TPA Benefit Administration to Maximize Efficiency

PLEXIS offers the most comprehensive core benefit administration software on the market

Third Party Administrators (TPAs) seeking to modernize their administrative processes need a unified 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 helps TPAs configure complex benefit plans, meet cost containment objectives, predict costs, and more.

PLEXIS empowers TPAs to:

  • Streamline benefit administration: 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.
  • Meet cost containment objectives: PLEXIS automates complex benefit configuration and payment calculations to drive high auto-adjudication rates and minimize the risk of paying claims incorrectly. TPAs recover significant savings and reduce utilization costs by leveraging PLEXIS’ configurable alerts, automatic audits, health risk assessments (HRAs), responsive reporting, and more
  • Connect and communicate: PLEXIS’ portals connect you to members, providers, and all essential stakeholders. Telehealth capabilities promote wellness and education. Additional efficiencies include automated online enrollment and mobile capabilities for smartphone/tablet connectivity.
  • 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.
  • 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 TPAs.
  • Simplify electronic workflows: PLEXIS’ EDI capabilities deliver enterprise-wide efficiencies with end-to-end workflows for claims, encounter data, and more.
  • Predict costs: PLEXIS’ quantitative analytics (BI/BA) delivers predictive modeling and actionable intelligence to give you a competitive edge in total cost comparison.
  • Enhance transparency for evolving compliance requirements: Accelerate growth while minimizing risk through end-to-end transparency and reporting capabilities. PLEXIS provides holistic visibility for compliance requirements.

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 rates, and collaboration with outside vendors.

Additionally, the PLEXIS platform 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.