Challenge

Because the systems were developed on outdated technology, they were unable to offer modern features and functions. Also, with two systems, the SAMBA staff was required to manage members and data in multiple environments, which increased employee workload and costs.

Finally, the company’s legacy systems made it difficult for them to comply with government regulations, including HIPAA and ICD-10.

Solution

SAMBA reached out to RAM Technologies for assistance in supporting FEHB administrative requirements and realized that RAM provided key benefits and was experienced in addressing and resolving the issues they faced.

"We heard of RAM from another federal health plan, so we knew they had experience in our market," said Pam Cummings, deputy executive director of SAMBA. "RAM's functionality was very good and allowed us flexibility in several areas, and they had several of the federal capabilities we needed already built into the system."

RAM's HEALTHsuite Mercato solution provided extensive functionality, flexibility and adaptability to accommodate SAMBA's unique processing requirements. For example:

  • RAM offered a comprehensive solution that addressed all of SAMBA's unique needs by supporting the company's FEHB program requirements – including interfacing with the Office of Personnel Management – and the ability to administer SAMBA's non-health insurance benefits (life, disability, etc.) in one solution rather than the two applications the company had been using.
  • The RAM solution suite provided the capabilities necessary to improve organizational efficiencies across all departments, which proved to be a differentiating factor over other competitive solutions SAMBA had considered.
  • The "human element" made RAM stand out over other providers. SAMBA appreciated the personal engagement and one-on-one interaction they had with the RAM team, including accessibility to RAM's executive management team.

"We had regulatory deadlines to meet that required getting the RAM solution up and running. During the implementation we had weekly conference calls with RAM to resolve issues and they visited us onsite frequently to help us with the implementation," said Walt Wilson, executive director of SAMBA.

Results

RAM's implementation of its HEALTHsuite Mercato solution enabled SAMBA to retire its two aging legacy applications and instead, administer all business on one fully-integrated platform. This conversion from dual platforms to a single platform simplified the company’s technology architecture and reduced the daily work efforts for both information technology and business department staffs. In addition:

  • SAMBA's claims auto adjudication rate more than doubled – increasing from 40 percent to 80 percent – significantly improving staff productivity and reducing the total cost of operations.
  • SAMBA is now able to automatically load 96 percent of employee eligibility records, whereas they were only able to automatically load 15 percent in the past and had to manually enter the others.
  • SAMBA's move to a modern technology infrastructure gave them the features and functions of a leading-edge solution while simplifying compliance with government mandates and regulations.
  • In addition to improving the effectiveness of their claims process, SAMBA's automated workflow now provides additional efficiencies across all departments.

The core concept that drove the success of this implementation was the flexibility and adaptability of RAM’s HEALTHsuite Mercato system and the methodology used to define all business requirements and properly configure the application to most appropriately meet SAMBA’s needs. The company also benefited from a technology environment that was greatly simplified and eliminated the manual intervention required to manage members and maintain data in multiple systems, the result of administering all business on one fully-integrated platform.

"RAM has been very accommodating in helping us modify fields and customizing the system," said Mary Livingston, health plans manager at SAMBA. "We found it very easy to train employees because it is much more efficient to locate items in the RAM solution than it was in our legacy systems."