PACE Organizations Gain Demonstrable ROI by Leveraging the PLEXIS Platform

The PLEXIS payer platform provides the best core administrative technology on the market for the Program of All-inclusive Care for the Elderly (PACE). Unlike other vendors whose only clients may be health plans, PLEXIS actively supports numerous PACE payers, facilitating collaborative enhancements which would otherwise not be possible. PLEXIS boasts over a 95% client retention rate across our 20 year history. PLEXIS has migrated clients from many of the other current platforms in the market.

The PLEXIS platform empowers PACE organizations to:

  • Enhance provider networks: The PLEXIS platform streamlines workflows for provider engagement. PLEXIS automates support for network management for multiple reimbursement arrangements allowing you to enhance collaboration with providers and members.
  • Lower utilization rates and close care gaps with coordinated care: PLEXIS can integrate care management, UM/UR, and disease management to enable powerful, preventative, outcome-based wellness. We include capabilities for medical management negotiations, data-driven utilization review, wellness services, and monitoring/management of high-dollar claims.
  • Simplify Medicare Prospective PricingSimplify APC and DRG pricing by embedding it within the adjudication process, delivering better accuracy with real-time results.
  • Administer better healthcare for dual eligibles: PLEXIS empowers payers to coordinate optimum healthcare delivery and payment for the growing population of over 9 million dual eligible beneficiaries with complex and costly healthcare needs.
  • Create significant savings: PLEXIS enables effective medical cost reduction through advanced PPO repricing and Medicare Advantage repricing.
  • Model and predict costs: PLEXIS can integrate powerful business intelligence + business analytics (BI/BA) to deliver actionable insights. Predict outcomes and reduce risks including different reimbursement configurations, CMS retroactive changes, HEDIS data, and more.
  • Manage your capitation contracts in addition to provider capitation arrangements.
  • Meet cost containment objectives: PLEXIS automates complex benefit calculations to drive high auto-adjudication rates and minimize the risk of paying claims incorrectly. Payers recover significant savings and reduce utilization costs by leveraging PLEXIS’ real-time alerts, automatic audits, responsive reporting, and more.
  • Simplify electronic workflows: PLEXIS’ powerful EDI hub delivers enterprise-wide efficiencies with end-to-end workflows for claims, encounter data (RAPS/EDPS), and more. Extensible functionality empowers payers to implement an enterprise data warehouse to track key performance metrics.
  • Connect and communicate: PLEXIS’ real-time portals connect you to members, providers, and all essential stakeholders. With PLEXIS’ self-service healthcare portal, members securely access eligibility, provider information, ID cards, claims history, and other configurable data fields – all from their computer, tablet, or smartphone.
  • Enhance automation and efficiencies: PLEXIS empowers efficient fraud, waste, and abuse (FWA) detection and automated claim editing.
  • Enhance transparency for evolving compliance requirements: Accelerate growth while minimizing risk through end-to-end transparency and centralized premium and claim data. The PLEXIS platform provides a centralized database for encounter data and other key data payers need for full compliance with reporting measures.