Business, Services

Essential plumbing for the business ecosystem

A brand new kitchen sink is useless unless it’s plumbed into the proper inlets and outlets. Likewise, a brand new healthcare payer platform will not perform unless it’s plumbed into the software of the rest of your business ecosystem. The core administration and claims management platform is the most essential financial and administrative software for most healthcare payer organizations. But an often-overlooked functionality that has the potential to make or break an organization is the interface connectivity layer that enables applications to work: the plumbing.


A refresher course on the systems development lifecycle (SDLC)

Healthcare organizations typically utilize multiple vendors and multiple enterprise technology systems within their administrative, financial, and clinical operations. Different systems operate at peak relevancy at different times, constituting the normal systems development lifecycle (SDLC). As you monitor technological effectiveness and efficiency, eventually it becomes time to phase out various systems and initiate new systems.

Because the core administrative platform is often the largest technological component within your network of systems, replacing it is sometimes called an enterprise “technology transformation.” According to Top Issues, the annual insurance industry report from PricewaterhouseCoopers (PwC), payers are increasingly investing in new core administrative platforms, “because their legacy systems have become antiquated and a patchwork of customization can no longer handle scale or expansion into new products and markets.”

Risk mitigation during a technology transformation

Replacing your organization’s principal technological component, the core administrative platform, involves a higher degree of risk than replacing individual system components. PLEXIS helps payers mitigate risk during this process by ensuring that your core admin/claims management platform will communicate and grow with you and the rest of your systems. The most essential aspect is the plumbing to create system interoperability.

Through extensive experience, PLEXIS has found that the most successful implementations are phased, multi-stage implementations instead of a “big bang” replacement approach. Often clients come to PLEXIS after a failed attempt to utilize a technology that is “one size fits all.” Most importantly, the essential plumbing must be in place to allow disparate system interoperability. Unlike other software vendors, PLEXIS provides the correct plumbing so that payer organizations can continue to run their businesses throughout the core technological transformation.

Passport connectivity services: the plumbing for seamless integrations

PLEXIS launched Passport connectivity services to create the limitless connectivity of complete system interoperability. It is the plumbing that connects the core platform to all the disparate systems an organization may utilize. Passport supports integration with real-time portals, workflow tools, custom apps, and external products. Flexible, agile, and efficient, Passport connectivity services include real-time and batch app integrations. The batch integration facilitates electronic data interchange (EDI) for inbound and outbound files (X12, flat files, etc.). its configurable rules include flexible file mapping.

When payers consider a technology transformation, PLEXIS recommends effective plumbing more than any other single component within the core administrative platform. PLEXIS deploys Passport with every implementation because it delivers the limitless connectivity that payers need to connect their diverse business ecosystems.

Author Bio:

Igniting Innovation: PLEXIS Healthcare Systems

authorPLEXIS Healthcare Systems is a leading payer technology company that delivers trusted enterprise core administration and claims management solutions to healthcare payers and delivery systems around the globe. PLEXIS empowers the business of healthcare, igniting growth, innovation, and efficiencies across diverse business lines for payer organizations. Based in Southern Oregon, PLEXIS currently serves organizations in 37 states (doing business in all 50), 15 countries, and over 50 million people worldwide. logoPLEXIS provides mission-critical solutions that catalyze efficiencies and connect evolving business ecosystems to a wide range of payer organizations. To learn more, please visit: 

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