Plexis Healthcare Systems Releases Plexis Claims Manager 8

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New upgrade improves benefit tree structure, enhances accumulator functionality and expands Medicare processing capabilities.

Plexis Healthcare Systems recently announced the release of Plexis Claims Manager (PCM) Version 8. The new upgraded version provides an enhanced benefit plan tree structure that significantly facilitates benefit plan building and claims processing. Clients now have the flexibility to create multilevel benefit plans where benefit groups may contain additional group levels and benefit classes/exceptions. Also, copayments and coinsurance amounts can now be overridden using a hierarchical benefit structure. The usage of Modifier Code Groups as part of benefit building was enhanced as well as the addition of benefit structure copying functionality from plan to plan. Additionally, PCM 8 enhanced accumulator functionality streamlines and improves overall processing with the addition of many new accumulator functions.

"Our goal is to constantly enhance our software products to meet the needs of the market, comply with federal governmental mandates and improve our client's productivity," explained Jorge Yant, Plexis CEO. "Plexis Claims Manager has grown to become one of the industry's most powerful solutions for cutting administrative costs and helping our clients succeed in an increasingly competitive environment," Yant added.

Medicare claims processing capabilities have been significantly enhanced as well. Clients using PCM 8, can now auto-adjudicate claims for members with dual eligibility having coverage through Medicare and Medicaid. Additional payment methodologies were added to price using the CMS Physician's Fee Schedule and integrated support for prospective pricing methods DRG and APC. In addition, PCM now supports processing of claims using the CMS Anesthesia flat rate pricing methodology and the CMS Assistant Surgeon Rule. This new rule allows validation of surgery procedures submitted with Modifier 81 against the CMS Physicians' Fee Schedule, indicating whether or not an assistant surgeon will be paid. PCM has also added a separate letters package containing 32 new Medicare Advantage specific letters.

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 million 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 plans. Plexis' solutions enable government healthcare organizations, health plans, TPAs and provider groups to reduce costs, automate claims payment and medical case management requirements, enhance customer satisfaction and expand market share. For more information, please call toll free (877) 475-3947 or visit


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