Health plans serving Medicare Advantage, Special Needs and Managed Medicaid populations face a number of complex and interconnected challenges. Members increasingly expect digital access and real-time answers; however, may struggle with health literacy and find benefits and claims confusing. Members want their healthcare journey to function much like their interactions with the other consumer brands they trust. Convenience, communication and efficiency are key to a positive member experience.  

Providers face their own frustrations, from administrative bottlenecks to delays with authorizations that take valuable time away from patient care. At the same time, health plans must navigate growing compliance requirements, pressure to reduce administrative costs and the inefficiencies of managing fragmented systems. The administrative demands of managing a health plan consume significant time and resources. When operations aren’t managed efficiently, the strain is felt by both providers and members. In fact,  of the nearly $4 trillion spent on healthcare annually in the United States, administrative spending is about one-quarter of the total.

These challenges create a need for an integrated solution that connects members, providers and plans in real time.

Built on RAM Health’s HEALTHsuite Advantage™ platform, eHealthsuite is the member and provider portal solution that transforms self-service into a powerful engagement tool. Because it draws directly from the same HEALTHsuite Advantage database, eHealthsuite delivers real-time, accurate information without the delays and errors common in third-party portals.

This seamless integration means health plans can deliver a better experience for members and providers, while also reducing administrative strain.

Empowering Members with Transparency and Control

Members expect convenience and clarity when it comes to their healthcare. With eHealthsuite, they gain:

• 24/7 access to benefits, eligibility and claims status
• Secure messaging with their health plan
• Tracking of deductible and out-of-pocket balances
• The ability to request an authorization/referral
• A search function to select providers
• Management of demographics updates
• And more

Supporting Providers with Efficiency and Accuracy

For providers, administrative tasks often take valuable time away from patient care. eHealthsuite helps alleviate that burden by offering:

• Instant eligibility verification
• Submission of real-time claims and status updates
• Access to existing authorizations with updating capability
• Access to benefits information
• Secure communication with the health plan
• And more

Why It Matters for Health Plans

When members and providers have the tools they need at their fingertips, everyone benefits:

• Lower administrative costs and time through self-service
• Improved satisfaction and stronger relationships with providers and members
• Greater compliance and accuracy, thanks to integration with HEALTHsuite Advantage
• Faster, more efficient operations that directly support plan profitability

Compliance and data security are built into every aspect of HEALTHsuite Advantage and eHealthsuite. Our platform is designed exclusively for government sponsored health plans to ensure that every transaction aligns with CMS and state requirements. With real-time processing and 24/7 engagement through a secure internet connection, health plans can operate with confidence knowing that compliance and security are never compromised.

eHealthsuite’s member and provider portals are fully HIPAA compliant. Because the solution is white-labeled, health plans retain control over branding, design and which features or transactions are made available. This means members and providers enjoy a seamless, branded experience that looks and feels like an extension of your own website.

At RAM Health, we know that operational excellence and engagement go hand in hand. HEALTHsuite Advantage powers your plan’s core operations, while eHealthsuite extends that value by empowering your members and providers. Together, they deliver the industry’s most complete solution for government sponsored healthcare.