RAM Technologies, Inc. Adds Integrated Grievance, Disputes and Appeals Capabilities to HEALTHsuite Advantage

RAM Technologies, Inc. increases depth and breadth of functionality for Medicare and Medicaid health plans with addition of Grievance and Appeals processing to enterprise claims management solution, HEALTHsuite Advantage.

RAM Technologies, Inc., the perennial leader in enterprise software and services for health plans administering government sponsored healthcare (Medicare Advantage, Special Needs Plans and Managed Medicaid), is pleased to announce the availability of their newly integrated Grievances, Disputes and Appeals Module with the latest release of HEALTHsuite Advantage.

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This new module enables health plans to simplify their application portfolio ridding themselves of disparate spreadsheets and databases, while bolstering compliance, in a single end-to-end enterprise solution.

The premier platform for the administration of government sponsored healthcare just got better.

The Grievances, Disputes and Appeals Module provides compliance teams with real-time insights into data, improving the decision-making process and accelerating resolutions. With the highly intuitive interface of this new module, team members can complete their tasks more effectively, identifying potential audit risks, improving member and provider relations, streamlining operational flows, and simplifying the process of universe creation and reporting. With this tool, G&A professionals can produce meaningful reports with the simple click of a button, providing the actionable intelligence your organization needs and ensuring compliance with CMS.

This fully integrated module supports both Part C and Part D grievances and appeals and includes the following key features:

• Case Intake / Categorization: grievance, provider dispute, pre-service appeal, post-service appeal, and re-openings
• Complaint Tracking (CTM’s): creation and tracking of cases, captures outreach activities (calls and letters), maintains history and enables trending analysis to drive continuous improvement (none of which are available in HPMS);
• Integrated Enterprise Workflow and Routing
• Universe Generation and Reporting
• And much more…

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“The expansion of HEALTHsuite Advantage to include an integrated Grievance, Disputes and Appeals module provides our clients with the capabilities essential to meet meticulous compliance requirements mandated by CMS for Medicare Advantage, Special Needs and Managed Medicaid Plans,” stated Christopher P. Minton, Executive Vice President of RAM Technologies.

Mr. Minton continued, “Health plans operating in the Government sponsored market know RAM Technologies and have come to expect more from the solutions and services we offer. The release of our Grievance, Disputes and Appeals module is another example of our commitment to our clients to substantially improve their operating efficiencies while reducing costs.”

HEALTHsuite Advantage’s robust features include all of the essential core system capabilities, including fully integrated workflow and bi-directional integration with CMS and state Medicaid agencies, a must have for Medicare Advantage and Managed Medicaid organizations.

In addition, RAM provides health plans the option to administer their plan on the RAM platform (SaaS) or outsource all or select operations to RAM Health Services, RAM’s internal BPaaS division. RAM’s BPaaS offering affords plans, both small and large, a wealth of expertise in government sponsored healthcare. For new market entrants, this offering dramatically reduces time to market, alleviates hiring and HR issues and enhances health plan revenue.

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