The ikaClaims Solution Suite

Comprehensive, Modular Functionality to Speed Time to Value

The ikaClaims solution suite empowers health plans to turbo-charge all of their claims administration activities or to extend their existing IT investments by adding on high-performance functionality.

Using ikaClaims, health plans can:

• Establish benefit categories, benefit plans, payment system rules and provider contracts
   
• Enroll members and determine member coverage based on benefit plans, dependent eligibility and pre-existing conditions
   
• Establish provider/professional information according to a defined hierarchy that includes network, facility, clinic or office, and individual physician
   
• Authorize referrals — even notify plan members and providers of each action taken for a referral — whether pended, denied or authorized
   
• Adjudicate claims automatically via electronic data interchange (EDI) or manually
   
• Pay claims based on customized provider reimbursement rules
   
• Maintain system codes, such as service codes, diagnostic codes, benefit categories and other internal codes (a set of predefined, industry-standard and optional codes are included)
   
• Create reports and letters based on processed claims using pre-formatted reports and letters
   
• Gain greater control of network management functions
   
• Deliver excellence in customer service operations

Two primary modules comprise the ikaClaims solution suite, which can be used separately or together for maximum benefit:

• ikaClaims, the core module, which delivers rapid, automated administration of claims for any line of business — group and individual as well as commercial, Medicare and Medicaid — in one highly streamlined, configurable system
   
• ikaEnterpriseService, which provides the exact level of support that any health plan needs to ensure its customer service function runs smoothly, efficiently and effectively

ikaClaims also works seamlessly with the following components of the ikaSales solution suite for comprehensive claims management:

• ikaBilling: for complete premium billing automation supporting all models, from premium and administrative services only to cost-plus and other proprietary billing models
   
• ikaCommissions: for commissions payment automation

Familiar, Intuitive User Interface

All ikaClaims screens follow a standard layout that is extremely intuitive to use because it employs familiar Web-based conventions. Displayed information will vary by user type/role. Privileges can be set at a broad level, such as screens and modules, or at a detailed level.

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