Correctional Health Facilities Leverage the PLEXIS Platform for Advanced Enterprise Efficiencies

Healthcare payers engaged in correctional healthcare often come to PLEXIS while searching for a unified platform solution to increase efficiency, automation, and core administrative capabilities. Payers utilize PLEXIS’ trusted platform to streamline workflows and manage providers, benefit plans, and core administrative processes.

PLEXIS’ integrated clinical, financial, and administrative payer platform not only helps organizations reduce manual workloads, but it includes numerous capabilities to allow payers and providers to connect, communicate, and share data in real-time. PLEXIS included specific capabilities for correctional healthcare for managing provider categories and specialties; tracking provider credentials; managing referrals and authorizations; and more.

The PLEXIS platform empowers correctional healthcare organizations to:

  • Streamline claim management with efficiencies including auto-adjudication, batch readjudication, and more. PLEXIS supports PPO claims repricing and flexible fee schedule payment methodologies.
  • Enhance provider networks: PLEXIS automates support for provider credentialing, referrals, and authorizations including network contracting/management for multiple reimbursement arrangements.
  • Simplify member tracking: For correctional healthcare organizations, PLEXIS optimized administration to allow users to search for members with alternate aliases.
  • Lower utilization rates with coordinated care: PLEXIS’ care management, UM/UR, and disease management gives you the full toolset for medical management negotiations, data-driven utilization review, wellness services, and monitoring/management of high-dollar claims.
  • Enhance automation and efficiencies: PLEXIS empowers efficient fraud, waste, and abuse (FWA) detection, automated claim editing, automated calculations and processing of network fees, and efficient electronic workflows through powerful EDI solutions.
  • Rapidly respond to critical conditions: Payers keep costs from spiraling out of control through early identification of outliers and critical health issues. PLEXIS empowers you with configurable alerts, automatic audits, and responsive reporting.
  • Effectively predict costs: PLEXIS’ powerful business analytics (BI/BA) enables predictive modeling and data mining to control costs and maximize health benefits by providing actionable intelligence.