Ppo Repricing Software
PLEXIS Quantum Choice™ 2011.1 Release Delivers Expanded Integration Platform ...
PLEXIS Quantum Choice™ 2011.1 Release Delivers Expanded Integration Platform Capabilities for Healthcare PayersMajor architectural enhancements leverage latest .NET technology to provide real-time automated workflow efficiency
(PRWEB) June 16, 2011
Plexis Healthcare Systems announced today that it has released major enhancements to its enterprise benefit management system. Already one of the most powerful claims processing software solutions in the healthcare payer marketplace, the Quantum Choice 2011.1 release leverages Microsoft's most advanced industrial integration technologies including Microsoft Message Queue Server (MSMQ) 5, .NET 4 and SQL2008r2, in addition to enterprise class enterprise service bus capability from NServiceBus to deliver rapid deployment of large scale, complex integrated workflow routines.
Building upon the Microsoft competencies platform and delivered via a familiar graphical user interface footprint, Quantum Choice 2011.1 provides healthcare payers with best-in-class tools to manage claims processing faster than ever before. Real-time messaging and automated complex workflow integration with existing newer or legacy claims processing systems efficiently accelerate adjudication processes that typically involve numerous diverse systems and/or human intervention to complete. Benefit administrators and health plans can significantly expedite their speed-to-market when rolling out new products and services by more easily integrating data from multiple sources and disparate formats in real time rather than relying on processing through cumbersome, time-consuming nightly batches.
In addition to its expanded integration and message bus environment, the Quantum Choice 2011.1 release provides several significant core functionality enhancements including support for initial X12 5010 EDI formats. Automated pricing and external ( PPO ) repricing integration functions leverage new adjudication and repricing services (service oriented architecture) and X12 5010 EDI to fully automate and orchestrate these repetitive routines. Additional enhancements include extended Medicare specific and dental automated processing rules, expanded dental forms and interactive tooth chart, improved global processing routine scheduler and enhanced claim form design.
“Plexis' successful investment in Microsoft frameworks, expanded integration technologies and service-based architecture directly correlates with leading indicators of where the industry is headed and how speed-to-market is important for all parts of the ecosystem.” – Sean Garrett, Chief Product Strategy Officer, Plexis Healthcare Systems.
Ppo Repricing Software - News
Automated pricing and external (PPO) repricing integration functions leverage new adjudication and repricing services (service oriented architecture) and X12 5010 EDI to fully automate and orchestrate these repetitive routines.
ClaimEDix software suite launched to manage network operations ...
ProviDRs Care, a leading preferred provider organization (PPO) network serving Kansas and western Missouri, went “live” May 2 with new operational software from ClaimEDIx, Inc. of Kansas City, MO. ProviDRs Care is owned by the Medical Society of Sedgwick County and headquartered in Wichita
The ClaimsEDIx system — MCO Pro software suite — supports inbound and outbound electronic data interchange (EDI), claims repricing, provider maintenance, fee schedule and schedule modeling, billing and remittance and sales support as well as customer service. The new system centralizes all the PPO’s data and supports all departments.
“The MCO Pro system will enable us to provide greater efficiencies and service to all of our partners, including physicians, insurance companies, third party administrators, employers and brokers” said Karen Cox, chief operating officer, ProviDRs Care. “We now have access to more and better data that is essential as we continue enhancing our high performing network.”
“We are delighted to have the opportunity to work with ProviDRs Care and are confident that we can assist them in streamlining their PPO operations, increasing productivity, lowering costs while still delivering the level of customer service and savings they are well known for,” said Mark Winner, co-founder, ClaimEDIx Inc.
About ProviDRs Care
ProviDRs Care, formerly known as WPPA and operational since 1985, is the only physician owned PPO network in Kansas. ProviDRs Care is accessed by insurance companies and self-funded employers for discounted health care services and utilization review. It has contracts with 2,039 primary care, 3,122 specialists, 144 acute care hospitals throughout Kansas and adjoining states. Visit http://www.providrscare.net/ to learn more.
About ClaimEDIx, Inc.
Founded in 2004 in Kansas City, MO, ClaimEDIx specializes in EDI claims repricing and transmission, database design, web applications, and administration software for the managed care community. Since its release in June 2010, the MCO Pro software suite has become the company’s flagship product and is currently utilized by PPO networks operating in nine states. MCO Pro affords PPOs a single application built upon a single database interfaced by all departments. With “auto-repricing” benchmarks over 80% and a single claims processor handling over 1m000 claims daily, the highest cost center for a PPO can be alleviated. The MCO Pro system is 4010 and 5010 compliant. Visit www.claimEDIx.com for more information.
Ppo Repricing Software - Bookshelf
Health care software sourcebook
Description GBAS administers managed care plans for TPAs, HMOs, PPOs, PHOs, insurance companies ... automatic adjudication; PPO repricing; and dental logic. ...Healthcare financial management, journal of the Healthcare Financial Management Association
Preferred provider organization (PPO) repricing contracts, in which the PPO must obtain a paper-based claim because it is not EDI capable. ...Managed care, outcomes, and quality, a practical guide
Any Willing Provider The PPO network may be subject to a number of state ... The effect of some is often repricing existing patients with discounted rates. ...Essentials of managed health care
CHAMPUS: Civilian Health and Medical Program of the Uniformed Services. ... Claims repricing: An activity in which a rental PPO (see Rental PPO) receives ...Managed care, what it is and how it works
CHAMPUS — Civilian Health and Medical Program of the Uniformed Services. ... Claims repricing — An activity in which a rental PPO (see Rental PPO) receives ...Day-after-day Report Directory
ppoONE, Inc.
At the heart of the ppoONE solution is a sophisticated provider/client data management process and claims repricing system.
Out of network claims - TC³
Repricing Optimizers Suite: The second suite of services comprising ... TC³ AccessPlus PPO Network increases PPO savings for payers without changing ...
Preferred Provider Organization (PPO) - PPO Health Insurance ...
with ppo repricing, dental ppo, ppo claim forms, ppo halth insurance and ppo healthcare reform services Vee Technologies offering cost effective solution
Bill Review / Service Bureau
AWC provides PPO Bill Review and Repricing services to help ensure accurate claim administration. ... interface for PPO repricing with multiple bill review software systems. ...
Bill Review/Service Bureau
Anthem Workers' Compensation provides PPO Bill Review and Repricing services to help ensure accurate claim administration. The services are tailored to meet the ...