ICD-10 compliant payer solutions

Opportunities for new efficiencies and competitive differentiation

As the final date for ICD-10 compliance passes, payers continue to leverage PLEXIS’ industry-leading claims management and benefit administration tools to turn ICD-10 compliance into an opportunity to increase operational efficiency and decrease MLR and a broad range of costs. PLEXIS’ trusted, integrated clinical, financial, and administrative payer platform has incorporated ICD-10 coding since 2010.

For the past five years, PLEXIS has helped take the worry out of the ICD-10 transition by offering progressive payer-provider collaboration tools and empowering payers to upgrade their core administrative technology. For the past 20 years, PLEXIS has specialized in leveraging payers’ technological investments for not only a rapid ROI but also opportunities for significant organizational advantages and competitive differentiation. From streamlined electronic health record (EHR) capabilities to unbeatable auto-adjudication rates, PLEXIS has you covered.

The critical components of ICD-10 claims adjudication software include:

  • A rules-based engine to automate all workflows for claims adjudication, auto-adjudication, benefit administration, enrollments, eligibilities, premium billing, and more
  • ICD-10 support including automated workflows for effective payer-provider collaboration
  • A flexible API integration offering complete interoperability to connect all your enterprise-wide systems
  • Agile technology built on service-oriented architecture to deliver scalable, enhanced transaction processing
  • EDI-ready claims adjudication with the full data integration to process electronic claim submissions in real-time
  • Advanced, enterprise-wide automation with real-time call outs to streamline workflows across a wide scope of operations, increasing administrative efficiencies, decreasing manual intervention, and increasing operating margins

A claims adjudication solution ready for expanding healthcare markets

For the past two decades PLEXIS has served all major healthcare markets by deploying the industry’s top claims adjudication software that consistently advances the industry’s best cost-of-care initiatives.

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.