Plexis Healthcare BPO

Plexis Healthcare BPO reduces claims processing costs and streamlines benefits administration operations to maximize productivity and profitability for many healthcare payer organizations including insurers, TPAs, Independent Physician Associations (IPAs), hospitals, managed care networks, and self-insured employers.

Paper Claim Conversion

Plexis Healthcare BPO converts all healthcare claim types and prescription claims using state of the art OCR (Optical Character Recognition) technology to achieve the highest level of claim accuracy. Typical turnaround times for claim conversion average 24 to 48 hours.

Claim Processing Services

Plexis' expert claim processors can efficiently manage your claim payment workflow from entry through adjudication. Using Plexis Claims Managers auto-adjudication engine, you can achieve higher rates of adjudication without human intervention, saving you time and money.

Optimization Services

Our healthcare business analysts can optimize your business processes and workflows increasing productivity and profitability, allowing you more time to focus on growing your business.

Database Administration Services

• Maintenance and Monitoring
• Querying and Custom Reporting
• Custom EDI Import and Export Routines

Reporting & Analytics

Access to our comprehensive reporting features provide immediate details about any aspect of your claim processing output - types of claims, payment amounts, provider cost, etc. Better reporting means enhanced forecasting capabilities, allowing you to measure success and examine areas in which improvement is needed.

Premium Billing

Plexis Claims Manager supports flexible premium billing options such as premium calculations, weighting options, numerous billing frequency types and billing benefit types.

Eligibility Management

Using Plexis Claims Manager's built in eligibility tools, our processing experts can create, validate or update eligibility for new or existing plan members with ease.

Flexible Pricing Model and Terms

Our flexible pricing structure can accommodate any business model. We offer several payment options including:

• PE/PM
• PM/PM
• Hourly
• Monthly
• Call for More Options

Advantages of Plexis Healthcare BPO

• Launch new lines of business without increasing staff
• Address claim backlog
• Reduce and control operating cost
• World-class capabilities -- Claims processing is managed on Plexis Claims Manager for flexible, reliable performance

Software for Health Insurance Co. • Software for Managed Care Orgs • Software for PPOs, PHOs, IPAs • Software for PACE Orgs • Software for TPAs