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ikaEnterprise Implements Total Health Plan Systems

ikaSystems has implemented health plan systems with two affiliated insurers, Detroit-based Total Health Care and Miami-based Total Health Choice.

The provider of enterprise-level web-based offerings has automated claims administration, member enrollment and billing processes, as well as delivered member and provider self-service web portals and two data warehouses.

According to ikaSystems, the Total Health organizations have gone live with the components of ikaEnterprise such as ikaClaims, a claims administration and customer service system that delivers high auto-adjudication rates. All system components and business rules can be user-defined, from the most basic to the most specific level of detail. Health plans can take advantage of pre-loaded benefit categories and fee schedules as well as standard/system codes to incorporate custom benefit plans and respond to changing market demands.

In addition, it includes ikaBilling, a configurable premium billing solution that allows health plans to set their own rules for late payments and benefit revocation, and members and others to make payments online; Member Portal, which supports administrative self-service as well as medical management self-care tools; and Provider Portal, which reduces providers’ administrative burden by automating processes such as eligibility verification, claims submission, authorization and referral submission and approval.

Other components include ikaDWH, a single, comprehensive database for claims, laboratory, pharmacy, encounter data, practice management and electronic medical record information that supports standard and ad hoc report generation, with drill-down and drill-up access to normalized and analyzed data.

Ravi Ika, president and CEO of ikaSystems, said: “The ikaSystems team really accomplished an incredible feat with this implementation. The agility of ikaEnterprise’s design and architecture is making these rapid implementations the norm rather than the exception, but even the most powerful technology needs to be fully supported by dedicated, knowledgeable and talented experts who always place the client’s interests first.

“Unless a health plan is ready for this type of rapid deployment, it simply cannot happen. Client by client, ikaSystems is changing health plans’ long-established culture of lingering, 18- to 24-month implementations to a more manageable 3 to 6 months.”