Plexis Healthcare Systems

Our delivery Partner, Plexis Healthcare Systems has one of the most reputed claims management systems in the industry. In fact, Plexis’ award-winning benefits administration and claims processing software is exceptionally well accepted by all market players within the Healthcare insurance sector.

Plexis Healthcare Systems' software employs flexible, rules-based engines for every payer organization. Combining flexibility, scalability, powerful reporting and workflow tools, these software applications provides tools which are critical to the effective and efficient processing of claims for Healthcare payers. The three core platforms highlighted below incorporate complete benefits administration, premium billing, capitation, managed care and claims management.

Some of the common benefits associated with Plexis Technology are as follows:
  • Enables “customization” via standard configuration
  • Service-oriented architecture (SOA) with an enterprise service bus (ESB) focused on being:
  • Incredibly reliable
  • Highly scalable
  • Unbreakable – services are version agnostic – updates will not cause failures
Plexis Healthcare solutions serve various industry segments. The important ones are:
  • Government: Plexis Healthcare System’s unique Quantum Choice, Claims Manager and LCS systems provide the tools for success to Government Healthcare Programs at the County, State, Federal and IHS program levels.
  • Health Insurance Companies: Plexis benefit administration software provides health insurance companies with a claims system that reduces costs by focusing on health plan results and increased automation
  • Managed Care Organizations: Plexis offers powerful managed care software packages that provide managed care organizations (MCOs) with technology tools to streamline business processes integrating authorizations, episodes, claims processing and capitation, increasing revenues through efficiency and improved administrative controls.
  • Third Party Administrators (TPA):Plexis claims processing and benefit administration software helps Third Party Administrators (TPAs) reduce their workload and costs and add value to their client services, improving member satisfaction and customer retention. With our software, users can manage member enrollment, provide instant and accurate information to call centers, generate flexible reports, auto-adjudicate claims, and administer complex contracts scenarios automatically.

Apart from the above mentioned broad industry segments, Plexis also supports dental, vision and other specialty group organizations, International Healthcare having clients in 12 countries on 4 continents, PPOs, PHOs, IPAs, Medical Groups and Cost Containment companies in cutting down their recurring costs, achieving higher efficiency and staying ahead of the rapidly changing healthcare payer market we are all faced with today.


425 Washington Blvd., Jersey City,
New Jersey 07302, USA

Phone: +1 201.258.4704 / 201.258.4704
Fax: +1 201.604.3480