Claims Software, Optimized for Modern Healthcare’s Best Practices
PLEXIS Healthcare Systems empowers healthcare payers with a centralized, modern claims processing environment. The PLEXIS platform integrates clinical, administrative, and financial components for a unified claims processing and benefit administration solution.
PLEXIS empowers healthcare payers to:
- Streamline benefit administration: With industry-leading benefit plan configuration and payment calculations, PLEXIS coordinates administration of medical, vision, dental, disability, life, travel assistance, and more.
- Improve the cost and quality of care: PLEXIS can integrate care management, UM/UR, and disease management to give you the full toolset for data-driven utilization review, wellness services, and value-based care.
- Meet cost containment objectives: PLEXIS automates complex benefit calculations to drive high auto-adjudication rates and minimize the risk of paying claims incorrectly. Healthcare payers recover significant savings and reduce utilization costs by leveraging PLEXIS’ configurable alerts, automatic audits, health risk assessments (HRAs), responsive reporting, and more.
- Proactively manage risk: With PLEXIS’ centralized access to claims data and our business analytics (BI/BA), you gain actionable intelligence for proactive risk-management through stop-loss coverage, PPO repricing, or other means for runoff protection.
- Scale to the size you need: PLEXIS’ proven platform was architected to process the largest transaction volume in our industry, yet we include scaled pricing options for smaller employer groups.
- Provide superior customer service: Delight your customers and simplify your workflows for call center support, customer engagement, support for first call resolution (FCR), and more.
- Connect and communicate: PLEXIS’ portals connect you to members, providers, and all essential stakeholders. Additional efficiencies include automated online enrollment, Telehealth, and mobile capabilities for smartphone/tablet connectivity.
- Optimize transparency, oversight, and accountability: Solutions such as integrated fraud, waste, and abuse (FWA) detection and automated claim editing reduce or eliminate duplication of your resources.
PLEXIS Healthcare Systems deploys mission-critical claims software solutions
PLEXIS’ enterprise platform is the premier claims adjudication and benefit administration software solution on the market. Serving a large number and variety of healthcare payers for the past 20 years, PLEXIS simplifies and automates claims processing operations. PLEXIS’ agile, flexible technology is eminently configurable to empower you to manage all aspects of claims adjudication.
Learn more about our rules-based core administration + claims management solution, our suite of readily-configured business apps, and the cutting-edge services we offer as part of our full-service platform solution.
