Plexis EDI

Data at the center of your universe.

Simplify your healthcare transactions

PLEXIS Ignite EDI is an all-in-one hub to simplify, empower, and visualize the management of your full EDI transaction lifecycles.

Simplify

Simplify your implementation by applying standard validations to all transactions, facilitating communication with trading partners. Reduce data entry needs.

Empower

Empower your organization by automating data entry and communication via X12, as well as increasing auto-adjudication rates with targeted processing rules.

Visualize

Visualize your data including provider and member management, claim status, eligibility status, payment status, and much more — reducing call volumes and supporting a higher level of self service

Your all-in-one EDI hub.

The Ignite EDI hub is powered by four smart, foundational building blocks.

  • EDI Gateway

    Connected Provider + Payer Systems
    EDI Transaction Management
    Standard, Compliant X12
    Lower-cost set up and management

  • Portal Technologies

    Provider Portal
    Encounter Data Portal
    Employer / Broker Portal
    Member Portal

  • Atlas Engine

    Automagic Rules Engine
    Robust EDI Transaction Utilities
    Early Issue Detection and Remediation
    Integrated Automation

  • EDI Exploration

    Trusted advisors with over 450
    client EDI X12 Implementations
    Ongoing holistic exploration +
    diagnosis of EDI lifecycle management

  • Portal Technology
  • EDI Gateway
  • Atlas Engine
  • Data Exploration

Ignite EDI Gateway

The Ignite EDI Gateway connects healthcare payers and providers — improving communication and empowering efficient management of EDI transactions to ensure the shortest cycle-time from claim submission to payment. Health Plans get data fast and Providers get paid faster!

The Ignite EDI Gateway ensures HIPAA compliance through standard X12 consistently applied to inbound and outbound transactions improving the quality of data.

Features

  • Seamlessly aggregates all connections to clearinghouses and other trading partners simplifying and improving EDI Operations.
  • Supplements your existing EDI clearinghouse relationships providing visualization of your connections and transactions.
  • Simplifies current EDI transaction management complexity while not disrupting your existing connections and relationships.
  • Streamlines operations using the Admin and Management Console delivering a robust and searchable transaction repository enabling you to visualize your entire EDI workflow – view, search, monitor, remediate, and report on all transactions.
  • Standardized formats and fewer connections improving efficiency to manage and support all your EDI transactions.

Benefits

  • Fewer connections and formats to manage, support and upgrade.
  • Simplified and faster routing of healthcare transactions to providers and other payers
  • IT simplification through the intuitive Admin Management Console allows redeployment of in-house IT staff and reduces the need to monitor status.
  • Reduce current EDI processing cost over industry clearinghouse per-transaction fees - Can reduce current EDI processing cost by 30-40%
  • Fewer and lower-cost set-up fees, upgrades, maintenance or migrations with clearinghouses.
  • Replaces expensive, custom-built one-to-many trading partner solutions through a cloud-enabled, secure, robust and scalable many-to-many solution.
  • Exceptional flexibility to streamline EDI management, improve visibility and control cost.

Ignite EDI Portal

Ignite EDI Portal Technologies empower your providers, members, and partners to visualize their data intuitively, reducing call volume and supporting a higher level of self-service capability.

A branded Portal will help reduce unnecessary calls to customer support, improve customer service and increase staff productivity.  Portal Technologies enable real-time eligibility inquiry, claim status, payment transaction visibility and other features using an intuitive interface available 24 hours a day, seven days a week.

In addition, Encounter Data Specialists have visibility to State and Federal Encounter Data submissions and the ability to correct pended claims to ensure their data is accepted for risk scoring.

Features

Provider Portal Features

  • User Self-Registration
  • Claim File Upload Capability
  • Visibility to File Submissions and Downloads
  • Ability to view and correct Pended Claims and Resubmit Online
  • Real-Time Eligibility Inquiry
  • Real-Time Claim Status Inquiry
  • View Payment Vouchers, EOBs and EOPs
  • Connects Providers with Health Plan Support Teams for customer service Inquiries

Encounter Data Portal Features

  • User Self-Registration
  • Visibility Real-Time Eligibility Inquiry
  • Ability to view and correct Pended Claims and Resubmit Online back to State and Federal Agencies
  • Real-Time Claim Status Inquiry
  • Reporting

Employer/Broker Portal Features

  • User Self-Registration
  • Real-Time Eligibility Inquiry
  • Real-Time

Member Portal Features

  • Self-Enrollment
  • Visibility to Benefit Coverages
  • Real-Time Eligibility Inquiry
  • Claim Status and History

Benefits

Reduced customer support call volume

Improved customer service through 24 x 7 self-service capability via the web

Delivers higher services levels for less cost

Full workflow visualization enabling easy identification of issues and status

Fully accessible and viewable transaction repository for monitoring and remediation

Ignite EDI Atlas Engine

The Ignite EDI Atlas Engine acts as a bridge between your X12 and your claims system. The Atlas supports, supports base imports and exports for a quick implementation, as well as the ability to refine processing rules to meet your business needs and to improve auto-adjudication rates.

It delivers a set of data mapping, conversion and load utilities with the capability to import and convert proprietary “low-tech” file formats into standard EDI X12 HIPAA compliant transactions as well as other proprietary formats.

Features

Advanced Rules Based Engine and Transaction Optimizer

Decision-based processing to support your business needs

Targeted processing for different lines of business and trading partners

Automation of manual transaction workflows

Implementation of specific matching of claims and other transactions

Increase auto-adjudication rates

Validation of data against your PLEXIS claims system records with configurable rejection and logging for your business decisions

Archive of inbound data transactions in human-readable format

Continuous Improvement through data analysis and rule validation

Benefits

  • 14 years of industry experience assisting clients with ICD-9 to ICD-10 transition
    • ICD-9 to ICD-10 transition
    • X12 4010 to X12 5010 transition
    • CAQH/CORE processing
    • Proprietary file format processing
    • Mapping EDI files to claim processing systems
  • Earlier detection of issues and remediation for fast claim to payment cycle
  • Increased auto-adjudication rates
  • Configurable rejection and logging for business specific processing decisions

Ignite EDI Exploration

Our approach to EDI is ‘continuous exploration” — always working with our customers on an ongoing basis to drive better EDI outcomes. PLEXIS’ Ignite EDI Specialists bring decades of experience with over 400 healthcare transaction implementations. We turn lessons learning from our experience into continuous improvement to our processes and core technology platforms resulting in streamlined EDI implementations and support to improve your end-to-end solution.

Over the past several decades we have seen many changes in healthcare transaction management and encountered numerous situations helping us gain valuable experience and knowledge which honed our skills for improved support of your EDI transaction processing needs.

Experience

  • 25 years in healthcare systems technology and management
  • More than 450 X-12 client implementations
  • Over 14 years of EDI workflow optimization for clients
  • 25+ years of IT Systems and Operations experience
  • Over 20 years designing, developing, and supporting database applications

Approach

We stay current with industry changes and in many cases help to drive change that benefits the industry as a whole. Our success is in our approach to the challenges and opportunities the industry and our customers bring us and we learn and grow every day from these experiences!

Compliant + intelligent solutions

Let us help you with the heavy lifting of managing your EDI

  • Eligibility
  • Enrollment
  • Encounter Data Reporting
  • Medicaid & CMS
  • Medicare Medicaid Coordination for Dual Eligibles
  • Maximum Out Of Pocket
  • X12 and Proprietary Formats
  • Coordination of Benefits
  • Upstream Capitation
  • Reconciliation
  • Referral and Authorization
  • Payer Provider Collaboration
  • Real-Time: Eligibility and
  • Claims Status Inquiry
  • HIPAA Compliance

Learn about all of Ignite EDI's solutions today.

Out of this world professional services

More than just your trusted advisors, our team offers best practices and services for EDI success

  • Managed Services

    Managed Services gives you deeper access to our Industry Knowledge and our assistance in tailoring your EDI solution to better support you specific needs.

  • Optimization

    Enhance validation and automation of your existing business flows to reduce manual intervention during the communication and persistence processes of your EDI transactions.

  • Quality Services

    Integrated Quality Services focuses on enhanced quality verification and documentation targeting your implementation and your solution ecosystem.

  • BI/BA

    Let us help you in integrating your EDI processing history and results into your consolidated reporting and analytics tools.

  • Solution Architecture

    Optimize your end-to-end solution to support communication of your data with internal and external parties.

  • Plus More

    From Encounter Data Filing Adjustments to EDI Concierge, our professional services will empower your organization.

Ask a data scientist

Seriously, ask our team of data scientists any question about EDI and we will answer you within 24 business hours.

About PLEXIS Healthcare

PLEXIS Healthcare Systems is a leading payer and provider technology company that delivers trusted healthcare solutions to payers and providers around the globe. PLEXIS empowers the business of healthcare, igniting growth, innovation, and efficiencies across diverse business lines for healthcare organizations.

Based in Ashland, Oregon, PLEXIS currently serves organizations in 37 states (doing business in all 50), 15 countries, and over 70 million people worldwide. PLEXIS provides mission-critical solutions that catalyze efficiencies and connect evolving business ecosystems to a wide range of healthcare organizations.

PLEXIS Healthcare Systems
340 Oak Street
Ashland OR, 97520
Office: (541) 494-2500
Toll Free: (877) 475-3947
info@plexishealth.com

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Empowering the Business of Healthcare