TPAs and Employer Groups Successfully Utilize the PLEXIS Platform

“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 37 states (doing business in all 50 states) across the U.S.A. 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, disability, life, travel assistance, commission support, premium billing, and more.
  • Meet cost containment objectives: PLEXIS automates complex benefit configuration and payment calculations to drive high auto-adjudication rates and minimize the risk of paying claims incorrectly. TPAs and employer groups 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.
  • 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 was architected to process the largest transaction volume in our industry, yet we include scaled pricing options for smaller TPAs and employer groups.
  • Simplify electronic workflows: PLEXIS’ EDI capabilities deliver enterprise-wide efficiencies with end-to-end workflows for claims, encounter data, and more.
  • Predict costs: PLEXIS’ quantitative analytics (BI/BA) delivers predictive modeling and actionable intelligence to give you a competitive edge in total cost comparison.
  • Enhance transparency for evolving compliance requirements: Accelerate growth while minimizing risk through end-to-end transparency and reporting capabilities. PLEXIS provides holistic visibility for compliance requirements.