Complete, ready Medicare processing solution.


ikaClaims for Medicare dramatically eases benefit configuration for Medicare business, reduces the need for administrative and IT resources, and simplifies adherence to the Centers for Medicare & Medicaid Services (CMS) regulations. This easy-to-implement, automated claims system meets fee for service (FFS) Medicare benefits, pricing, and clinical editing rules for provider services.

ikaClaims for Medicare delivers a complete claims processing solution for Medicare Advantage and other Medicare lines of business. It has enabled our clients to achieve Medicare claims accuracy of up to 99.9% and auto-adjudication rates of more than 90%.

Efficiency, flexibility, and compliance

ikaClaims for Medicare integrates seamlessly with other ikaSystems modules to provide automated letter generation; automated CMS file generation, transmission, and processing; and real-time eligibility and entitlement verification. Because ikaSystems continually reviews CMS guidance and regulations and makes updates to the system to reflect them, this solution lessens the burden of meeting CMS requirements.

As your Medicare business evolves, you can easily configure the system to update existing plans, products, and membership yourself without changing any code, significantly reducing the cost of maintenance.

ikaClaims for Medicare can also be integrated with any third-party solution or legacy system—and can be automatically upgraded with little additional effort as updates become available.

The benefits speak for themselves

ikaClaims for Medicare enables you to:

  • Automate processing for most Medicare claims to achieve high auto-adjudication rates
  • Adhere to Medicare pricing, benefits, and clinical editing rules with minimal staff effort
  • Configure expanded benefits or minimally altered pricing—such as a percentage of Medicare FFS rates—for any product designed to offer coverage like Medicare
  • Increase administrative efficiencies by speeding processes and reducing rework; one client saw a 50% reduction in costs
  • Maximize claims processing productivity and return on investment via integration with complementary ikaSystems solutions such as ikaBilling, ikaCorrespondence, ikaMedicareGateway, Payment Reconciliation, and ikaCommissions

View other products in Government Services Solutions:

ikaMedicareGateway Fundamentals
Consumer Web Portal
Payment Reconciliation
ikaCRM for Medicare
« Back to Modular Solutions