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, worker’s compensation processing, premium billing, authorizations, referrals, extensive reports, easy customer correspondence, and more.

To administer purchased referred care and corresponding NDW and CHEF reporting, the claims administration system must also include information about the tribal member receiving care, and the referral information which originates from the EHR system. PLEXIS has created a group of system interfaces, referred to as Registration (demographic data, NDW elements, and alternate resources) and Referrals, that will create new records for members/eligibility and referrals when they do not already exist within the system. This will enable PRC groups to leverage their clinical electronic health record (EHR) systems to serve as the system of record for the administration of tribal members who must receive care outside of the tribal clinic(s). The automated import of new member/eligibility and referral records into the system from data which originates from the PRC group’s EHR system eliminates the need for human intervention to manually update records in the claims administration system when updates to member information occur.

Streamlined Tribal Healthcare solutions, including:

  • Electronic health record (EHR) integrations
  • 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
  • Intelligent alerts and reporting
  • 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

Since 1996, 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.


  • EDI solutions streamline electronic data exchange with hospitals and other organizations, eliminating expensive manual data entry and automating administrative operations.
  • PLEXIS integrates with industry leading electronic health records (EHRs).
  • The PLEXIS platform allows you to easily access your data to create custom reports, as well as providing access to numerous pre-built PRC-specific reports.
  • PLEXIS offers standard purchase orders and the option to create custom purchase orders.
  • 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 seamlessly by integrating your data from the old RPMS system.