Maximizing payment accuracy.
ikaSystems Payment Reconciliation solution streamlines the reconciliation process to maximize accuracy of payments to the Centers for Medicare & Medicaid Services (CMS). It is an automated, integrated system that improves processing efficiencies, speeds resolution of discrepancies, and enhances management reporting.
ikaSystems Payment Reconciliation module is a valuable option for Medicare Advantage plans using ikaMedicareGateway, the premier Medicare enrollment solution.
ikaSystems Payment Reconciliation module helps plans get accurate reimbursement and avoid the risk of misrepresentation, by ensuring that information is submitted correctly and swiftly to CMS. With Payment Reconciliation, you can quickly see that monthly payment files were received and properly loaded as well as view “plan versus CMS” payment discrepancies for faster prioritization and resolution.
Payment Reconciliation saves administrative resources by streamlining submission and verification while providing the configurability to meet your business needs. The solution also provides high-level payment reporting by month at the contract and PBP levels on crucial indicators that allow you to make better financial and operations decisions—such as total payment, membership counts, and PMPM.
As CMS regulations change, ikaSystems updates the system. Our simple, cost-effective maintenance enables you to automatically promote these updates to meet CMS requirements.
The benefits speak for themselves
ikaSystems Payment Reconciliation module enables you to:
- Compare totals from CMS plan payment reports with MMR and MPWR files to facilitate appropriate payment verification
- View CMS versus plan payment amounts received by year/contract/PBP
- Identify member-level payment discrepancies and easily prioritize them for research and resolution
- View average risk scores and member, payment, and PMPM month-over-month by contract
- View count of members, total dollars received, and average PMPM month-over-month in specific categories such as ESRD, community, and hospice; data is further configurable by year, contract, and PBP
- Create management reports for payments and adjustments
- Gain valuable trending data such as average risk adjustment factor by contract/year
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