Built From the Ground Up for Dental Insurance Administrators

“A lack of dental coverage may be hurting your company’s productivity. According to the Henry J. Kaiser Foundation, employed adults lose more than 164 million hours of work each year related to oral health problems or dental visits.”
–Steven Johnson, Employee Benefit News

Dental insurance is growing faster than ever. Insurers’ increased demand high-performance processing systems with cafeteria-style automation, user-friendly tools and agile solutions drove PLEXIS’ decisions to tightly couple powerful dental administration processing capabilities with our core platform, enabling this insurers to meet the speed of change.

Cost-saving efficiencies for dental plans

PLEXIS’ transaction processing engine enables dental benefit administrators to build a virtually unlimited number of unique specialty plans, including coverage incentive features such as tiered coinsurance to promote client retention. The PLEXIS platform includes an interactive tooth chart and other dental-specific toolsets to reduce costs while delivering greater value for dental plans or multi-line health plans.

Whether your organization administers dental insurance alone or as part of a wider scope of products – including managed care – PLEXIS’ platform solutions offer a flexible, centralized technology platform to empower collaboration and greater business efficiencies, including extensive auto-adjudication, capitation and flexible premium billing capabilities.

The PLEXIS tech stack empowers payers with an innovative, comprehensive set of extensible, scalable, and performant solutions.

The PLEXIS Solution for Dental Plans Includes:

  • Dental specific claim entry and adjudication form
  • Claim management, including auto-adjudication and batch readjudication
  • Flexible benefit plan administration (multiple product, multiple line of business support)
  • Configurable, automated incentives to promote preventative care and member retention 
  • Claim accumulation at tooth and surface levels
  • MManage care / DHMO capabilities including capitation and referral and authorization management
  • Support of US and international codes and tooth numbering
  • Robust member and eligibility management
  • Premium billing administration
  • Options for real-time portals and automated EDI services
  • Intelligent customer-defined workflows, alerts and reporting