ikaAM

Streamlined, Web-Based Authorization Management

ikaAM is a Web-based authorization management system that allows provider requests to be handled differently depending on providers’ utilization and quality track records. Requests from providers who meet certain parameters can be automatically approved, helping medical reviewers focus their efforts where they will have the greatest impact in reducing resource utilization and controlling costs.

ikaAM comprises two modules, both of which allow users to directly interact with industry-leading Milliman and InterQual guidelines and workflows:

• The Precertification Module allows healthcare providers to easily check for eligibility and coverage and to generate prior authorizations for procedures and referrals. At the same time, health plan utilization management staff can review the medical necessity criteria and approve, pend, deny or return authorizations along with reason codes. Authorization history can be saved in any claims system, so claims received for approved authorizations can autoadjudicate.
   
• The Concurrent Review Module allows case managers to generate concurrent reviews and medical directors/supervisors to review requests, check for medical necessity and approve, deny, pend or return requests along with reason codes. All activity is archived for continuity of care purposes and to facilitate auto-approvals. 

Precertification Module

The Precertification Module of ikaAM has comprehensive functionality for both providers and health plan utilization management staff. Providers can use the Precertification Module to:

• Search for members and determine their eligibility, coverage and accumulators
   
• Generate referrals and authorizations for inpatient and outpatient procedures
   
• View the status of all previously generated authorizations under the following tabs: submitted, approved, denied, pended, returned (for more information)
   
• Launch medical necessity criteria workflows and bring relevant information back into ikaAM
   
• Upload medical record documentation to substantiate the diagnosis or requested referral or procedure
   
• Add free-text comments and mark information as “confidential” so that only users with appropriate access can view the comments

Health plan utilization management staff can use the Precertification Module to:

• Search for members and determine their eligibility, coverage and accumulators
   
• View referrals and authorizations generated by provider offices, including any attached medical record documentation
   
• Input any faxed requests into the system, for one comprehensive record
   
• Launch medical necessity criteria workflows and bring relevant information back into ikaAM
   
• Approve, pend, deny or return (for further information) authorizations, providing the necessary reason codes
   
• Add free-text comments and mark information as “confidential” so that only users with appropriate access can view the comments
   
• Use system-generated utilization management reports to review utilization by provider, procedure, facility and member and to determine cost drivers

Concurrent Review Module

The Concurrent Review Module of ikaAM gives case managers and medical directors/supervisors full Web-based review capabilities. Case managers can use the Concurrent Review Module to:

• Access patient information, including precertification information
   
• Generate concurrent review request
   
• Flag “emergent” requests
   
• Upload medical records as well as lab, radiology and other clinical data
   
• Launch medical necessity criteria workflows and bring relevant information back into ikaAM
   
• Determine level of care

Medical directors/supervisors can use the Concurrent Review Module to:

• Access and review concurrent review requests generated by nurse case managers
   
• Launch medical necessity criteria workflows and bring relevant information back into ikaAM
   
• Approve, pend, deny or return requests
   
• Determine and authorize level of care

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