TPAs and Employer Groups Utilize the PLEXIS Platform to Successfully Manage Their Self-Funded Plans

“In my 23 years in claims adjudication, I have never worked on a claim system where the plan setup is as easy, efficient and as straightforward as PLEXIS.” –Associate Director, Veteran’s Administration Financial Services

PLEXIS has a long and distinguished history of partnering in the success of TPAs and employer groups in 44 states across the USA (doing business in all 50 states and the District of Columbia). The proven PLEXIS platform coordinates industry-leading benefit plan administration, cost containment objectives, and all electronic workflows to empower you to connect, communicate, and automate while reducing enterprise-wide costs.

PLEXIS empowers TPAs and employer groups to:

  • Streamline benefit administration: With industry-leading benefit plan configurability, PLEXIS coordinates administration of medical, vision, dental, fully-insured products, travel assistance, commission support, premium billing – for health, and ancillary products, and more.
  • Meet cost containment objectives: The PLEXIS platform enables administration of complex benefit configuration, reimbursement arrangements, and corresponding payment calculations to drive high auto-adjudication rates, which minimizes the risk of paying claims incorrectly. TPAs and employer groups recover significant savings and reduce utilization costs by leveraging PLEXIS’ configurable alerts, health risk assessments (HRAs), responsive reporting, and more.
  • Connect and communicate: Integrated portals enable self-service by plan administrators, members, providers, and brokers alike to access critical information on demand. Additional efficiencies and benefits include automated online enrollment and mobile capabilities for smartphone/tablet connectivity, as well as telehealth capabilities to promote wellness and education.
  • Improve the cost and quality of care: PLEXIS’care management, UM/UR, and disease management give you the full toolset for data-driven utilization review, wellness services, and value-based care.
  • Provide superior customer service: Delight your customers and simplify your workflows for call center support, customer engagement, support for first call resolution (FCR), and more.
  • Scale to the size you need: PLEXIS’ proven platform is architected to process the largest transaction volume in our industry, yet we include scaled pricing options for all sizes of TPAs and employer groups.
  • Simplify electronic workflows: PLEXIS’ EDI and claims inventory management capabilities deliver enterprise-wide efficiencies with end-to-end workflows for claims, encounter data, and more.
  • Actionable intelligence: PLEXIS’ quantitative analytics (BI/BA) delivers capabilities to perform research and modeling which can help give you a competitive edge in attracting new, and retaining existing clients.
  • Enhance transparency for evolving compliance requirements: Accelerate growth while minimizing risk through end-to-end transparency and reporting capabilities.