Radiology Payers Successfully Leverage the PLEXIS Platform

Automated solutions for adjudication, repricing, cost containment, and more

“PLEXIS’ full-circle transaction design between eligibility, referrals/authorizations, claims processing, and payment offers control of each process to ensure accuracy. The PLEXIS platform is user-friendly, and the efficient workflows are easy to learn, which allows for timely processing and payment of claims.” –Karen Page, Physician Health Partners

Healthcare payers involved in the field of radiology, including national networks of radiologists and imaging centers, successfully leverage PLEXIS’ platform solution to achieve their highest growth objectives. Client testimonials attest to the distinct competitive advantages the PLEXIS platform provides. PLEXIS empowers radiology payers to automate care management, enhance provider networks, deliver superior customer service, simplify electronic workflows, and create enterprise-wide efficiencies and cost-savings.

PLEXIS provides payers with the right tools and technology to:

  • Automate and simplify care management with a seamless EHR/EMR integration for coordinated care success.
  • Enhance provider networks: PLEXIS automates support for provider credentialing and network management for multiple reimbursement arrangements allowing you to enhance collaboration with providers and members.
  • Deliver superior customer service: Delight your customers and simplify workflows for call center support, customer engagement, and more.
  • Simplify electronic workflows: PLEXIS’ EDI capabilities deliver enterprise-wide efficiencies with end-to-end workflows for claims, encounter data, and more.
  • Enhance automation and efficiencies: PLEXIS empowers efficient fraud, waste, and abuse (FWA) detection, automated claim editing, automated calculations and processing of network fees, and more.
  • Meet cost containment objectives: PLEXIS automates complex benefit calculations to drive high auto-adjudication rates and minimize the risk of paying claims incorrectly. Payers recover significant savings and reduce utilization costs by leveraging PLEXIS’ configurable alerts, automatic audits, health risk assessments (HRAs), responsive reporting, and more.
  • Connect and communicate: PLEXIS’ portals connect you to members, providers, and all essential stakeholders. Telehealth capabilities promote wellness and education. Additional efficiencies include automated online enrollment and mobile capabilities for smartphone/tablet connectivity.
  • Enhance transparency for evolving compliance requirements: Accelerate growth while minimizing risk through end-to-end transparency and centralized premium and claim data. PLEXIS provides holistic visibility for compliance requirements.

The PLEXIS platform delivers significant cost savings and administrative efficiencies

PLEXIS’ integrated clinical, financial, and administrative payer platform enables proactive engagement with providers and ultimately reduces costs and improves quality of care. PLEXIS’ radiology imaging solution coordinates access to patients’ EHR/EMR for seamless workflows. Easy to configure, agile enough to address demanding daily business requirements, and flexible enough to capitalize on new growth opportunities, the PLEXIS platform solution delivers speed-to-value with a demonstrable return on investment. With our progressive stance on connecting evolving business ecosystems, PLEXIS continues to set market trends for configurability, reusability, and interoperability. Our average 8-year client tenure illustrates PLEXIS’ strength at creating mutually-beneficial business relationships.