TPA claims processing and core administrative technology

Increasing value for self-funded and fully insured clients

Third Party Administrators are the experts at flexible, cost-efficient services for self-funded or fully insured clients. Because of rising costs associated with regulatory change and compliance, the most powerful tool today’s TPA can leverage is a centralized, affordable core administrative system such as the trusted PLEXIS platform solution. With streamlined auto-adjudication capabilities and efficient benefit administration, PLEXIS platform solutions provide critical success factors for TPAs by increasing value for their clients.

  • 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

    Veterans Administration Financial Services

Outdated, disconnected claims management and benefit administration systems cause inefficiency, discontinuity obstacles, and ultimately a loss of value to TPA clients. The centralized PLEXIS core administration (benefit administration) and claims management system allows TPAs to meet the challenges of rapidly evolving regulatory compliance with an affordable, trusted technology solution. PLEXIS payer platforms empower TPAs with the following benefits:

  • Streamline benefit administration: Coordinate 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 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
  • Simplify electronic workflows: PLEXIS’ EDI capabilities deliver enterprise-wide efficiencies with end-to-end workflows for claims, encounter data, 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.

Engage with a proven partner to drive business enablement

For the past 20 years, PLEXIS has worked closely with TPAs in 37 states across the U.S.A. (doing business in all 50), putting many TPAs behind the wheel of their new system in less than ninety days, including data conversion and training. With a record of a 95% customer retention rate, PLEXIS has industry-leading experience empowering TPAs to deliver superior customer service and capture a quick ROI with the legendary speed-to-value of the PLEXIS platform solution.

World-class payer platforms for TPAs

PLEXIS Payer Platforms

Core Admin + Claims Management
Apps Icon Sidebar

PLEXIS Business Apps
PLEXIS Connectivity Services

Passport Connectivity Services

Learn more about the features of the PLEXIS Solution for TPAs

  • Claim management, including auto-adjudication and batch readjudication
  • Flexible benefit plan administration (multiple product, multiple line of business support)
  • Referral and authorization management
  • Robust member and eligibility management
  • Premium billing administration
  • Real-time portals and batch EDI services
  • Real-time claim editing
  • Intelligent alerts and reporting
  • Capitation capabilities
  • Easy-to-manage multi-level security
  • Configurable add-ons such as external Medicare grouper and pricer routines