TPAs Deliver Greater Business Value

“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

For over two decades, PLEXIS has partnered in the success of TPAs in 37 states (doing business in all 50 states) across the U.S.A. The trusted PLEXIS platform coordinates industry-leading benefit plan administration, cost containment objectives, and all electronic workflows to empower TPAs to connect, communicate, and automate while reducing enterprise-wide costs.

The PLEXIS platform empowers:

  • Benefit administration: The PLEXIS platform is the industry’s leading benefit plan management platform. It 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 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.
  • 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.
  • 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.
  • Medicare Section 111 Reporting: Our Quantum Choice™ platform will generate the MSP and TIN files and import response data. The Benefit Contract/Plan/Period features a Section 111 Reporting tab which will hold Benefit Plan Coverage Type and pharmacy information for the MSP Input File submission.

Configuration to meet your needs

PLEXIS’ integrated clinical, financial, and administrative payer platform gives TPAs a competitive edge in total cost comparison and empowers the TPA to offer more proactive and creative benefit consulting services with numerous advantages for the stop-loss carrier. The PLEXIS platform automates and simplifies the TPA’s benefit administration process for cost-saving efficiencies.

TPAs administering fully insured plans leverage the PLEXIS platform to successfully manage risk transfer schemes and produce profitable underwriting gains for their carrier and reinsurer. PLEXIS’ core administration + claims management engine empowers TPAs with an unbeatable flexibility in benefit design, greater predictability of cost, and more competitive total cost.