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What is HEALTHsuite?

HEALTHsuite offers an all-encompassing benefit management system along with claims processing software tailored for health plans that oversee Medicare Advantage and Medicaid benefits. As a rules-driven auto adjudication solution, HEALTHsuite streamlines every facet of enrollment and eligibility, benefit management, provider contracting and reimbursement, premium billing, care coordination, claim adjudication, customer service, and reporting, among other functions. By integrating these processes, HEALTHsuite enhances efficiency and accuracy for health plan administrators. This comprehensive approach ensures that all stakeholders can manage their responsibilities with greater ease and precision.

What is Edifecs?

If you require help navigating the complexities of the CMS and ONC final regulations, developing a compliance strategy, or implementing an effective solution, we are ready to support you. As a leader in interoperability, Edifecs has the expertise to assist you in meeting the newest requirements while enabling the secure and efficient exchange of electronic health data. Our exceptional Smart Trading and Encounter Management solutions are tailored for small to medium-sized health plans. By harnessing financial, clinical, and administrative data, organizations can enhance their operational strategies and streamline administrative processes. Enhance your encounter management systems and boost first-pass rates for managed Medicaid and Medicare Advantage with the hosted solution model offered by Edifecs. Furthermore, Edifecs provides COTS-based modular solutions that focus on improving data quality and facilitating payment reform efforts. With these cutting-edge tools, health plans can adopt a proactive stance towards compliance and data management, ultimately driving better health outcomes for their members. Our commitment to innovation ensures that you are not only meeting compliance but also thriving in an evolving healthcare landscape.

Media

Media

Integrations Supported

Additional information not provided

Integrations Supported

Additional information not provided

API Availability

API Availability

Pricing Information

Pricing not provided

Pricing Information

Pricing not provided

Supported Platforms

SaaS

Supported Platforms

SaaS

Customer Service / Support

24 Hour Support
Web-Based Support

Customer Service / Support

Standard Support
Web-Based Support

Training Options

Documentation Hub
Webinars
Online Training
On-Site Training

Training Options

Documentation Hub
Online Training
On-Site Training

Company Facts

Organization Name

RAM Technologies

Date Founded

1981

Company Location

United States

Company Website

ramtechnologiesinc.com/solutions-services/healthsuite-advantage/

Company Facts

Organization Name

Edifecs

Date Founded

1996

Company Location

United States

Company Website

www.edifecs.com

Categories and Features

Claims Processing

Adjustor Management
Case Management
Claim Resolution Tracking
Co-Pay & Deductible Tracking
Compliance Management
Customer Management
Electronic Claims
Forms Management
Paper-Based Claims
Payor Management
Policy Administration

Categories and Features

Healthcare Compliance

Not specified

Hospital Management

Accounting Integration
Appointment Scheduling
Medical Billing

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