One Integrated, Web-Based Solution to Fuel Rapid Growth

The individual market is one of the most promising growth opportunities open to healthcare payer organizations. Fewer employer-sponsored programs and explosive growth of the Medicare-eligible population are just two of the drivers causing health plans to hone in on their individual market strategies, looking for ways to capitalize on the potential while minimizing the risk.

Profitability in the individual market is about flexible benefits, accurate underwriting and proactive medical management. The recruitment is more complex, the products vary widely and, when government agencies are involved, the reporting requirements are significant. A new level of automation is required to quickly and cost-effectively develop and administer such highly tailored offerings.

Create a Highly Intelligent and Effective Organization

ikaEnterprise automates all key processes in the individual business cycle, combining business intelligence and transactional systems for sales automation, core claims adjudication, care management and proactive quality measurement and reporting with self-service portals for sales, administrative, member and provider use. The result is an end-to-end, fully Web-deployed solution for process automation and intelligence management.

Using our agile, modular technology, payers can create a single intelligent ecosystem — comprising health plan staff, members, providers and brokers — that feeds on the same real-time information and fluidly responds in a way that benefits the ecosystem as a whole.

Build Your Own Solution

ikaEnterprise modules can be implemented one at a time or all at once, helping health plans better manage IT expenses and develop their confidence in ikaSystems as a technology partner while delivering increasing value. With ikaEnterprise, you can innovate at your own pace and create your ideal solution.

For the individual market, ikaEnterprise offers solutions in the following areas:

Sales	ikaSales is a comprehensive suite of integrated marketing and sales force automation tools that also encompasses electronic billing and commission payment.
Medicare	ikaMedicare solutions automate the complexity of CMS data exchanges, delivering greater accuracy and speed to member enrollment, member/payment reconciliation, diagnostic reporting and care coordination.
Portals	ikaPortals provide self-service capabilities for sales, members, providers and health plan administrative staff.
Medical Management	ikaMM’s integrated medical intelligence and management solutions proactively measure and act to improve quality, utilization, satisfaction and regulatory reporting.
Claims	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, configurable system.
Customer Service	ikaCustomerService provides the exact level of support that any health plan needs to ensure its customer service function runs smoothly, efficiently and effectively.