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, May 2015

Dental insurance is growing faster than ever. In addition to employers looking to expand dental coverage, the Affordable Care Act’s definition of dental coverage as an “essential benefit” for children is resulting in more consumers than ever opting for dental insurance. Modern consumer demands for mobile, user-friendly tools and responsive dental customer service accelerated our agile solutions to meet the speed of change.

Easy-to-build unique 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, PLEXIS’ platform solutions offer a flexible, centralized technology platform to empower collaboration and greater business efficiencies, including extensive auto-adjudication and flexible premium billing capabilities.

PLEXIS’ best-of-breed solutions empower payers with an innovative, comprehensive set of solutions including mobile, self-service portals, clinical and wellness integration, automated enrollment, and many more value-based payer benefits.

The PLEXIS Solution for Dental Plans Includes:

  • Dental specific claim entry and adjudication form
  • Support of US ADA and non-US dental codes and tooth numbering
  • Real-time alternate course of treatment and restorative bundling processing
  • Interactive tooth chart and missing tooth indicators
  • Claim accumulation at tooth and surface levels
  • 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 automated EDI services
  • Intelligent alerts and reporting
  • Automatic messaging reduces manual intervention for reports
  • Capitation capabilities
  • Easy-to-manage multi-level security