Combining Industry-Leading Healthcare Operations with the PLEXIS Platform
PLEXIS Healthcare Systems and Wipro bring together a powerful combination of healthcare technology, payer administration expertise, and business process services to help health plans, TPAs, provider-sponsored organizations, Medicare, Medicaid, and specialty health programs accelerate transformation.
While PLEXIS delivers its proven Quantum Choice® platform for claims administration, Wipro provides the operational support, and digital transformation capabilities required to help organizations achieve business outcomes faster.
· Claims adjudication and claims operations
· Enrollment and membership administration
· Appeals and grievances
· Contact center operations
· Mailroom and document processing
· Back-office healthcare operations
Wipro also helps PLEXIS clients accelerate:
· Healthcare interoperability and FHIR implementations
· CMS compliance readiness
· Intelligent automation and RPA
· AI-powered operations
· Member and provider experience transformation
· Cloud modernization and managed service
The joint offering supports:
· Medicare Advantage Plans
· Medicaid Managed Care Organizations
· Dual Eligible Programs
· PACE Organizations
· Provider-Sponsored Health Plans
· Regional Health Plans
· ACA Marketplace Plans
About Wipro
Wipro Limited is a leading AI-powered technology services and consulting company focused on building innovative solutions that address clients’ most complex digital transformation needs. Leveraging our consulting-led approach and the Wipro Intelligence™ unified suite of AI-powered platforms, solutions and transformative offerings, we help clients realize their boldest ambitions to build intelligent and sustainable businesses.
Wipro strives to enable payers and providers to create personalized member and patient experiences at competitive costs and become a community healthcare hub delivering high value care. This has been achieved by delivering digital platforms for payers and healthcare providers; creating avenues for cost-efficient care; total operation and business transformation; and enabling digital health.
We have provided quick and cost-effective, end-to-end support to managed care organizations across the country since 1986, achieving:
· 35+ Years of CMS Partnership
· 100+ Health Plans Benefited
· 26M+ Medicare and Medicaid Members Served
· 500k+ Duals Processed
MedAdvantage360
MedAdvantage360 is Wipro’s integrated Medicare Advantage BPaaS platform designed to help health plans streamline core administration, improve operational efficiency, and support regulatory compliance across Medicare, Medicaid, and Medigap lines of business. The platform combines healthcare technology with back-office operational support to automate CMS compliance requirements, optimize day-to-day plan operations, and enable health plans to focus on delivering better services to members.
Key Capabilities
· End-to-end support for Medicare Advantage, Part D, Medicaid, Duals, SNP, MSA, Cost Plans, and Medigap lines of business.
· Modular capabilities for enrollment, commissions, HRA, member management, billing, revenue reconciliation, appeals and grievances, encounter data processing, provider network management, claims and adjudication, care management, HCC risk analytics, reporting, dashboards, portals, and API-based data integration.
· CMS compliance automation supported by a HITRUST-certified application, SSAE compliance, and Tier-3 data center hosting.
· Operational support for health plans entering new markets, expanding organically, or growing through acquisition.
Who It Supports
MedAdvantage360 supports a broad range of health plan organizations, including Medicare Advantage Plans, Part D Sponsors, Cost Plans, Dual Eligible and Special Needs Plans, Medicaid plans, Medicare Supplement plans, provider-sponsored health plans, and direct contracting entities.
Business Value
By unifying technology, compliance support, and administrative operations, MedAdvantage360 helps health plans reduce operational complexity, enhance scalability, and improve responsiveness to evolving CMS requirements. With Wipro’s experience supporting more than 100 health plans and high-volume CMS transaction processing, the platform is positioned to help payers modernize operations while maintaining compliance and member-centric service delivery. For additional information about Wipro, visit us at www.wipro.com.