Third Party Administrator Software Delivers Enhanced Administrative Efficiencies

Claims management, streamlined workflows, and more

Third Party Administrators (TPAs) gain significant cost-savings and ROI by replacing legacy claims + benefits administration systems. Modernizing administrative processes requires a centralized platform solution to streamline workflows and track providers, benefit plans, and core administrative processes.

PLEXIS’ integrated clinical, financial, and administrative payer platform delivers the competitive edge that you need for cost-effective benefit administration. The PLEXIS platform not only helps TPAs reduce manual workloads, but it includes responsive portal capabilities to allow members, providers, and administrators to connect, communicate, and share data in real-time. PLEXIS’ Third Party Administrator software ensures your technology infrastructure will stay up-to-date to provide long-term value for your existing clients while helping you win new business.

PLEXIS’ agile, scalable solution for TPAs enables you to:

  • Configure complex benefit plans: With industry-leading benefit plan configurability, PLEXIS coordinates administration of medical, vision, dental, fully-insured products, disability, life, travel assistance, commission support, premium billing, and more. Premium billing includes retroactive adjustments and multiple premium rate structures.
  • Meet cost containment objectives: PLEXIS automates complex benefit calculations to drive high auto-adjudication rates and minimize the risk of paying claims incorrectly. Payers recover significant savings and reduce utilization by leveraging PLEXIS’ real-time alerts, automatic audits, responsive reporting, and more.
  • Connect and communicate: PLEXIS’ real-time portals connect you to members, providers, and all essential stakeholders. With PLEXIS’ self-service healthcare portal, members securely access eligibility, provider information, ID cards, claims history, and other configurable data fields – all from their computer, tablet, or smartphone.
  • Create significant savings: PLEXIS enables effective medical cost reduction through advanced PPO repricing, Medicare Plus repricing, Meaningful Use/PQRS measures, and maximum network discounts (primary, wrap, and supplemental).
  • Lower utilization rates and close care gaps with coordinated care: With integrated care management, UM/UR, and disease management, PLEXIS enables powerful, preventative, outcome-based wellness. We include capabilities for medical management negotiations, data-driven utilization review, wellness services, and high-dollar claim solutions.
  • Simplify electronic workflows: PLEXIS’ powerful EDI hub delivers 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 and automated claim editing.
  • Enhance transparency for evolving compliance requirements: Accelerate growth while minimizing risk through end-to-end transparency and centralized documentation.

The PLEXIS platform delivers demonstrable return on investment

For the past 20 years, PLEXIS has collaborated with domestic and international TPAs to empower them to lower costs and offer attractive solutions for their clients. From innovative benefit plan design and automated, accurate processing for claims and premiums, PLEXIS’ payer platform optimizes administrative processes and improves communication, utilization, and collaboration with outside vendors.

PLEXIS’ Third Party Administrator software delivers powerful risk management tools to empower TPAs with extensive control over the process of claim adjudication and resolution. PLEXIS automates repricing workflows and offers significant cost savings with auto-adjudication, automated online enrollment, and other enhanced efficiencies. As medical costs continue to rise, PLEXIS enables TPAs to offer preventative value-based Wellness programs including Telehealth and member/provider portals.