Ashland, Oregon – December 2021 PLEXIS Healthcare Systems (PLEXIS), an established innovator in second-generation digital core administrative processing solutions (CAPS) platforms for healthcare payers, announces a long-standing partnership with Payer Compass, a next-generation healthcare technology provider offering cost containment solutions, price transparency, and claims pricing and contract management.
Payer Compass’ SaaS-based pricing and editing platform, Visium, integrates seamlessly with the auto-adjudication process of Quantum Choice™, a second-generation enterprise CAPS platform provided by PLEXIS Healthcare, adding rules-based configurability and transparency to manage pricing for all health programs such as Medicare/Medicaid, VA/TRICARE, Tribal programs, Medicare Reference Based Pricing programs, and bundled payment models. Equipped with its unique gap-fill technology, Visium can generate a price for the most challenging claims to resolve provider reimbursement processing delays.
PLEXIS provides, implements, supports, and provides enhancements to three different core administration and claims management platforms with the flagship solution, Quantum Choice, being highly scalable to millions of claims per day as well as more than 3,000 concurrent users at one site. Quantum Choice, boasting the highest degree of automation and configurability, utilizes SOA, web services, and an embedded enterprise service bus.
Visium™, from Payer Compass, applies real-time edits and regulatory updates specific to each plan’s goal and process output for pricing/repricing that is both accurate and compliant, which helps to minimize claim pass-through frustration. Visium™ is a HITRUST-compliant platform featuring robust auditing and reporting tools that deliver defensible pricing, customized edits, and reimbursement logic to complement any claim processing workflow. At the helm of the latest legislative changes in healthcare, Payer Compass unveiled a transparency solution, CompassConnect. The platform facilitates educated healthcare decision-making for the plan and members with provider searchability and price comparison.
“The PLEXIS Healthcare Systems partnership with long-time industry colleague and trusted digital claim processing solution provider Payer Compass, allows us to truly differentiate ourselves and demonstrate how we are igniting growth and innovation for our payer clients,” said Sean Garrett, Chief Operations Officer for PLEXIS Healthcare Systems.
Slayton Gorman, Chief Revenue Officer for Payer Compass echoed Garrett’s sentiments and noted, “Our technology continues to be what sets us apart from others and we are appreciative of PLEXIS recognizing that by solidifying this partnership.”
About Payer Compass
Payer Compass is dedicated to restoring rationality to the cost of care. We focus squarely on tackling the most elusive problems in today’s healthcare landscape: spiraling costs and associated lack of price transparency. For health plans, we are minimizing overall spend on claims pricing, administration, and processing. And for self-insured organizations, our innovations and services are driving down the costs of healthcare claims reimbursement. Our multi-faceted, SaaS platform, VisiumTM, yields 99.9% pricing accuracy on more than $200 Billion in repriced claims and is the cornerstone of our comprehensive suite of solutions that address the need for cost control while bridging the gap between payer and provider. Payer Compass does this with reference-based pricing, patient advocacy, balance billing, and appeals services, value-based payments, care management, predictive modeling and analytics, and tools for provider search and price transparency. Combine our next-gen technology with an emphasis on client success, and Payer Compass is dramatically reducing overall healthcare spend.
About PLEXIS Healthcare Systems
PLEXIS Healthcare Systems is a leading payer technology company that delivers trusted enterprise core administration and claims management solutions to healthcare payers and delivery systems around the globe. More than 100 organizations trust PLEXIS core administrative enterprise solutions to manage over 55 million lives in all 50 states and around the globe. PLEXIS provides mission-critical solutions that catalyze efficiencies and connect evolving business ecosystems to a wide range of payer organizations. PLEXIS Healthcare Systems, an established innovator in digital core administrative processing solutions (CAPS), is featured in Gartner’s Market Guide for U.S. Healthcare Payers’ Core Administrative Processing Solutions (25 June 2019) as a Representative Vendor.