Overview
Nascentia Health, a New York-based organization providing home and community-based health services for more than 130 years, had deep organization expertise as a Medicaid Managed Long-Term Care (MLTC) but limited experience with Medicare. When Nascentia Health made the strategic decision to launch its first Medicare Advantage plan, the organization needed a partner with the expertise and flexibility to guide them through the process.
While Nascentia Health had long excelled in managing Medicaid services, expanding into Medicare introduced an entirely new level of complexity. The team needed expert support in plan setup, claims adjudication, compliance and reporting to ensure a smooth transition. At the same time, their existing third-party administrator (TPA) for Medicaid was underperforming, with inconsistent customer service and recurring issues in claims processing.
“Our previous partner was not very attentive to our needs, and we frequently experienced errors and issues with our claim adjudication process,” said Janet Billington, compliance officer, EVP, business process optimization for Nascentia Health. “We were looking for a reliable single source that could support our Medicaid Managed Long-Term Care and Medicare Advantage lines of business.”
The challenge was compounded by New York’s uniquely complex Medicaid environment—one that many vendors are reluctant to take on.
At a national healthcare conference, Nascentia Health discovered RAM Health, a company specializing in solutions for government-sponsored health plans. Nascentia Health quickly recognized the alignment between RAM Health’s experience and their own operational needs, seeing in RAM a partner capable of supporting both its new Medicare plan and existing Medicaid operations.
That initial connection sparked a multi-year collaboration that continues to strengthen both lines of business.
Solution
RAM Health began by supporting Nascentia Health through the launch of its first Medicare Advantage plan—providing the operational backbone and hands-on expertise needed to get the plan off the ground. “They were very engaged, helping us understand how to administer the plan and offering guidance every step of the way,” said Billington.
From the start, RAM Health deployed its HEALTHsuite Advantage™ platform, an integrated, end-to-end core administration solution that streamlines plan management across enrollment, claims, billing and member services. Leveraging HEALTHsuite Advantage’s enterprise capabilities and flexible delivery model, Nascentia Health gained the scalability and compliance readiness required to enter the Medicare Advantage market quickly and confidently.
As the partnership deepened, Nascentia Health transitioned its MLTC operations including claims adjudication, encounter submission and reconciliation to RAM Health, expanding the engagement through its Business Process as a Service (BPaaS) model. This allowed Nascentia Health to combine the power of RAM Health’s technology with dedicated operational expertise for greater accuracy and responsiveness across both lines of business.
“They’re just nice people to work with. They don’t play the blame game. When something goes wrong, we fix it together. That’s what a real partnership looks like.”
Both organizations were innovating in real time. Nascentia Health was expanding into Medicare Advantage while RAM Health customized a New York–specific Medicaid solution within HEALTHsuite Advantage to meet state and plan requirements. “We were building the plane while flying it,” said Billington. “But the team’s ‘nothing’s impossible’ mindset made all the difference. RAM’s team never drew hard lines about what was ‘in scope’ or not,” Billington added. “Even when something wasn’t part of their direct responsibility, they took the time to guide us or share their expertise so we could get it right. That level of support is rare.”
Results
From the beginning, the relationship was defined by close communication and accessibility. “RAM Health’s team is attentive and available,” said Billington. “We meet weekly. When problems come up, they don’t run from them. We work together until things are resolved.”
That collaboration extends from leadership to day-to-day operations. “I can text my contact anytime, and he always responds,” she added. “I’ve worked with vendors where you just submit a help desk ticket and hope for the best. This is nothing like that—it’s personal.”
Both organizations also share a similar culture rooted in family values. “They’re a family-owned company, and we’re family-oriented too,” she noted. “That connection makes working with them even easier.”
The operational impact of the partnership is undeniable. Claims are paid accurately and on time every week, something that wasn’t always the case with previous vendors. “Our Medicaid volume is huge, and timeliness is everything,” said Billington. “Now we have confidence that claims are adjudicated and paid on schedule. We don’t have backlogs and nothing falls through the cracks. That’s the metric that matters.” “Our main goal from the start was to have all of our plans up and running with RAM Health supporting them,” said Billington. “We know perfection doesn’t exist, but they’re one of the best partners I’ve worked with in 25 years. They’re reliable, responsive and genuinely good people.”
