Accountable Care Organizations leverage PLEXIS’ core administrative platform for successful payer-provider collaboration

Our proven platform creates cost savings for accountable care organizations (ACOs) by enhancing payer-provider collaboration for evolving reimbursement models. Supporting multiple models of PMPM capitated arrangements, PLEXIS’ integrated clinical, financial, and administrative payer platform enables you to link reimbursements to KPIs such as patient satisfaction and reductions in the total cost of care. The PLEXIS platform saves time and costs with advanced components such as flexible network features and automated payment bundling.

A 360° view of utilization leads to improved clinical outcomes

PLEXIS’ powerful care management solution empowers payers with a 360° view of actionable data regarding costs, utilization, and care metrics. The integrated clinical support of PLEXIS’ care management, case management, and utilization management gives payers greater control over contract execution, cost containment, and disease management. We simplify workflows for performance-based reimbursements to automate the impact payers can have on reducing utilization costs and improving clinical outcomes.

PLEXIS empowers ACOs to:

  • Enable significant savings: PLEXIS enables effective medical cost reduction through advanced PPO repricing, Medicare Advantage repricing, the Medicare Shared Savings Program (MSSP), claim negotiations, and maximum network discounts (primary, wrap, and supplemental).
  • Lower utilization rates with coordinated care: PLEXIS’ care management, UM/UR, and disease management solution gives you the full toolset for medical management negotiations, data-driven utilization review, wellness services, and monitoring/management of high-dollar claims.
  • Automate capitation (PMPM) processing including retroactive adjustments.
  • Meet cost containment objectives: PLEXIS automates complex benefit calculations to drive high auto-adjudication rates and minimize the risk of paying claims incorrectly. ACOs recover significant savings and reduce utilization rates by leveraging PLEXIS’ configurable alerts, automatic audits, health risk assessments (HRAs), responsive reporting, and more.
  • Enhance provider networks: PLEXIS automates support for network management for multiple reimbursement arrangements allowing you to enhance collaboration with providers and members.
  • Connect and communicate: PLEXIS’ real-time portals connect you to members, providers, and all essential stakeholders.
  • Simplify electronic workflows: PLEXIS’ EDI capabilities deliver enterprise-wide efficiencies with end-to-end workflows for claims, encounter data, and more.
  • Enhance automation and efficiencies: PLEXIS empowers efficient fraud, waste, and abuse (FWA) detection, automated claim editing, automated calculations and processing of network fees, and more.
  • Enhance transparency for evolving compliance requirements: Accelerate growth while minimizing risk through end-to-end transparency and centralized premium and claim data. PLEXIS provides holistic visibility for compliance requirements.