PLEXIS Claims Manager
Driving high auto-adjudication rates and minimizing the risk of paying claims incorrectly.
Overview
PLEXIS provides a core administration and claims management platform for healthcare payers, including TPAs, health plans, and government agencies. The system is designed to increase efficiency through high auto-adjudication rates, automated workflows, and flexible benefit plan configuration, helping to contain costs and ensure regulatory compliance.
✨ Key Features
- High-rate auto-adjudication
- Benefit plan administration
- Coordination of Benefits (COB)
- EDI capabilities for claims and encounter data
- Support for medical, dental, and vision claims
- Cost containment features (audits, alerts)
- Member and provider portals
🎯 Key Differentiators
- Focus on TPAs and flexible benefit administration
- High auto-adjudication rates
- Trusted platform with a long history in the industry
Unique Value: Empowers healthcare TPAs and payers to achieve high levels of automation in claims adjudication, reducing manual intervention and costs while improving accuracy and compliance.
🎯 Use Cases (4)
✅ Best For
- Centralizing claims and benefit administration for healthcare TPAs and payers.
💡 Check With Vendor
Verify these considerations match your specific requirements:
- Property & Casualty insurance claims.
- Non-healthcare related claims.
🏆 Alternatives
Offers a flexible and cost-efficient solution specifically tailored to the needs of TPAs, which may be more adaptable than larger, more rigid enterprise payer systems.
💻 Platforms
🔌 Integrations
🛟 Support Options
- ✓ Email Support
- ✓ Phone Support
- ✓ Dedicated Support (All tier)
🔒 Compliance & Security
💰 Pricing
🔄 Similar Tools in Claims Adjudication
Claimable
A web-based claims management platform that facilitates communication with claimants and efficient p...
FileHandler Enterprise
A comprehensive claims administration system for TPAs, insurance carriers, risk pools, and self-insu...
Origami Risk
A highly configurable, integrated SaaS platform for insurance, risk, safety, and compliance manageme...
Sapiens ClaimsPro for P&C
A cloud-native solution that streamlines end-to-end claims processing for all personal and commercia...
Majesco Claims for L&A and Group
A comprehensive claims management solution for Life, Annuity, and Group benefits insurance....
TPA Stream
An insurtech software company that provides solutions for Third-Party Administrators (TPAs) and heal...