A Distinctly Different Approach to Claims Administration

ikaClaims 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, enterprise-class system. ikaSystems has designed ikaClaims with one primary goal in mind: rapid time to value. System features expedite set-up and configuration while quickly delivering higher-than-average auto-adjudication rates. In fact, ikaClaims users typically achieve auto-adjudication rates as high as 90 percent within three months of go-live.

Essential system differentiators include:

• Unparalleled agility. Health plans can rapidly and easily configure even the most granular benefit plans and provider contracts. All system components and business rules can be user-defined, from the very basic to the highly specific.
• Fast, intuitive set-up. Pre-loaded benefit categories, pre-loaded fee schedules and standard/system codes speed incorporation of custom benefit plans and allow quick response to changing market demands. Robust copy functionality eliminates rework and redundancy while it reduces errors, dramatically shortening set-up timeframes.
• Seamless interoperability. User-friendly Web-based access and integration with other Web-based applications (via Web service calls) make it easy to share processes and information internally as well as externally, facilitating key business initiatives such as transparency and collaborative care management.
• Comprehensive HIPAA compliance. ikaClaims accepts and produces all HIPAA-compliant transaction code sets (270, 271, 276, 277, 278, 820, 834, 835, 837). In addition, multiple security levels are possible using user-defined role- and rule-based access configurability.
• Exceptional accuracy. With high auto-adjudication rates, ikaClaims virtually eliminates the need for manual intervention, resulting in consistent, accurate claims payments.

Comprehensive, Modular Functionality

Using ikaClaims, health plans are empowered to perform the following functions, supplied by various modules; each module can work on its own or be used in tandem with other modules:

• 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

Modules of ikaClaims — for example, Network or Member Management — can be used separately to extend the life of a health plan’s legacy systems. In addition, ikaClaims works seamlessly with the following additional components of ikaEnterprise 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
• ikaCustomerService: customer service automation for members, providers and employers

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.