PLEXIS Healthcare Systems is included in Gartner’s recent Market Guide for Healthcare Payers’ Core Administrative Processing Systems (28 January 2015) with eight other core administrative technology vendors as “representative of the market and as major competitors” selling in the U.S. healthcare commercial payer space.
“With 19 years of experience serving as a trusted leader in the healthcare payer industry, PLEXIS’ vision is to continue growing and to continue providing our clients with the key components Gartner recommends in this guide,” said Sean Garrett, PLEXIS’ Chief Operating Officer. “From an extremely flexible, rules-based high volume claims processing engine to real-time self-service interfaces, PLEXIS deploys the full toolset modern healthcare payers need to ensure the success of their business.”
Gartner summarizes the principal challenges facing today’s healthcare payers as the need to modernize their core administrative systems, solve interface connectivity issues between disparate systems, streamline processes, and adjudicate claims more accurately and efficiently.
“Gartner defines core administrative capabilities within two main categories — standard and differentiator components — which follows Gartner’s pace layer approach to application architecture. Standard components include benefits administration, membership management, provider administrative configuration and management, claims processing, rating and underwriting, and premium billing. Differentiator capabilities include enterprise workflows, self-service interfaces, integrated customer service, pricing transparency, and automated business intelligence (BI)/analytics and reporting via dashboards for informed decision making.”
“Through PLEXIS’ architecture and strategic partnerships, we believe PLEXIS’ core platforms and extensible business apps include all the standard and differentiator components that Gartner defines as necessary tools to meet the challenges facing today’s healthcare payers.” said Garrett. “Furthermore, PLEXIS’ Passport Connectivity Services create a complete application interface connectivity solution allowing payers to integrate any application with PLEXIS’ Quantum Choice platform.”