January 23, 2008
America's 1st Choice goes live with ikaEnterprise
America's 1st Choice (AFC) went
live with ikaEnterprise and online enrollment (Member Portal) on January
1, 2008, completing the first phase of its implementation of the
ikaEnterprise solution. AFC is a start-up PFFS Medicare plan
headquartered in Columbia, South Carolina. Within its first year of
operations, AFC contracted with ikasystems to implement
ikaEnterprise system which consists of five self-service portals and
a series of business and transactional systems: core claims
adjudication, data warehouse, disease management, profiling,
utilization analytics and HEDIS® reporting.
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 complete physician profiling
system that defines the total health plan's quality vs. the
performance of each individual primary care physician. It also
includes other functions like code management, payer management,
authorizations and payments. Similarly, the online enrollment
process provides access to plan benefit information and disease
management. It sends proactive reminders for prescreening tests,
allows claim status and authorization check and lets members update
personal information.
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. The integration of
ikaEnterprise will help AFC achieve its strategic objective of
improving business efficiencies in all administrative processes of
its Medicare business line. “The back-end business intelligence and
transactional system simplifies daily transactions including
authorizations, claims adjudication and rebundling and the friendly
user interface makes it convenient at the front end,” says David
Caruso, Director of Operations for AFC.
For a rapidly growing health plan, the ikaSystems platform is a
powerful and scalable, HIPPA-compliant n-tier infrastructure that
will support America’s 1st Choice’ current and future business
requirements. “AFC chose us after careful review and were convinced
that in addition to providing robust solutions we really understand
health plan administration and how to incorporate business
intelligence in a way that would enable them to effectively achieve
their business objectives," says Ravi Ika, President and CEO of
ikaSystems. David Caruso adds, “We are a rapidly growing health plan
and the flexibility of the ikaEnterprise portals is something that
we are excited about. There is no need to manually enroll members
and process claims. As AFC expands we are confident that the further
implementation of other modules will result in a lot of value
addition both in terms of improving efficiency and decreasing
operational cost.”
About America's 1st Choice
America's 1st Choice of North Carolina is a Medicare Advantage
Organization offering Private-Fee-For-Service (PFFS) products in
certain counties in the State of South Carolina. The principal of
America's 1st Choice, a physician himself, along with key management
staff have long standing experience in organizing, managing and
providing medical care services to beneficiaries under government
programs.
