Plexis Claims Manager: Dental Claim Processing and Benefit Administration

Dramatically Reduce Administrative Costs, Auto-adjudicate Dental Claims in Seconds!

Plexis Claims Manager provides complete dental claim processing with an automated, rules-based system that optimizes productivity and significantly reduces costs associated with dental benefits administration. Rules-based technology offers health insurers, TPAs and managed care organizations the dental benefit administration flexibility required to achieve growth and provide a level of service that keeps your customers smiling.

Easy to Build Unique Dental Plans

Dental plans offer subscribers a wide array of unique benefits packages. The Plexis dental claim processing solution allows benefit administrators to build a virtually unlimited number of unique, specialty plans.

Plexis Claims Manager provides a "Duplicate" feature that makes it easy to copy an entire plan and revise elements of the plan to allow the user to accommodate the unique features. There's no need for hard coded changes that can take weeks, or months: simply duplicate, revise and the new plan is in your system. And Plexis Claims Manager's scalability allows you to add as many unique plans as your organization requires.

Dental Claims Auto Adjudication

Plexis Claims Manager makes it easy to build your business rules right into the claims editing process to automatically approve, deny or pend claims based on very specific criteria. Dental claim processing and auto adjudication is accomplished by entering claim processing data on a single screen. Dental claims flow seamlessly from their source to final preparation for payment in seconds and at only pennies per claim. In addition to auto-adjudicating claims, the Plexis solution enables organizations to offer web access to consumers and trading partners, provide HIPAA-ready EDI services, and improve customer service.

Dental Claim Processing Features Save Time and Money

Plexis Claims Manager includes the detailed automated functionality you need to streamline your dental claims operations. For example, the Plexis system identifies duplicate claims using tooth number and area of oral cavity as criteria; supports the "Missing Tooth Clause," with the ability to specify "x" number of months of continuous coverage, and much more.

Plexis Dental Claims Solution and the Bottom Line

Automated rules-based adjudication improves productivity by reducing claims processing time, reducing errors, and leaving fewer dental claims pended due to data validation issues. Combining flexibility, scalability, and powerful reporting and workflow tools, Plexis healthcare software keeps your operations running smooth and gives you the data tools you need to make smarter, faster decisions.

Installing a leading technology solution can improve the operational efficiencies of dental organizations of all sizes, saving thousands of dollars and providing a rapid ROI.

Features and Functionality

• Easily view dental claim history from the claim form or member form.
• Pends selected procedures for Dental Consultant Review.
• When the system cannot identify an extraction for a bridge or denture, PCM pends the claim for review.
• Process claims for procedures that can be performed within "X" number of months following another procedure.
• Ability to pay benefit at "X%" based on "Y" months member is on dental plan, including prior dental coverage.
• Enter and track distributions for orthodontics.
• View tooth diagram and noted missing teeth in claims entry.

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