Behavioral Healthcare Payers Successfully Leverage the PLEXIS Platform to Manage Evolving Payer and Delivery Models

As TPAs, MBHOs (managed behavioral health organizations), and other payers managing health and human services adapt to meet rapidly evolving market challenges, PLEXIS offers a distinct competitive advantage by providing the experience and tools necessary for managing unique payer models for individuals with complex needs.

By partnering in your success, PLEXIS empowers behavioral healthcare payers to:

  • Reduce or eliminate manual processes by automating timely and accurate claims adjudication
  • Save costs by automating and improving core administrative efficiencies including simplified coordination for multiple lines of funding
  • Create greater value for their clients with readily-customized benefit plan design
  • Automate and simplify care management with a seamless EHR/EMR integration for coordinated care success
  • Offer preventative, value-based Wellness programs including Telehealth and member/provider portals.
  • Meet regulatory compliance standards by providing support for standard government encounter reporting processes.

The PLEXIS platform empowers coordinated care management, network, and contract management

PLEXIS’ integrated clinical, financial, and administrative payer platform optimizes enterprise-wide administrative processes such as authorization management, enrollment, utilization visibility, and capitation (PMPM) revenue management.

PLEXIS ensures care management success by enabling proactive engagement with providers and ultimately reducing costs and improving quality of care. PLEXIS empowers payers to deliver superior customer service, enhancing customer engagement and network management via use of automated business activity monitoring and customizable web portal solutions.

PLEXIS’ Platform Features at a Glance:

  • Claims and encounter 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
  • Real-time portals
  • HIPAA-ready X-12 5010 EDI hub for end-to-end processing of encounter data and all electronic workflows