PLEXIS Healthcare Systems positioned as a major contender in the Everest PEAK Matrix
Quantum Choice® and Orion® provide configurable core administration, workflow automation, and operational visibility for MA Dual Eligible Special Needs Plans
Quantum Choice provides configurable admin, automation, and flexibility that help organizations improve efficiency while supporting the complex requirements of government-sponsored programs.”
— Sean Garrett, COO of PLEXIS
MEDFORD, OR, UNITED STATES, July 27, 2026 /EINPresswire.com/ -- Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs) continue to operate within an evolving regulatory and operational environment while balancing Medicare and
Medicaid administration, claims accuracy, member service, and cost management. PLEXIS Healthcare Systems highlights how its Quantum Choice® core administration platform and Orion® operational workspace support these organizations with configurable technology designed to automate administrative processes and improve operational visibility.Health plans administering complex government-sponsored programs require technology capable of adapting to changing business requirements while supporting efficient claims administration, provider management, enrollment, and customer service operations – including enabling self-service by plan members and providers via a PLEXIS-provided real-time integrated web portal. Quantum Choice supports these needs through configurable business rules, automated claims adjudication, provider administration, enrollment management, premium billing, capitation administration, revenue reconciliation support, and real-time interoperability through web services-based integration capabilities.
Complementing the core platform, Orion provides an integrated operational workspace for customer service, task management, claims inventory management, call tracking, configurable claims routing, dashboards, and operational reporting. Together, Quantum Choice and Orion help organizations improve workflow management while providing greater visibility into day-to-day administrative operations.
"Health plans need technology that can adapt as business and regulatory requirements evolve," said Sean Garrett, Chief Operating Officer of PLEXIS Healthcare Systems. "Quantum Choice was built to provide highly configurable administration, workflow automation, and operational flexibility that help organizations improve efficiency while supporting the complex requirements of Medicare, Medicaid, and other government-sponsored healthcare programs."
Additional Quantum Choice capabilities include:
• Configurable benefit administration supporting Medicare and Medicaid products
• Automated rules-based claims adjudication
• Provider contract and fee schedule management – including automated Medicare and Medicaid claim pricing
• Premium billing and capitation administration
• Revenue reconciliation support
• Real-time integration through Quantum Application Interface Services (AIS)
• Workflow and alert notification automation through PLEXIS Alerts
• AI-assisted provider data management and configuration support
As Medicare Advantage enrollment continues to evolve, health plans continue to evaluate administrative platforms that offer configurable business rules, automation, and scalable operational capabilities to support changing business requirements and new line of business growth, while helping reduce manual administrative effort. Quantum Choice was designed to provide the flexibility, automation, and interoperability organizations need to support today's complex healthcare administration environment
For more information about Quantum Choice and PLEXIS Healthcare Systems, visit www.plexishealth.com.
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