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Health Plan of San Mateo Successfully Achieves Cal MediConnect Readiness With HEALTHsuite® Mercato
HEALTHsuite® Mercato from RAM Technologies is the solution of choice for health plans looking to maximize efficiency in the administration of Medicare / Medicaid dual eligible programs.
Cal MediConnect is California’s version of the Medicare-Medicaid Financial Alignment Initiative (FAI) instituted as part of the Affordable Care Act (ACA). The focus of the FAI program is for states and their contracted health plans to implement fully integrated care programs for Medicare and Medicaid eligible beneficiaries in coordination with the federal government. In order to successfully complete the readiness review, health plans must meet core Medicare and Medicaid requirements. As part of the review, CMS and the State perform an in-depth analysis of each plans’ operational capabilities to meet the complexities of the FAI program.
The Health Plan of San Mateo will be providing integrated Medicare-Medicaid benefits to dual eligible residents in San Mateo County. HPSM has used HEALTHsuite Mercato and eHealthsuite™, RAM’s fully integrated healthcare administrative suite, for several years and has been able to quickly and easily incorporate the administration of this new line of business onto the RAM platform.
“We are very pleased with the extensive capabilities that HEALTHsuite Mercato and eHealthsuite provide to us in support of our Medi-Cal (California Medicaid) and Medicare Advantage business,” stated Ron Robinson, Director of Finance and Administration for the Health Plan of San Mateo. “Leveraging those capabilities to administer our Cal MediConnect dual eligible line of business was an easy decision. We value our partnership with RAM and look forward to working together on future endeavors.”
“The Health Plan of San Mateo administers many health programs – each with their own unique processing requirements and business needs,” said Robert Tulio, President of RAM Technologies. “RAM is committed to partnering with HPSM as they expand their service offerings to accommodate the rigors of the Cal MediConnect (Dual Eligible) program. We are pleased to have the Health Plan of San Mateo as a client. We embrace their experience and perspective as we work together to meet the challenges of our industry.”
HEALTHsuite Mercato is a browser-based solution designed to simplify healthcare administration. HEALTHsuite Mercato provides unparalleled automation across the enterprise including eligibility and enrollment, plan / product and benefit administration, provider contracting and reimbursement, provider credentialing, medical / utilization management, care management, encounter and claim administration, overpayment recovery, customer service and contact management, premium billing, capitation, subrogation, fulfillment, EDI processing, management / operational reporting and more.
In addition to the enterprise capabilities provided by HEALTHsuite Mercato, RAM also offers a flexible and secure web portal, eHealthsuite. eHealthsuite enables members and providers to interact in real time with the health plan through a secure Internet connection. This 24 x 7 self-service functionality reduces administrative costs for a health plan by reducing demands on the plan’s customer service personnel.
About Health Plan of San Mateo
The Health Plan of San Mateo (HPSM) is a public health plan that provides health care benefits to San Mateo County’s historically underserved residents. Members of HPSM receive benefits through Medi-Cal, CareAdvantage (HMO SNP), HealthWorx, and the San Mateo County ACE Program. HPSM is governed by the San Mateo Health Commission. Members of the Commission represent community advocates, physicians, pharmacists, hospitals, and elected officials who serve on the San Mateo County Board of Supervisors. HPSM fights to make a difference in the community, to turn the vision of better health into a reality. You can learn more on the web at www.hpsm.org.
About RAM Technologies:
RAM Technologies is the leading provider of enterprise software solutions for healthcare payers. For over 33 years RAM Technologies has led the way in the creation of superior software solutions for health plans serving Medicaid, Medicare, Commercial, and Federal Employee Health Programs. RAM Technologies has been recognized on Inc. Magazine’s List of Fastest Growing Private Companies for the last four years and has been repeatedly featured in the Philadelphia Business Journal’s Lists of Top Technology Employers and Top Software Developers. To learn more about RAM Technologies call (877) 654-8810 or visit www.ramtechnologiesinc.com.
RAM Technologies, Inc.