A Third Party Administrator (TPA) is an organization that performs benefit administration and claims processing services for other organizations, like self-funded employer groups. However, TPAs may contract with insurance companies and managed care health plans to perform these same services on their behalf.

Plexis claims processing and benefit administration software helps Third Party Administrators (TPAs) reduce their workload and costs and add value to their client services. Our rule-based claim processing systems typically create very high auto-adjudication rates, which means that only a small percentage of all claims processed require manual intervention.

Plexis software solutions for TPAs reduce steps in every area of claim processing and benefit administration. With our software, users can manage member enrollment, provide instant and accurate information to call centers, generate flexible reports, adjudicate claims in seconds, and administer contracts in a few keystrokes. In short, your staff will accomplish more work in less time.

Plexis WEBWorks™ offers Healthcare TPAs a complete web tool set that provides control of the online process and allows TPAs to manage a client's information, view progress, and share information with all plan vendors. Plexis WEBWorks™ puts the Healthcare TPA in control of both the information users (members, plan sponsor, providers, agents, brokers, stop-loss carriers) and the content those users are authorized to view. By entering a registered name and password, medical providers verify benefits, check claims status and access payment history of previously submitted claims.

With its comprehensive reporting capabilities, Plexis WEBWorks™ also adds value to Healthcare TPA's client services. Plan cost modeling and other forecasting features help Healthcare TPAs retain clients, reduce costs and increase efficiency. By providing member and provider information over the Internet, WEBWorks™ improves customer service, eliminates the unnecessary call center activity and saves time and money.

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