PLEXIS Claims Software

plexishealth.com · checked 14 Nov 2026

#7 · Claims Processing Software

Visit plexishealth.com ↗ Alternatives PLEXIS Claims Software vs Guidewire ClaimCenter

How it plugs in

—Public API

NoOpen source

NoFree tier

Signal on Claims Processing Software4.8#7 of 16

PLEXIS provides healthcare payers a centralized claims-processing environment that integrates clinical, administrative, and financial components.

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Runs on

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Windows
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Linux
iOS
Android

Facts

Website: plexishealth.com
Price: Not published
Free trial: Not stated
Additional capabilities: The core platform also handles member and eligibility management, premium billing, provider administration, referrals, authorizations, and capitation.
Benefit administration: The platform supports benefit plan configuration and payment calculations across multiple coverage types.
Claims processing: Its payer platform includes claims auto-adjudication, mass readjudication, and real-time claim editing.
Cloud option: PLEXIS Cloud offers HIPAA-compliant hosting and describes average 99% uptime.
Company: PLEXIS Healthcare Systems says it was founded in 1996.
Customers: PLEXIS identifies healthcare payers and delivery systems as its customers, including health plans, TPAs, government, international, delegated-risk, and specialty groups.
Cybersecurity certification: PLEXIS announced HITRUST e1 certification for foundational cybersecurity in August 2024.
EDI: Passport supports inbound and outbound EDI batch integrations using X12 and flat files.
Headquarters: PLEXIS lists its address in Medford, Oregon.
Integrations: Passport connects PLEXIS with third-party, in-house, and custom applications through real-time or batch integrations.
Pricing: The claims page mentions scaled pricing options for smaller employer groups but gives no price amount.
Security: PLEXIS describes configurable multi-level access controls, advanced encryption, and Windows Active Directory integration.

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