PLEXIS Quantum Choice™ 2012.1 Release Will Deliver Expanded Auto-Adjudication Rules and Premium Billing Capabilities

Share Article

Major expansion of claims processing and premium billing rules flexibility drives significant levels of automation for healthcare payer organizations

Plexis Healthcare Systems, Inc. is pleased to announce the newest release of its Quantum Choice™ product. Version 2012.1 is due to be made commercially available in mid-May, 2012, and will contain significant new features and capabilities to further support the processing capabilities of Plexis’ healthcare payer clients. Version 2012.1 includes additional automation capabilities for medical and dental claims processing, premium billing – including life insurance premium administration, and accounting automation functions.

Enhancements in claim processing include expanded automation in relation to dental processing rules, medical fee schedule, modifier and NCCI rules, and the introduction of Quantum Choice’s new Claim Processing Rule Framework, expanding upon the product’s already robust rule-set configuration capabilities. The Claim Processing Rule Framework allows for configuration of default claim processing rules based on user-selectable criteria, regardless of the benefit plan and provider reimbursement contract/fee schedule associated with a claim. “This expanded capability, which includes additional NCCI editing capabilities, allows for user configuration of ‘rules that should always fire’ during the adjudication process, which may be tailored by line of business, group or provider, and help to minimize the amount of configuration required in the system, regardless of how many different benefit plans and/or reimbursement contracts may be involved”, said Kathy Caulfield, Quantum Choice Product Manager for Plexis.

Version 2012.1 of Quantum Choice also provides significant new premium billing flexibility, with expanded billing configuration options, including the introduction of life billing and “contiguous month billing”, required for school district premium administration where the billing and policy period is often based on a nine or ten month period (vs. twelve month annual periods).

Additionally, version 2012.1 includes service framework expansion, providing an ever increasing amount of application services made available for loosely coupled, tightly integrated system-to-system interfacing, allowing Quantum Choice to provide high availability and high scalability transaction processing capabilities for large enterprise environments.

“It has taken a significant level of effort to provide such a large amount of new application functionality in such a short period of time”, said Sean Garrett, Plexis Chief Product Strategy Officer, “which is a testament to the spirit and dedication of our product development teams, and to their commitment to easing the burden of the users of our software, by providing increased levels of flexibility and automation with our Quantum Choice product. These changes further demonstrate Plexis’ goal of having Quantum Choice be the preeminent healthcare payer transaction processing system providing the highest levels of flexibility, automation, and real-time integration capabilities.”

About Plexis Healthcare Systems, Inc.
Plexis Healthcare Systems is a leading payer solution and claims processing technology company based in Ashland, Oregon. Founded in 1996, Plexis software and services now process millions of claims transactions daily for healthcare payer organizations throughout the United States and internationally. Plexis’ family of core software products includes Plexis LCS for small and medium size third party administrators and self-funded groups; Plexis Claims Manager for mid-size healthcare organizations; and MITA 2.0-aligned Plexis Quantum Choice, for government healthcare organizations and large health and dental plans. Plexis' solutions enable government healthcare organizations, health plans, TPAs and provider groups to reduce costs, automate claims payment requirements, enhance customer satisfaction and help expand market share. For more information, please call toll free (877) 475-3947 or visit http://www.plexisweb.com.

Share article on social media or email:

View article via:

Pdf Print

Contact Author

David Goodwin
Plexis Healthcare Systems
(541) 494-2500 x549
Email >
Visit website