GROWING WITH PUBLIC OR PRIVATE EXCHANGES


THE PROBLEM

The transition to a highly regulated yet individualized marketplace has begun with the establishment of Health Insurance Exchanges (HIX). For payer participants and Exchange sponsors to mine this opportunity, they must meet complex technology and regulatory requirements while at the same time containing administrative costs.



THE SOLUTIONS

Flexible, easy-to-maintain technology

ikaExchange delivers a highly configurable, easily maintained technology platform that supports interactions and transactions in public or private exchanges at a low total cost of ownership.

Streamlined data management

The ikaExchange platform sends, receives, and reconciles data—including product information, rates, membership, eligibility, and financial data—to maximize the efficiency of HIX-related data processes and workflow.

Full financial reconciliation

ikaExchange performs all the financial and member reconciliations required via EDI functionality, including processing 820s (payments) and handling custom 834s (enrollment) and “augmented” 834 files.

Gateway to stakeholders

ikaExchange allows a state or private HIX sponsor to act as the administrator and auditor while giving participating payers, navigators, brokers, employers, and members the ability to conduct their exchange-related business via easy-to-use portals.



THE RESULTS

Meet technology requirements

A hosted Web-based enterprise data and workflow management platform with updates as needed as well as full support for navigator, broker, employer, member, and state administrator roles provide the complete range of capabilities to support HIX programs—whether you are offering a single product in a single state or multiple products in many states.

Regulatory compliance

With ikaSystems’ extensive knowledge of and experience with the Centers for Medicare & Medicaid Services (CMS) processes, you can feel confident that ikaExchange capabilities meet current ACA mandates for functionality, security, governance, connectivity, integration, and reporting—and will continue to be updated as guidelines change.

Fast, low-cost entry

Payers enter the market more quickly and realize lower cost of ownership by leveraging existing IT investments and using an aggregator platform for all commercial and HIX business channels.

Optimal HIX support

Automated and integrated plan, enrollment, and financial management capabilities along with robust reporting provide the flexibility to support multi-product, multi-carrier functions and minimize the resources needed for HIX participation or sponsorship.

Improved satisfaction, lower costs

A self-service tool set for members and other external stakeholders gives end users more control over their experience while reducing business unit operational costs.


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