Reduced costs and greater agility.


ikaClaims transforms a health plan’s claims operations by dramatically increasing processing efficiencies and agility. It delivers automated claims administration in an easily configured, low-maintenance delivery model to reduce errors, administrative expense, and IT expense while maximizing flexibility.

ikaClaims is ideal for any line of business—commercial (group and individual), Medicare, Medicaid, or ACO. It has allowed some of the nation’s largest health plans to drastically reduce total cost of ownership.

Easy maintenance, maximum flexibility

ikaClaims is designed to ensure long-term success. It can be seamlessly integrated with any third-party solution or legacy system—and can be automatically upgraded with little additional effort as updates become available.

As market demands and business needs evolve, you can easily configure the system without changing any code. This flexibility allows you to update existing plans, products, and membership networks yourself, significantly reducing maintenance costs.

The benefits speak for themselves

ikaClaims enables you to:

  • 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—including notifying plan members and providers of each action taken for a referral—whether pended, denied, or authorized
  • Adjudicate claims manually or automatically via EDI
  • 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 is included)
  • Create reports and letters based on processed claims using pre-formatted reports and letters
  • Gain greater control over network management functions
  • Deliver excellence in customer service operations

Cost reduction and quick speed to value

ikaSystems clients have implemented ikaClaims in as little as three to six months and realized a nearly 50% reduction in total operating costs.

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