The Leader in Payer Solutions for Tribal Healthcare

Purchased/Referred Care (formerly Contract Health Services) serves an extremely important role as Indian Health Service’s gateway for health care outside of IHS/Tribal healthcare facilities.

The Southeast Alaska Regional Health Consortium (SEARHC), a non-profit health consortium comprised of 18 Tribal communities, needed an economical claims administration solution that could be implemented in a short period of time. Using the PLEXIS suite of solutions, SEARHC reduced claim processing time by 60%. Implementation took less than 60 days. The resulting 35% reduction in costs allowed SEARHC to reallocate more funds for furthering health care initiatives.

The PLEXIS platform provides tribal healthcare with complete benefit administration, claim processing, electronic health records (EHRs), worker’s compensation processing, premium billing, authorizations, referrals, extensive reports, easy customer correspondence, and more.

Streamlined Tribal Healthcare solutions, including:

  • Time-saving claim adjudication
  • 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
  • Intelligent alerts and reporting
  • Real-time claim editing
  • Capitation capabilities
  • Configurable add-ons such as external Medicare grouper and pricer routines

Replacing the legacy RPMS system with a powerful, cost-effective solution for the Tribes and Alaska Natives

Over the past 20 years, PLEXIS has received excellent feedback from Native healthcare payers about recurring problems with the legacy Resource and Patient Management System (RPMS). In response, PLEXIS customized our core platform with specific solutions to meet those needs and deliver cost-effective administrative efficiency.

THE BENEFITS OF PLEXIS’ MODERN SOLUTION VS. RPMS INCLUDE:

  • EDI solutions streamline electronic data exchange with hospitals and other organizations, eliminating expensive manual data entry and automating administrative operations.
  • PLEXIS integrates electronic health records (EHRs) while RPMS cannot.
  • Unlike RPMS’ limited reporting capabilities, the PLEXIS platform includes numerous pre-built reports including multiple PRC-specific reports to easily access your data. We also support CHEF reporting (Catastrophic Health Emergency Fund).
  • Unlike RPMS, PLEXIS offers standard purchase orders and the option to create custom PO’s.
  • PLEXIS allows you to track member demographics, including Medical Health Record number, Tribe membership, and eligibility status. Within eligibilities, PLEXIS added numerous fields, including: facility, current community, Class/beneficiary, Tribe Quantum, etc.
  • PLEXIS’ speed-to-value implementation can be completed in 60-90 days, seamlessly integrating your data from the old RPMS system.