HEALTHsuite® Mercato

The Premier Solution for Health Payers

Payers must rely on new technology and system advancements to allow them to do more with less. Keeping your edge and maintaining your ability to compete in a rapidly changing market requires forward thinking and flexibility. HEALTHsuite Mercato features the leading technology to transform your business and create a platform for success in today's healthcare environment. Featuring a superior design based on the HIPAA standards, HEALTHsuite Mercato is a rules-based, plan-configurable system that accommodates all of your business needs in a single, fully integrated solution.

A Fully Integrated Solution

Strategic alliances give us an edge to meet the demands of the ever-changing healthcare world.

Capabilities To Give You A Competitive Edge

  • Member Management
  • Group Administration
  • Eligibility / Enrollment
  • Benefit Administration
  • Premium Billing
  • Network Management
  • Provider Contracting
  • Provider Credentialing
  • Provider Reimbursement
  • Automated Repricing
  • UM & Med. Management
  • Referrals
  • Authorizations
  • Pre-certifications
  • Care Management
  • Claims Adjudication
  • Encounter Processing
  • Capitation
  • Subrogation
  • Overpayment Recovery
  • Customer Service
  • Fulfillment
  • Data Warehouse
  • EDI Interfaces
  • Web Portals

Available as an on-site solution, as a Software-as-a-Service (Cloud), or as a comprehensive technology and services offering (BPO).

Is Compliance With Hipaa A Challenge For Your Organization?

The HEALTHsuite Mercato repository leverages HEALTHsuite's advanced data model and eliminates the burden and cost of re-engineering existing systems to comply with HIPAA.

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Sharing Knowledge to Improve Healthcare Administration
Value-Based Benefit Design for Medicare Advantage, Managed Medicaid and Duals

See how health plans, utilizing advanced analytics and administering carefully designed benefit plans, can incentivize both patients and providers to make cost-effective choices.

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We selected HEALTHsuite and RAM Technologies due to their depth and breadth of functionality and their ability to meet our needs.
Eben Yong

Director of MIS Health Plan of San Mateo