Services and Software
Software
Our end-to-end solution empowers your team with everything they need. In one place.
HEALTHsuite Advantage is a fully integrated suite of modules offering an unparalleled solution for administering Medicare Advantage, Special Needs and Managed Medicaid Plans. In our SaaS model, your staff’s efficiency and performance are powered by our core administrative processing system enhancing member experiences and ensuring regulatory compliance.
Services
We’ll focus on operations. You focus on your members and providers.
With our BPaaS model, we’ll simplify and automate operations with a solution designed to your plan’s needs with our own personnel to maximize your team’s efficiency. Our experts, who specialize in government-sponsored healthcare administration, join your team to increase productivity and efficiency, reduce human-error, and speed up processing times. We administer your specific programs on our end-to-end platform to make it almost effortless for your team.
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Seamless self-service for members and providers
eHealthsuite is a secure, HIPAA-compliant self-service portal that delivers instant access to essential tools. Built on the same core system as HEALTHsuite, it ensures a single source of truth—every update flows instantly to the core system, keeping information accurate, consistent, and up to date.
Members
Members can do things like go paperless, view claims, track deductible and out-of-pocket balances, access and request ID cards, search for providers, submit grievances or pre-service appeals, enroll in ACH, request direct reimbursements, and manage demographic updates—including power of attorney and authorized representative details.
Providers
Providers can verify member eligibility, submit new claims and authorizations, check real-time status of claims and authorizations, update existing authorizations, manage provider demographics, confirm covered services and authorization requirements, and more.
DASH delivers the data you need, when you need it
DASH provides insight into operations while eliminating information overload. This capability allows you to anticipate and answer business questions in real time. This one-stop view of your analytics, organizing service requests, grievances, service level agreements, and more, is a huge development for the industry, putting HEALTHsuite Advantage a step above.
Powerful Connections, Smarter Operations.
A core strength of HEALTHsuite Advantage is its ability to seamlessly exchange data with external systems and entities. Designed for interoperability, the platform supports secure, real-time integration with government agencies, regulatory bodies, and key trading partners—ensuring smooth, compliant operations across your entire ecosystem.
- Centers for Medicare and Medicaid Services (CMS)
- Pharmacy Benefit Managers (PBMs)
- State Medicaid Agencies
- Sales/Broker Portals
- External systems via robust APIs for seamless data exchange and interoperability
Fully integrated suite of modules to meet your unique needs
From administrative functions to revenue cycle management and compliance aspects of your plan, HEALTHsuite Advantage offers end-to-end solutions through various features and function-rich modules.
Administrative
Our administrative modules are the backbone of our platform, facilitating plan design and benefit administration, member enrollment, eligibility management, call center/customer support, utilization management, managing appeals, disputes and grievances and more.
Financial
Our financial modules encompass all essential components of revenue cycle management, including premium billing, financial reporting and reconciliation, provider contracting, both standard and complex provider reimbursement and capitation, claims administration, and encounter reporting and reconciliation.
Compliance
We function as an extension of the health plan compliance department and actively monitor and oversee the regulatory environment to ensure both systems and services remain complaint. This includes compliance reporting, audit universes, audit support, and transparent communication of regulatory changes.
Proven. Predictable. Perfectly On-Time.
Our implementation process eliminates risk, collapses timeframes, and reduces duration and costs through a rapid, fixed-price deployment powered by our proprietary preconfigured solution. With a proven methodology, dedicated liaison, and comprehensive support, we ensure a 100% on-time go-live—accelerating market readiness while meeting your plans unique needs.
See how HEALTHsuite Advantage can simplify your operations.