Provider Portal

Achieve True Care Collaboration Support While Lightening Administrative Burdens

With ikaSystems’ Provider Portal, physicians and their office staff can take charge of their interactions with the health plan. The Provider Portal does not simply provide information but allows providers to perform processes that both minimize their (and the health plans’) administrative burden and facilitate participation in more proactive, preventive care plans. Rule-based functionality and role-based security provide a real-time, HIPAA-compliant environment for the collection, storage and exchange of medical and administrative data.

Real Administrative Simplification

On the administrative front, office staff can search for a member using a wide range of criteria (e.g., member first and last name, DOB, member ID and any other plan-specific criteria), then update contact information or access and print the member's plan benefit summary. Eligibility verification is fast and efficient, with details provided on claims, authorizations, benefits and COB. Staff can submit authorizations and referrals online and get instant information about whether they have been approved, pended or denied.

Claims management is just as straightforward. Staff can auto-populate claims (UB04, HCFA1500 and encounter claim forms) with member and provider information to improve speed and accuracy, then submit claims electronically. Approved, pending and denied status can be easily viewed, and any rejected claims can be corrected and re-submitted online, even when the claims originated from another source (e.g., a clearinghouse). In addition, the Provider Portal makes it easy to determine how much of the claim is the patient's responsibility versus the health plan's, as well as to engage in point-of-service adjudication.

The Provider Portal can also be used to contact customer services about plan benefits, members' benefit limitation status and other topics, as well as to submit service issues, freeing phone lines for more complicated calls.

Care Collaboration for Optimal Outcomes

For greater collaboration between patients, providers and health plan care management staff, the Provider Portal enables office staff to access patient medical records, x-rays, lab and clinical reports, patient self-reported information (e.g., personal health records) and care plans. They can also scan documents and upload them to a specific patient case, as well as enter notes and send secured messages.

In addition, when combined with ikaMM workflow and business intelligence tools, the utility of the Provider Portal grows exponentially, proactively supporting quality improvement initiatives such as pay-for-performance (P4P), chronic disease management and prospective HEDIS compliance through more complete, current and actionable information and workflow support.

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