Nations Largest Managed Long Term Care Health Plan Selects Plexis

VNS CHOICE, a Medicaid Managed Long Term Care (MLTC) health plan organized as a not-for-profit subsidiary of the Visiting Nurse Service of New York (VNSNY), selected Plexis to provide its benefit administration and claims adjudication solution. VNS CHOICE purchased industry-leading software application Plexis Claims Manager and Plexis EDIWorks -- an electronic data interchange (EDI) tool.

Ashland, OR (PRWEB) February 4, 2005 -- VNS CHOICE, a Medicaid Managed Long Term Care (MLTC) health plan organized as a not-for-profit subsidiary of the Visiting Nurse Service of New York (VNSNY), selected Plexis to provide its benefit administration and claims adjudication solution. VNS CHOICE purchased industry-leading software application Plexis Claims Manager and Plexis EDIWorks -- an electronic data interchange (EDI) tool.

VNS CHOICE is contracted with the New York State Department of Health to provide long term home and community-based services to the frail elderly to maintain them in their homes for as long as possible. VNS CHOICE has been operating since January 1998 and has grown to be the largest MLTC in the country. The health plan administers enrollment, claims payment, provider contracting, quality assurance, data reporting, and other areas. VNS CHOICE has contracts with approximately 125 providers ranging from transportation and nursing homes. Some of these providers are third party network managers or preferred provider organizations that have networks of providers throughout the service area. VNS CHOICE has a current membership of approximately 3,750 elderly individuals and provides services in the five boroughs of New York City. Future plans for the organization include a PACE (Program for All-inclusive Care of the Elderly) program -- a comprehensive health plan for nursing home eligible individuals that integrates both Medicare and Medicaid funds and services.

As a MLTC, we cover several non-traditional services that support our members in their homes that cannot be billed as typical health care claims such as car service or meals on wheels," said Peggy Chan, VNS CHOICE Director of Health Plan Operations. In addition, we must account for income deduction determined by Medicaid unique to each individual when paying a nursing home claim. Of the six solutions we considered, Plexis showed the most flexibility and configurability in handling our special needs in a straightforward manner," continued Chan.

We are very pleased that VNS CHOICE, the largest long term managed care health plan in the U.S., selected Plexis," said Jorge Yant, President and CEO of Plexis Healthcare Systems. Plexis software offers many advantages to long term care organizations, such as PACE, and we look forward to supporting more long term health plans in the United States and abroad," said Yant.

About Plexis Claims Manager
Plexis Healthcare Systems Claims Manager software was recently ranked number one in functionality for health plans with 50,000 to 350,000 lives in an independent survey of Managed Care Information Systems (MCIS) conducted by the AC Group, Inc. of Houston, TX. Fifteen leading MCIS software vendors were asked to respond to 542 questions covering 30 areas of functionality.

Plexis Claims Manager provides the functionality to facilitate accurate and automatic claims adjudication, referral authorizations, benefit administration, and contract management, while meeting all present HIPAA compliance requirements. The Plexis rules-based engine allows healthcare organizations to readily customize the claims processing system to meet its processing goals.

About Plexis Healthcare Systems, Inc.
Plexis Healthcare Systems is a leading payer solution and claims processing technology company based in Ashland, Oregon. Plexis is one of the fastest growing claims processing companies in the healthcare marketplace and has been developing high-end payer solutions since 1996. Plexis Healthcare Systems claims processing tools employ the very latest Microsoft technology and are highly rated by independent healthcare consultants. Their payer solutions enable healthcare organizations to reduce costs, streamline and automate their claims payment and medical case management requirements, increase profitability, enhance customer satisfaction and expand market share, while helping them meet all current governmental regulations, including HIPAA. For more information, please call toll free (877) 475-3947 or visit www.plexisweb.com.

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