May 14, 2004

US Healthcare Holdings implements the entire ikaEnterprise Enterprise-wide System.

ikaSolutions, a leading provider of intelligent, rules-based business process management (BPM) software, announced that US Healthcare Holdings (USHH), a full-service managed care outsourcing and management company in Cleveland, Ohio and Evansville, Indiana is implementing the ikaEnterprise Enterprise-wide System, the “Total Health Care Web-based System.”  ikaEnterprise handles all front and back-office administration and claims processing for Managed Care Organizations.

ikaEnterprise is a highly flexible and dynamic web-based solution designed specifically to replace the paper, faxes, and phone calls that plague most managed care operations. In the simplest terms, ikaEnterprise is a series of self-service web-portals integrated with the ikaClaims administration and processing system allowing for real-time access and update to information that enables licensed users to maintain full control transactions across the enterprise.  ikaEnterprise utilizes proprietary breakthrough technology that automates the electronic adjudication of healthcare claims with expert, rules based precision. This automated technology permits claims input (with EDI), adjudication and payment in milliseconds, thereby reducing average claims processing expenditures by up to 80%. 

“USHH management has a great deal of experience in health plan turnarounds and in working with management, IT systems, and operations that have been leveraged to build an operating platform that can propel plans to profitability by reducing administrative expenses.  Although we have been able to develop streamlined workflows, policies and procedures that have resulted in our ability to increase our operating performance, USHH is always looking for ways to elevate health plans to the next level of product service and efficiency.  Through our ongoing research, USHH has identified ikaSolutions as the technology partner to help achieve this goal,” says Chris Reef, President and COO of USHH.

The ikaClaims System includes over thirteen comprehensive modules including EDI–PAYER, BENEFITS, PROVIDER, MEMBERSHIP, CLAIMS, AUTHORIZATION, REBUNDLER, CODE MAINTENANCE, BILLING/REINSURANCE, PAYMENT, NOTEBOOK, DATA EXCHANGE, and CALL CENTER.  ikaClaims includes a comprehensive system that defines the total health plan’s quality versus the performance of each individual primary care physician. This form of quality profiling allows statistical analyses for comparison with the financial performance analyses of providers, giving plans the ability to establish tiers of providers that can impact marketing and pricing for healthcare managers. ikaSolutions has integrated its comprehensive Reporting and Practice Pattern Analysis system into the ikaClaims administration system. This provides healthcare managers and their operational personnel with rapidly deployable actuarial tools that monitor the normalized cost of care and utilization patterns of all providers.  USHH and ikaSolutions will marry this data to create the most efficient networks and products available in each market. 

Carrier Portal provides the ultimate control over these departments: Sales, Underwriting, Customer Service, Provider Services, Preauthorization, Referral Services, and Finance.  The Carrier Portal provides clients with an unlimited number of hierarchal controls built into the system at every level and department.

Sales Portal provides the client with more than thirteen functions including Quoting of individual, Small, and Large Group Products, Experience Rating, Proposal Generation, Enrollment Initiation, Renewals, Client/Prospect Management, Commissions Status, Secured Messaging, Licensing, View Account Receivables, Premium History, Customer Service, and Comprehensive Reporting.

Member Portal allows health plan members to perform the following functions in a Self-Service Environment including Enrollment, Plan Benefit Information, Claim Status, Provider Search, Order ID Cards, Benefit Limitation Status, Eligibility Verification, Customer Service, Update Personal Information, PCP and Pharmacy Changes.

Employer Portal empowers the benefit administrators to perform Group Enrollment, Add/Modify/Terminate Members, Plan Benefit Management, COBRA Management, Invoice and Bill Payments, Eligibility Verification, Benefit Limitation Status, Group Claims Reporting, Provider Search, and Customer Service.

Provider Portal increases the efficiency of healthcare delivery by performing functions online in real-time including, Eligibility Verification, Member Benefit Verification, Preauthorization, Referrals, Claims Submission, Claims Tracking, and utilizing Electronic Medical Records.

About US Healthcare Holdings (USHH) and Welborn Health Plans (WHP)

USHH was formed in September 2003 to serve as a national resource for the managed care industry. The founders of USHH bring over 50 years of healthcare experience, with the primary goal of helping clients achieve their short- and long-term business and financial objectives.  USHH will achieve this through a variety of means, including management/operational consulting, merger and acquisition consulting/management, and management/operational outsourcing.

On November 1, 2003, USHH entered into its first long-term HMO management and operational outsourcing agreement with Welborn Health plans www.welbornclinic.com a 36,000-plus member HMO. Under this agreement, USHH is responsible for all day-to-day operations and management, including claims, enrollment, member services, marketing/sales/advertising, underwriting, medical management, quality assurance, provider contracting/service, information systems, pharmacy management, data reporting/analysis, and regulatory, legal and financial management.  “USHH has managed to build an efficient and effective infrastructure that can compete with organizations 10 times larger, but with better performance and at a lower cost. It is our mission to provide the plans we manage the highest level of service, marketing and technology available.  From the plans’ perspective, we are looking to develop a platform that can create member, employer and provider loyalty by giving plans the ability to increase service to all constituencies and pass the administrative savings to employers/members through reduced premiums.  From the provider perspective, we look for ways to increase claims processing performance to increase provider satisfaction,” says William Macko, USHH’s Chairman and CEO.