PLEXIS Healthcare Systems Highlights Claims Automation to Help Payers Improve Accuracy and Reduce Operational Burden

Payers are increasing automation at intake, but many still struggle to achieve accurate, end-to-end claims processing without downstream rework

MEDFORD, OR, UNITED STATES, May 13, 2026 /EINPresswire.com/ -- PLEXIS Healthcare Systems today highlighted its continued advancements in claims automation capabilities within its Quantum Choice^® platform, helping healthcare payers to increase processing accuracy while reducing manual intervention across the claims lifecycle.

As payer organizations face growing claim volumes, increasingly complex benefit designs, and ongoing pressure to control administrative costs, many are investing in automation at the point of intake. However, achieving consistent, end-to-end automation remains a challenge when adjudication logic, benefit configuration, and downstream processes are not fully aligned.

Quantum Choice addresses this gap through a rules-based architecture that connects EDI intake, claims adjudication, and payment workflows into a unified system. This approach enables higher rates of auto-adjudication while maintaining accuracy across diverse plan structures and regulatory requirements.

“Automation is not just about processing more claims faster. It is about processing claims correctly the first time,” said Sean Garrett, COO. “When adjudication logic, benefit configuration, and workflows are aligned, organizations can reduce rework, improve turnaround times, and operate with greater confidence.”

Key Quantum Choice capabilities include:
•High levels of claims auto-adjudication driven by configurable rules-based processing
•Real-time claim editing and integration with pricing and validation solutions
•Automated intake and processing of industry-standard EDI transactions, including 837 claims and 835 electronic remittance advices.
•Automated Mass re-adjudication capabilities to support retroactive changes without manual effort

By reducing the need for manual review and downstream correction, payer organizations can improve SLA performance, lower administrative costs, and better manage increasing transaction volumes.

These advancements reflect the broader PLEXIS commitment to helping healthcare payers modernize core administrative operations through practical, scalable automation that aligns with real-world operational complexity.

For more information about Quantum Choice and PLEXIS Healthcare Systems, visit www.plexishealth.com.

About PLEXIS Healthcare Systems:
PLEXIS Healthcare Systems delivers enterprise-grade core administration and claims processing solutions that power modern healthcare payers and delivery organizations. Recognized as a representative vendor in Gartner’s 2026 “Market Guide for U.S. Healthcare Payer Core Administration”, PLEXIS enables organizations to navigate evolving market demands around automation, integration, and benefit complexity. Through its flagship platform, Quantum Choice^®, PLEXIS supports the full spectrum of core administrative functions, including claims adjudication, enrollment, premium billing, provider data management, and benefit configuration. Built on a scalable, API-enabled architecture, the platform allows payers to streamline workflows, reduce manual intervention, and adapt to shifting regulatory and product requirements.

PLEXIS solutions are designed to align with the market’s shift toward composable, API-driven ecosystems and real-time data integration, empowering health plans to modernize at their own pace while maintaining operational continuity. With advanced automation, configurable rules-based processing, and seamless interoperability, PLEXIS helps organizations improve efficiency, reduce administrative friction, and deliver accurate outcomes across the claims lifecycle.

More than 100 organizations trust PLEXIS to manage complex benefit structures and process millions of covered lives across all lines of business. By combining deep domain expertise with flexible technology, PLEXIS enables payers to meet today’s operational challenges while building a foundation for future innovation.

Dennis Hubbard
PLEXIS Healthcare Systems
+1 5416461350
email us here
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