Parkview Health Plan Services Improves Auto-Adjudication Rate With ikaSystems' ikaClaims Solution

FORT WAYNE, IN - Dec. 4, 2006 - ikaSystems Corp. today announced that the ikaClaims system went live at Parkview Health Plan Services on Monday, Oct. 30 as the first batch of EDI claims was smoothly processed. Implementation for the solution, which replaced a legacy system at Parkview, began March 1, 2006.

ikaClaims is a rule-based system that allows health plans to upload benefit plans and provider contracts online. It includes more than 13 comprehensive modules and provides a comprehensive physician profiling system that defines the total health plan's quality vs. the performance of each individual primary care physician.

For health plans, one way of streamlining claims processing is to increase the adjudication rate. With ikaClaims, benefit plans and provider contracts are inserted online at a very high level of granularity. This enables the system to auto adjudicate claims in the 95% range.

Parkview Health Plan Services was in need of an efficient claims processing system, and it selected ikaClaims. The health plan chose an ASP model, so the hardware and software maintenance for the solution is completely handled at ikaSystems' headquarters in Southborough, MA. This enables Parkview employees and users to utilize the portals and solutions with an Internet connection from anywhere in the world. Meanwhile, the solutions' EDI transactions have streamlined processes and greatly reduced the need for manual data entry.

The ikaClaims system now completely automates claims processing at Parkview. According to Philip Henneman, Director of Clinical and Technical Operations for Health Plan Services, Parkview's legacy claims system featured a sluggish auto-adjudication engine that utilized an inferior and obsolete programming language. By comparison, the ikaClaims system provides a newer platform that allows more flexibility for configuring benefits and provider contracts, resulting in significantly increased auto-adjudication rates. ikaSystems quickly migrated and converted all of the data from the legacy system into the ikaClaims system. Whereas Parkview's legacy system produced auto adjudication rates of about 30 to 40% of only one segment of claims, the ikaClaims system provided auto-adjudication rates of 80 to 85% during its first EDI load. Henneman says Parkview now expects the ikaClaims system to consistently provide auto-adjudication rates of 90 to 95%.

"The flexibility of the ikaClaims adjudication engine is something that we are excited about," says Henneman. "Many times, with the old system, we had to manually process claims. With the ikaSystems solution, this will no longer be necessary."

ikaSystems also integrated the ikaClaims system with Parkview Health's Optical Character Recognition software. This useful tool helps claims processors at Parkview identify a specific claim by image. The ikaClaims system also provided Parkview with innovative tools that are helping the health plan take a creative approach to profitable contracting and negotiating pricing agreements with employer groups and provider networks. These are enabling Parkview to offer a variety of products and provider networks to employer groups. ikaSystems integrated its call center with all of the modules in the ikaClaims system, helping Parkview Health's customer service representatives resolve appeals and grievances quickly and accurately.

In addition, Parkview selected the Member and Employer web portals, which are part of the ikaEnterprise System. Testing is now being completed. The Member and Employer portals integrate business processes, enable the plan to collate key information into one system and empower users to make more effective strategic, tactical and operational decisions.

The Member and Employer Portals will enable groups that join Parkview Health Plan Services to select their coverage plans online. This will eliminate many manual, paper-based processes and significantly reduce the health plan's administrative costs. Henneman says Parkview will use the Employer Portal to promote Signature Care, its regional PPO plan, which will enable the health plan to gain new membership. By using the Employer Portal, the Parkview Health Human Resources Department will be relieved of all the manual work involved in the administration of employee benefits.

"The Employer Portal will allow for open enrollment," says Henneman. "Prior to this, we did everything manually. Now, these processes will be completed electronically. This will allow for fewer errors."

"We are pleased by the results that Parkview Health Plan Services has seen, but this is only the beginning," says Ravi Ika, president and CEO of ikaSystems. "Our system will enable Parkview Health Plan Services to dramatically reduce its administrative costs and open the doors to increased membership and profit."

About Parkview
Parkview Health is a not-for- profit, community owned system that is a major Northeast Indiana health care provider. Parkview Health owns seven hospitals with 777 beds and has more than 6,100 employees. Health Plan Services administers the Parkview owned Signature Care PPO with 9,000 providers throughout the State of Indiana and 60,000 members. For more information visit www.parkviewhealth.com