Purchased/Referred Care software for Tribal Healthcare Payers
The Contract Health Services (CHS) program, now renamed Purchased/Referred Care (PRC), provides accelerated opportunities for payers to deliver optimized, cost-effective care. PLEXIS has established a reputation for delivering the resources and tools that CHS (PRC) payers are successively utilizing to maximize PRC dollars and improve PRC business practices.
PLEXIS’ core administration + claims management solutions enable PRC payers to cap costs, meet regulatory standards, leverage federal funding, and grow the business of healthcare while expanding healthcare delivery to tribal members. PLEXIS’ enterprise-level core administrative platform solutions deliver the administrative efficiency that drives payer success.
PLEXIS’ core administration software delivers Purchased/Referred Care administrative efficiency via:
- A rules-based engine that automates workflows for claims processing, benefit administration, enrollments, eligibilities, premium billing, and more
- Passport connectivity services that provide enterprise-wide interoperability for your entire business ecosystem
- Progressive, modern technology built to deliver scalable results for PRC payers
- Configurable capabilities for care management to simplify and automate coordinated care success
- Dedicated customer relationship management tools to streamline proactive, transparent customer service for member retention, sales & marketing, and more
PLEXIS’ flexible, agile platforms streamline payer workflows
For the past 20 years, PLEXIS has provided mission-critical platform software to catalyze efficiencies and connect evolving business ecosystems. Serving over 70 million people worldwide, PLEXIS helps payers decrease costs and create the positioning you need to capitalize on evolving business opportunities. As a trusted vendor in all major fields of healthcare, PLEXIS empowers payer organizations involved in Purchase/Referred Care and other specialties to ignite growth and innovation across multiple lines of business.
Replacing RPMS with a modern, cost-effective solution for the Tribes and Alaska Natives
The legacy Resource and Patient Management System (RPMS) has been freely available for over thirty years, but PLEXIS is helping increasing numbers of PRC organizations migrate off of this labor-intensive system. PRC payers are unhappy with the high administrative costs of manual adjudication procedures, the rising number of claims errors, and the high price of fraud, waste, and abuse (FWA) within the RPMS solution. The hidden costs are quite high for a “free” system. Responding to payers’ urgent need for a powerful, cost-effective alternative to RPMS, PLEXIS customized our core platform with the specific solutions to meet those needs, and we went the extra mile to streamline migration from RPMS to the PLEXIS platform for a demonstrable return on investment.
Learn more about PLEXIS’ solution for modernizing and optimizing your IHS/PRC system.
