STREAMLINING DUAL ELIGIBILITY ADMINISTRATION


THE PROBLEM

Health plans serving dual eligibles, particularly those participating in D-SNP programs, must address core administration challenges to serve this specialized, distinct, yet highly variable population effectively and efficiently.



THE SOLUTIONS

Manage dual claims

ikaClaims provides the pricing, benefits, and clinical editing configurability that is ideal for the dual eligibles population. This complete solution enables you to create and maintain a consolidated record for a person with both Medicare and Medicaid coverage as well as to process FFS and capitated payments. These benefits are coordinated automatically according to rules set by the plan and are defaulted to those adherent to the Centers for Medicare & Medicaid Services (CMS) regulations.

Coordinate dual enrollment

The integration of ikaClaims and ikaMedicareGateway—which automates enrollment and payment reconciliation processes—provides a coordinated source of truth for state and federal enrollment data by aligning the eligibility of individuals for Medicare and Medicaid.

Promote quality

Our quality measurement reporting solution, ikaProHEDIS, empowers health plans and providers to address and prospectively manage quality for dual eligible Special Needs Plans (D-SNPs)-specific HEDIS® measures.

Optimize revenue

The ikaSystems RAPS and EDPS solutions help ensure that you receive correct payments for Medicare services, by automating the validation, processing, and submission of data accurately and on time.

Consolidated data

ikaDWH aggregates all data in ikaSystems’ modules and other systems as integrated to create a single source of data across your enterprise.



THE RESULTS

Fast time to market

ikaSystems solutions are delivered via the Web, so they are up and running quickly in a marketplace where agility is key. Plus, ikaMedicareGateway provides real-time enrollment capability for a shorter time to sale and earlier revenue recognition.

Lower costs

ikaSystems solutions deliver a single, integrated source of truth in eligibility and enrollment processes for all lines of business, lowering administrative costs. Plus, easy configuration and low-effort maintenance keep the total cost of ownership low.

Accurate payments

ikaSystems RAPS and EDPS solutions automate the submission of claim and chart review data to CMS, ensuring adherence with Medicare guidelines and optimizing your revenue stream.

Improved quality measures

ikaProHEDIS helps plans provide clear feedback to physicians at any time of the year. Providers are prompted to take action when gaps in care are identified. The result: more proactive care planning and higher HEDIS® scores.

Better reporting and compliance

ikaClaims and ikaMedicareGateway aggregate data from the Medicare and Medicaid sources into ikaDWH to create a single reporting source. Your organization can use self-service tools to create reports or create extracts for analysis in other systems. And ikaSystems solutions are designed to address CMS Chapter 2 requirements so you can feel confident your exchanges adhere to these regulations.


reducing-costs