Administering cost containment services

Payers leverage the PLEXIS platform to successfully control expenses

While healthcare costs have risen dramatically over the past decade, cost containment organizations are successfully leveraging PLEXIS’ proven payer platform to reduce the utilization and cost of unnecessary health services. A growing number of payers are utilizing PLEXIS’ integrated clinical, financial, and administrative platform to replace a legacy system or stand-up a new line of business. The PLEXIS platform empowers effective care management, PPO repricing, business intelligence, and automated efficiencies to help enhance quality of care and patient outcomes while significantly reducing utilization and costs.

The PLEXIS platform empowers cost containment organizations to:

  • Lower utilization rates with coordinated care: PLEXIS’ care management, UM/UR, and disease management give you the full toolset for medical management negotiations, data-driven utilization review, wellness services, and monitoring/management of high-dollar claims.
  • Enable significant savings: PLEXIS enables effective medical cost reduction through advanced PPO repricing, Medicare Advantage repricing, claim negotiations, and maximum network discounts (primary, wrap, and supplemental).
  • Rapidly respond to critical conditions: Payers keep costs from spiraling out of control through early identification of outliers and critical health issues. PLEXIS empowers you with configurable alerts, automatic audits, incisive health risk assessments (HRAs), and responsive reporting.
  • Enhance automation and efficiencies: PLEXIS empowers efficient fraud, waste, and abuse (FWA) detection, automated claim editing, automated calculations and processing of network fees, and efficient electronic workflows through powerful EDI solutions.
  • Effectively predict costs: PLEXIS’ powerful business analytics (BI/BA) enables predictive modeling and data mining to control costs and maximize health benefits by providing actionable intelligence for effective cost containment.