PLEXIS spotlights D-SNP administration tools for Medicare Advantage plans

PLEXIS Healthcare Systems says its Quantum Choice and Orion platforms are built to help Medicare Advantage D-SNPs handle claims, enrollment, billing and member service as regulatory demands keep shifting. The company is pitching the tools as a way to automate work, improve visibility and support Medicare and Medicaid operations.

Why it matters: - Medicare Advantage Dual Eligible Special Needs Plans must manage Medicare and Medicaid requirements at the same time. - Those plans also face pressure on claims accuracy, member service, provider management and cost control. - PLEXIS is positioning Quantum Choice and Orion as tools that can reduce manual work and improve operational visibility in that environment.

What happened: - PLEXIS Healthcare Systems highlighted the capabilities of its Quantum Choice core administration platform and Orion operational workspace for D-SNP administration. - The company said the platforms are designed to support health plans that run complex government-sponsored programs. - PLEXIS pointed to configurable technology, workflow automation and real-time visibility as the main benefits. - For more information, visit the company's announcement.

The details: - Quantum Choice supports configurable business rules, automated claims adjudication, provider administration, enrollment management, premium billing, capitation administration and revenue reconciliation support. - Quantum Choice also includes real-time interoperability through web services-based integration capabilities. - The platform supports member and provider self-service through a PLEXIS-provided real-time integrated web portal. - Orion adds customer service, task management, claims inventory management, call tracking, configurable claims routing, dashboards and operational reporting. - PLEXIS said the combination of Quantum Choice and Orion is intended to improve workflow management and day-to-day administrative visibility. - Additional Quantum Choice capabilities include configurable benefit administration for Medicare and Medicaid products, provider contract and fee schedule management, automated Medicare and Medicaid claim pricing, premium billing and capitation administration, revenue reconciliation support, real-time integration through Quantum Application Interface Services, workflow and alert notification automation through PLEXIS Alerts, and AI-assisted provider data management and configuration support.

Between the lines: - PLEXIS is aiming at a market where payers want systems that can adapt to changing regulations without rebuilding core operations. - The emphasis on configurable rules, automation and interoperability suggests the company is competing on flexibility more than on a one-size-fits-all claims system. - Sean Garrett, chief operating officer of PLEXIS Healthcare Systems, said health plans need technology that can evolve as business and regulatory requirements change.

What's next: - PLEXIS said Medicare Advantage enrollment trends are pushing health plans to evaluate platforms that can support new lines of business and reduce manual administrative effort. - The company said Quantum Choice was designed to provide the flexibility, automation and interoperability needed for today's healthcare administration environment. - PLEXIS directed readers seeking more information to its website and LinkedIn presence.