RAM Technologies, Inc., a leading developer of software applications for health care payers has released Version 9.0 of their enterprise payer solution HEALTHsuite. Version 9.0 features several significant advancements in the areas of enrollment, benefit administration, premium billing, customer service and claims management for health plans and benefit administrators.
The HEALTHsuite system is constantly evolving to accommodate the needs of the industry. New features are added quarterly to increase the overall value to RAM clients. The new features of HEALTHsuite 9.0 have been designed and implemented around HEALTHsuite’s rules-based processing engine - allowing each client the flexibility to administer their business according to their individual needs.
HEALTHsuite 9.0 features detailed support for value based benefits processing, enabling plans to increase benefits and reduce patient responsibilities for making healthier lifestyle choices. With this feature, health plans can raise, lower or waive patient copays and deductibles as well as increase benefits for participating individuals.
The customer service capabilities of HEALTHsuite have been dramatically expanded and allow health plan representatives to log, track and route inquiries and requests for service from all constituent groups. Customer service representatives can capture multiple requests for service from a single contact, prioritize them and can electronically attach any information to the request (specific claims, authorization information, benefits, bills, payments, etc.) and route each component to the appropriate individual or queue for review and completion. HEALTHsuite’s new Customer Service capabilities embrace CRM philosophy and utilize technology to organize, automate, and synchronize business processes allowing health plans to better service their members, providers and employer groups.
HEALTHsuite has expanded support for the following Medicare Prospective Payment Systems: Ambulatory Surgical Center (ASC), Long Term Care (LTC), Inpatient Rehabilitation Facility (IRF), and Skilled Nursing Facility (SNF). All of these prospective payment systems, in addition to DRG and APC, may be invoked in real-time as components of HEALTHsuite‘s unmatched claim adjudication process.
Version 9.0 features customized enrollment capabilities. This function allows each health plan to customize HEALTHsuite dialogs to align with their specific enrollment process by selectively removing / naming the data elements that are important to their organization. This capability allows plans to customize on-line enrollment processes reducing errors and data entry time.
HEALTHsuite’s Interactive Voice Response (IVR) capabilities have been streamlined providing even more access for members and providers to their information. This enhancement utilizes web services to support eligibility requests and claim status inquiries. Users are now able to submit inquiries via phone and instantaneously receive responses with specific information returned from HEALTHsuite to match their query.
Support for Taxonomy Code has been added to Provider, Benefits, Fee Schedules, Authorization and Claim modules. The Healthcare Provider Taxonomy Code (HPTC) is an external non-medical data code set used to classify health care providers according to provider type and/or practitioner specialty.
In response to the subsidy requirements of Health Care Reform, HEALTHsuite’s premium billing capabilities have been expanded to accommodate the splitting of financial responsibility among unlimited parties including local / state / federal government entities, associations / unions, employers, guardians, and individuals, etc.
“The latest release of HEALTHsuite improves the flexibility and efficiency of the fully integrated, enterprise solution” states Christopher P. Minton, Executive Vice President of RAM Technologies. “Many of the enhancements found in version 9.0 were a direct result of close interaction with our clients. RAM is dedicated to exceeding the needs of our clients and positioning our applications to meet the demands of the future.”
HEALTHsuite is an enterprise wide application with fully integrated modules to support eligibility / enrollment, benefit administration, provider contracting / reimbursement, medical management, premium billing, care management, claims adjudication, overpayment recovery, customer service / call tracking, subrogation, reporting, EDI and more. eHealthsuite™ is RAM’s portal product that provides real-time, self service access to information for members, providers, brokers and employers via the Internet.
About RAM Technologies, Inc.
For over 29 years RAM Technologies (ramtechnologiesinc.com) has developed and implemented their advanced solutions at health care payer organizations throughout the United States and Puerto Rico. RAM Technologies provides superior system solutions to health plans administering Medicaid, Medicare, Commercial, Correctional and Federal Health Benefits.