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IGNITE GROWTH + INNOVATION

Enterprise payer solutions for the evolving healthcare landscape

It is our business to improve your business.

PLEXIS provides best-in-class healthcare payer solutions for a diverse group of payers

PLEXIS Healthcare Systems is a leading payer technology company that delivers trusted enterprise core administration and claims management platform solutions to healthcare payers and administrators around the globe. PLEXIS empowers the business of healthcare, igniting growth, innovation, and efficiencies across diverse business lines for payer organizations. PLEXIS solutions reduce operating costs and greatly enhance client satisfaction.

More than 100 organizations trust PLEXIS core administrative enterprise solutions to manage over 55 million lives in all 50 states and around the globe. PLEXIS connects diverse business ecosystems, building trusted, healthcare payer solutions through the relationships we build and maintain with our clients. Our worldwide network of customers includes a diverse base of healthcare payers including:

With PLEXIS I have enjoyed the best vendor relationship that I have experienced in my thirty-year career.

Ty Moore
VP of Information Systems

Davis Vision
After we implemented the PLEXIS platform, the time it takes to set up a custom benefit plan for new customers was reduced from approximately eight hours to less than 30 minutes.

Enrollment Manager

AlwaysCare
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
We’ve been working with PLEXIS for over ten years and have a wonderful relationship. We collaborate on new ideas in product development that have enhanced our capabilities on several levels.

Michele Torvik
Chief Operating Officer

ABCT Management Services

Configurable, Agile, Scalable Platforms

Solution-driven payer platforms

The key differentiators behind PLEXIS' platform solutions are configurability, agility, and reusability. From early on in our history, we understood that healthcare payer needs are not only complex but always evolving. Therefore we build an exceptionally high amount of flexibility and configurability into our platform solutions.

Our platforms are comprised of three components:

your mission-critical core administration and processing engines;
integrated business applications;
and our Passport connectivity services

Learn more about our payer platforms

Core Admin + Claims Management
- Claims management, auto-adjudication, & readjudication
- Benefit administration & premium billing
- Robust member and eligibility management
- Workflow automation with real-time bundling/unbundling
- Provider administration / referrals & authorizations
Extended Business Apps
- Self-service apps whereby customers use their mobile devices to perform a wide variety of healthcare tasks
- Real-time portals for automated adjudication, readjudication, & benefits administration
- Automated, high-volume EDI (Electronic Data Interchange) translation and transmission
- Supports BYOA - Build Your own Application
Passport Connectivity Services
- Real-time integration architecture
- Agile connectivity layer for existing or custom applications
- Batch EDI services conducted via an ESB for scalability
- Ad-hoc queries, custom reports, annual extracts, and more
- Portal, workflow, and application automation

World-class, Enterprise Payer Platforms

See why PLEXIS is the leading trusted software vendor in the global payer community.

Request a Demo

Explore Related Resources

Empowering the Business of Healthcare

Health Plans

TPAs + Employer Groups

Government Healthcare

International

Delegated Risk Groups

Speciality Groups

Core Admin + Claims Management Engines

Passport Connectivity Services

Technology

Business Apps

IGNITE GROWTH + INNOVATION

Enterprise payer solutions for the evolving healthcare landscape

It is our business to improve your business.

PLEXIS provides best-in-class healthcare payer solutions for a diverse group of payers

Health Plans

TPAs

Government

International

Delegated Risk

Specialty Groups

VP of Information Systems

Enrollment Manager

Associate Director

Chief Operating Officer