Employer Groups Leverage the PLEXIS Platform for Better Benefit Administration

“Self-insured group health plans now provide coverage to the majority of U.S. employees and dependents” –KFF Survey, 2014.

An increasing number of employer groups are embracing the proven strategy of self-administering their self-funded health plans. Self-funding offers significant value through greater cost containment opportunities, customized plan coverage, ownership of claims data, and an increase in employer cash flow. Self-insured employers leverage the PLEXIS platform to coordinate better benefit administration; improve the cost and quality of care; meet cost containment goals; and optimize transparency and risk management for self-funded success.

PLEXIS empowers employer groups 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’ care management, UM/UR, and disease management 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. Employers recover significant savings and reduce utilization rates 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 predictive modeling and 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.

The PLEXIS platform delivers demonstrable return on investment

For the past 20 years, PLEXIS has enabled self-funded employer groups to lower costs and offer attractive solutions for their clients including innovative benefit plan design and automated, accurate processing for claims and premiums. PLEXIS’ integrated clinical, financial, and administrative payer platform optimizes administrative processes and improves communication and collaboration with outside vendors in every field from provider networks to pharmacy benefit managers (PBMs).

The PLEXIS platform solution delivers powerful risk management tools to empower plan sponsors with extensive control over the process of claim adjudication and resolution. PLEXIS supports repricing workflows and offers significant cost savings with auto-adjudication, automated online enrollment, and other enhanced efficiencies. In today’s competitive market, PLEXIS provides self-funded groups the option to deliver value-added services such as mobile-enabled member/provider portals and health and wellness features, which include Telemedicine, access to health-related news and videos, healthcare advocacy programs, etc.

PLEXIS partners in the success of employer groups by empowering them to offer a more comprehensive and valuable set of solutions.