Eligibility

i-Plexus delivers an on-line eligibility and referral management system, designed to ease the burden of complying with the countless rules and regulations in today's managed care environment. It is a single solution for handling all of your eligibility inquiries and specialist referrals and notifications. Please review our eligibility payer list at your convenience.

i-Plexus connects you to commercial and state payers, and self-funded plan administrators so that you have to use only one system. We handle all the costs and communications for numerous connections. Importing your transactions into your practice management system is easy, and most of the major systems are already importing this data.

Patient eligibility verification can be automated, requiring no staff involvement. Either way, you reduce denied claims and shorten accounts receivables, while enhancing patient account management. Instant access to benefits streamlines administration of patient care.

Referrals and notifications are easy with i-Plexus. You have access to the latest rules and regulations for most managed care insurance providers in your state, including up-to-date names and addresses of every participating specialist, by plan.

Our interface eligibility allows you to perform individual eligibility determinations through a series of easy-to-navigate screens. Our Main Menu pages give you a quick reference of all of the plans we have set up for your clinic to determine eligibility.

Our Eligibility Search Screen contains the following benefits:

• Defaults to the most common and successful search by payer
• Minimal patient demographic and plan information is required
• Users can enter a single date of service or a date range in some cases allowing for current and past date searches
• Multiple search criteria options are available
• Enables correction and resubmission of previous searches

Our Search Results Page provides you with a history of completed searches and contains the following helpful features:

• The status of the search is listed and color coded enabling quick determination of transaction success and eligibility
• Search function allows you to review past eligibility determinations by patient
• Search criteria are listed and combined with functionality to enable correction and resubmission of inquiries
• Data can be sorted by status and history

Our Search Result Details Page enables a printable display of the eligibility results in a standard and easy-to-view format. We enable you to add the results to your patient list for later authorization or referral functionality. We also offer a number of eligibility reports allowing you to see a history of searches sorted a number of useful ways.