

  • Claim auto-adjudication
  • Benefit administration
  • Robust member and eligibility management
  • Premium billing administration
  • Real-time bundling/unbundling
  • Workflow automation
  • Mass claim re-adjudication
  • Provider administration/referrals and authorizations
  • Intelligent alerts and reporting
  • Capitation capabilities
  • Easy-to-manage multi-level security
  • Configurable add-ons such as Section 125 benefits

Benefits for CHS:

  • Meet cost containment objectives by investing in affordable CAPS (Core Administrative Processing System) technology for the greatest ROI.
  • Streamline management of self-funded medical plans, including dental, vision, disability, and HRAs (Health Reimbursement Arrangements).
  • Simplify regulatory compliance without hiring any IT staff.
  • Automate complex benefit calculations and drive high auto-adjudication rates with PLEXIS’ rules-based .NET system.
  • Flexible configuration capabilities drive outcomes with an agile, dependable software solution.
  • Deploy the most advanced Benefit Administration platform on the market with the assurance of proven reusability to ensure success throughout ongoing changes in healthcare policy and technology.

Proven Product Features & Advantages:

  • The CHS administrator controls the information that various users are authorized to view with PLEXIS’ smart portal solutions.
  • Process Claims on a familiar Windows interface with hot keys.
  • Load legacy data far more quickly than SQL with the PLEXIS GFFI
  • For Business Activity Monitoring (BAM), PLEXIS Alerts sends automated, intelligent alerts to a variety of user-defined media devices including a cell phone or pager.
  • Linked Accumulators automatically track contingent benefits.
  • Conduct Encounter Reporting in compliance with CMS protocol.
  • Customize result/EOB codes and control their action (deny/pend/approve), and further customize forms for reporting purposes.
  • Automate sequestration payments, interest, and penalties with our Withhold tool.
  • Effective from and through dates allow users to proactively implement changes before they take effect.
  • Accounting abilities are included with AP/AR.