PLEXIS Introduces AI Assistants Portfolio to Accelerate Payer Operations

Purpose-Built AI Assistants Within the Quantum Choice® CAPS Platform Optimize Payer Operations Without Disruption

MEDFORD, OR, UNITED STATES, January 20, 2026 /EINPresswire.com/ -- PLEXIS Healthcare Systems, a trusted healthcare payer technology solutions provider since 1996, today announced the introduction of its AI Assistants Portfolio, delivering embedded, purpose-built artificial intelligence optimization across the Quantum Choice core administrative platform to help healthcare payers operate with greater speed, clarity, and confidence.

The PLEXIS AI assistants portfolio introduces multiple AI-driven capabilities designed to support—not replace—payer workflows. Each assistant is embedded directly within Quantum Choice and aligned to specific operational needs across claims, configuration, provider data management, and system and corresponding documentation navigation.

“Our philosophy around AI is simple: apply intelligence where it creates immediate, practical value for healthcare payers,” said Sean Garrett COO at PLEXIS. “These assistants are designed to enhance understanding, reduce friction, and preserve governance in the most complex operational environments.”
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QC GPT: Embedded AI Guidance for Configuration, Setup, and System Understanding

QC GPT is an embedded AI assistant accessible through the Quantum Choice Help experience. It is designed to help users quickly understand system functionality, configuration concepts, terminology, and recent updates—without necessarily having to search through documentation or release notes.

QC GPT enables users to:
• Ask natural-language questions about Quantum Choice features and configuration
• Understand benefit setup, claims concepts, codes, and system terminology
• Access guidance on new releases and resolved issues
• Navigate complex system knowledge more efficiently

QC GPT serves as an always-available learning and reference assistant, supporting faster end user and new client onboarding, reduced support dependency, and greater user confidence across roles.
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QC Buddy: Embedded AI Assistant for Claims Operations

QC Buddy is an in-workflow AI assistant designed to help claims analysts and operations teams quickly interpret and summarize complex claims, documents, and system content directly within Quantum Choice.

QC Buddy capabilities include:
• Instant summarization of claims, attached documents, and operational notes
• Context-aware claim summaries leveraging adjudication results and accumulator values
• Natural-language questions related to claims and codes
• Slash-command navigation to quickly access QC forms and workflows
• Full alignment with existing role-based permissions and security controls

QC Buddy operates as an assistive layer only and does not modify claims or adjudication logic, ensuring transparency, auditability, and trust.
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Provider Data Management (PDM) Assistant: AI-Powered Provider Validation and Creation

The Provider Data Management (PDM) Assistant applies AI to one of the most critical and error-prone areas of payer operations: provider data accuracy.
Embedded within Quantum Choice, the PDM Assistant integrates PLEXIS Application Integration Services (AIS) with the CMS National Plan and Provider

Enumeration System (NPPES) to support:
• Natural-language provider lookup by NPI, name, taxonomy, or location
• Validation of internal provider records against authoritative external data
• Identification of discrepancies to support compliance and audit readiness
• Creation of new provider records within the Quantum Choice system seeded with verified data
• Faster, more accurate provider onboarding and maintenance

The PDM Assistant presents validated insights and recommendations while keeping users in control of final actions.
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A Responsible, Scalable Approach to AI in Healthcare

The PLEXIS AI Assistants Portfolio is built with security, compliance, and governance at its core. All assistants respect existing access controls, operate within established workflows, and prioritize transparency over autonomous automation.

These AI capabilities are currently available through the PLEXIS AI Beta Release Program with additional assistants and enhancements planned across the Quantum Choice platform. Contact marketing@plexishealth.com to learn more.
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About PLEXIS Healthcare Systems
PLEXIS Healthcare Systems delivers trusted enterprise core administration and claims management solutions to healthcare payers and delivery systems worldwide. More than 100 organizations trust PLEXIS core administrative enterprise solutions to manage millions of lives in all 50 states and around the world. PLEXIS provides mission-critical solutions that catalyze efficiencies and connect evolving business ecosystems to a wide range of payer organizations. PLEXIS leverages cloud hosting, next-generation BPO, open APIs, modular solutions, highly configurable benefit administration, and greater visibility with ready access to real-time data.

For more information, visit www.plexishealth.com

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Dennis Hubbard
PLEXIS Healthcare Systems
+1 541-613-3741
email us here
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