December 03, 2008 WellMed Selects ikaSystems’ Full Medicare Process Automation and Intelligence Management Suite  

Award-Winning Care Delivery and Management Company Will Use ikaEnterprise for Medicare to Achieve End-to-End Process Automation and Integration

WellMed Medical Management, Inc., an award-winning senior-focused healthcare company headquartered in San Antonio, Texas, has entered into a multiyear agreement with ikaSystems, a premier provider of enterprise-level Web-based technologies for healthcare payer organizations. WellMed will license ikaSystems’ full ikaEnterprise for Medicare suite of applications for Medicare process automation and intelligence management, allowing the company to dramatically enhance administrative efficiency while better integrating and sharing information for medical management purposes.

WellMed has two primary lines of business: a physician-owned practice management company operating more than 30 medical clinics and the Physicians Health Choice Medicare Advantage HMO that leverages the practice management company’s medical risk management model. WellMed and its affiliated companies serve approximately 77,000 insured members and patients, mostly Medicare-eligible seniors, throughout Texas, along Florida’s Treasure Coast and in the Las Cruces, New Mexico, area and will use ikaEnterprise for Medicare across most of this population.

“When we looked at all the available options in the market, two characteristics really distinguished ikaSystems’ offerings,” said Bill Connolly, senior vice president of Shared Services for WellMed. “First, ikaEnterprise is clearly designed to address the needs of complex Medicare offerings, and second, no other company offers the same integrated, end-to-end functionality, from pre-sales through medical management and every process in between. We didn’t want to simply bring our administrative capabilities to where everyone else is in the market — we wanted to leapfrog to the forefront. ikaSystems’ best-in-class solutions were the right choice for WellMed to reach our efficiency goals and support our rapid growth.”

WellMed and its affiliated companies will implement the following modules of ikaEnterprise for Medicare:

ikaPortals for Sales/Brokers, which automate and combine sales processes for both individual and group Medicare with a complete array of marketing functions, including prospect, lead, campaign, literature and event management. Payers can easily evaluate the effectiveness of marketing campaigns, electronically route work to more productive resources, receive alerts about delinquent leads and perform a host of other useful functions. The results are highly efficient work processes, reduced workloads and processing time, and most importantly increased throughput — essential during the crush of enrollment periods.

ikaMedicareGateway, which delivers an unprecedented level of automation, speed and accuracy to eligibility verification, enrollment processing and membership reconciliation. Available through a unique partnership with Government Works, a CMS contractor that hosts the Medicare Beneficiary Data (MBD) extract file from CMS’ MARx database, Module 1 can cut application processing time by as much as 80 percent through integrated and almost instant eligibility queries combined with automated enrollment application processing. Module 2 allows Medicare beneficiaries to be enrolled in minutes by pre-filling applications with already reported information, supporting beneficiary and code maintenance. Module 3 supplies real-time data warehousing after enrollment to allow payment reconciliation to beneficiaries’ specific plans.

ikaClaims, which provides flexible, efficient claims administration and customer service while quickly delivering high auto-adjudication rates. All system components and business rules can be user-defined, from the most basic to the most specific level of detail. Health plans can take advantage of pre-loaded benefit categories and fee schedules as well as standard/system codes to effortlessly incorporate custom benefit plans and respond quickly to changing market demands. ikaClaims accepts and produces all HIPAA-compliant transaction code sets (834, 270, 271, 278, 837, 276, 277, 835, 820) and allows plans to set rule- and role-based security levels. Greater payment efficiency and transparency made possible by Web-based access and integration also significantly improve provider relations and the impact of collaborative care management programs.

Premium Billing and Commissions Module, which allows health plans to set their own rules for late payments and benefit revocation, and members and others to make payments online. In addition, plans can configure any type of commission payment formula, as well as automatically calculate and deduct retroactive changes to commission payments based on changes in enrollment.

ikaPortals for Members, which support administrative self-service as well as medical management self-care tools. For example, members can verify eligibility verification, order ID cards, check claims status, collaborate with the care team and keep personal health records.

ikaPortals for Providers, which reduce providers’ administrative burden by automating processes such as eligibility verification, claims submission, authorization and referral submission and approval. In addition, the Provider Portal gives physicians proactive access to quality information so they can improve HEDIS measures and pay-for-performance results.

ikaMM, which seamlessly blends insight and workflow collaboration into a single, comprehensive and highly intelligent system to support the business intelligence and workflow needs of Medicare programs. From utilization analysis and provider performance assessment to disease and case management and quality improvement, ikaMM modules draw upon a consolidated database of claims, laboratory, pharmacy, encounter data, practice management and electronic medical record information to provide a more automated, proactive and effective approach to care management.

According to Ravi Ika, president of ikaSystems, “WellMed, which just received the Outstanding Quality Initiative Award from DMAA: The Care Continuum Alliance, has built an exceptional reputation in the high-growth Medicare arena for its innovative, highly effective care management programs. As the company continues its successful expansion, ikaEnterprise will provide the superior technology foundation that will maximize WellMed’s workflow and information-sharing efficiency, further improving the quality of the services its members and patients receive while lowering administrative costs.”

About WellMed
WellMed Medical Management is a diversified healthcare company and insurance provider serving 77,000 patients and insured members, mostly Medicare‐eligible seniors throughout Texas, along Florida’s Treasure Coast and in the Las Cruces, New Mexico area. WellMed is an industry leader in medical risk management, highly effective disease management and chronic care programs, healthcare delivery services, and more.  WellMed is South Texas’ largest physician‐owned practice management company, specializing in senior health care since 1990. With more than 30 medical clinics in Texas and Florida, the mission of the healthcare company and insurance provider is to change the face of healthcare delivery for seniors. To learn more, please visit www.wellmedmedicalgroup.com.


About ikaSystems Corp.
ikaSystems is healthcare payers’ premier provider of Web-based ERP technology for process automation and intelligence management. ikaEnterprise, the company’s flagship product, automates all key processes in the payer business cycle, supporting commercial, Medicare and Medicaid lines of business. The system consists of five stand-alone, self-service Web portals for sales/broker, administrative, employer, member and provider use, each of which are tightly integrated with business intelligence and transactional systems for core claims adjudication, care management and proactive quality measurement and reporting. Using our agile, modular technology, organizations can move quickly to lower administrative and medical care expenses through greater automation and highly intelligent decision-making. To learn more, please visit www.ikasystems.com.