Capitation capabilities & core administrative solutions for managed care

Effective risk management for value-based healthcare

As organizations involved in commercial delegated risk such as ACOs, PPOs, IPAs, and MSOs formulate pioneering developmental strategies for managed care contracting, PLEXIS is proud to help you deploy our proven and effective core administrative solution. For the past 19 years, PLEXIS has worked on some of the toughest operational challenges for these organizations. Our track record of a 95% customer retention rate reflects our experience and our capability transforming today and tomorrow’s healthcare challenges into innovative, strategic solutions for leading healthcare payers around the globe.

As delivery models evolve through current legislative initiatives, payers in the delegated risk space are increasingly moving from a fee-for-service model to value-based service. From effective administration of risk mitigation on capitated or shared-risk contracts to higher competencies in administrative contract organization and alignment, PLEXIS has you covered. With real-time reporting and centralized oversight, PLEXIS platforms are mission critical and provide the connectivity you need throughout your business ecosystem.

See the features of the PLEXIS Solution for Commercial Delegated Risk

  • Claim management, including auto-adjudication and batch readjudication
  • Flexible benefit plan administration (multiple product, multiple line of business support)
  • Referral and authorization management
  • Robust member and eligibility management
  • Premium billing administration
  • Real-time portals and batch EDI services
  • Real-time claim editing
  • Intelligent alerts and reporting
  • Capitation capabilities
  • Easy-to-manage multi-level security
  • Configurable add-ons such as external Medicare grouper and pricer routines