ikaMedicareGateway

Speed Medicare Membership Growth Through Highly Automated Enrollment Processing and Streamlined Reconciliation

Medicare Advantage plans struggling to grow rapidly in the face of cumbersome, slow and error-prone Medicare enrollment and membership and payment reconciliation processes now have a single, powerful solution at their fingertips: ikaMedicareGateway. Available through a unique partnership with Government Works, ikaMedicareGateway is an innovative Web-based solution that delivers greater accuracy and speed to membership enrollment and member/payment reconciliation processes. The result is dramatically reduced administrative costs, increased compliance conformance and higher levels of member satisfaction through more streamlined process management.

Offered as a Software-as-a-Service (SaaS) solution, ikaMedicareGateway can be rapidly deployed to help plans:

• Easily accommodate rapid Medicare membership growth without building large infrastructures
   
• Minimize the need to commit highly skilled personnel to comply with CMS data
  submission requirements
   
• Enhance cash flow and capture lost revenue through more accurate and timely enrollment processing and reconciliation
   
• Maintain full control of every process and make more informed business decisions -- even through crunch enrollment periods
   
• Stay ahead of enrollment trends affecting administrative, financial and sales arenas through comprehensive data warehousing and reporting

Enrollment Pathways Module

The Enrollment Pathways Module reduces application processing time by as much as 80 percent. First, real-time eligibility and entitlement queries — rather than batch processing — significantly minimize the time it takes to determine whether a member is eligible for enrollment. Then, built-in plan-specific/CMS Chapter 2 (Medicare Advantage Enrollment and Disenrollment Manual) validations and instantaneous feedback on application completeness creates virtually error-free membership accretion files, resulting in significantly reduced rejection rates and rework. In addition, information is fully integrated with and auto-populates enrollment screens, dramatically increasing efficiency. Clients using ikaMedicareGateway have achieved new enrollment success rates of over 99 percent. Downstream benefits include reduced enrollment-related discrepancies and more timely payments.

Reconciliation Module

The Reconciliation Module is the ultimate in automated, streamlined and integrated reconciliation processing. With daily, weekly and monthly reconciliation, plans remain in compliance with CMS and increase the accuracy of membership, enrollment and payment data. Fewer discrepancies and more efficient discrepancy resolution combine to significantly reduce the resources required to perform time-consuming research and rework.

Key features of the Reconciliation Module include:

• Single point of data correction: ikaMedicareGateway  facilitates both membership and payment reconciliation by supplying a unified Web-based dashboard. Users can correct discrepancies, such as demographic, plan or special status, all without needing to access multiple applications.
   
• Streamlined data warehousing: All plan-to-CMS and CMS-to-plan files and data are archived in a structured database, extremely useful for research and auditing purposes because information is readily available at both plan and member levels.
   
• Advanced member reconciliation functionality: Features include:
  
  
  • Daily membership reconciliation: BCSS, TRR
     
  • CMS-to-plan discrepancy identification and resolution: SCC, PBP, LIS, demographics, etc.
     
  • CMS special-status reconciliation — Automated daily maintenance TRR processing: HIC changes, etc.
     
  • Letter generation
     
  • Track submission to CMS/Reed & Associates  
     
• Advanced payment reconciliation functionality: Features include:
  
  
  • Payment reconciliation: monthly plan payment files (MMR)  
     
  • Member, PBP, contract and MCO-level ledger reporting
     
  • Management reporting for payments and adjustments  
     
  • Track submission to CMS/Reed & Associates  

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