Total Health Selects ikaEnterprise to Support Medical Cost Stabilization for Medicaid and Commercial Memberships

Business Editors/Technology Editors

SOUTHBOROUGH, Mass.--(BUSINESS WIRE)--March 19, 2009--Two affiliated insurers, Detroit-based Total Health Care and Miami-based Total Health Choice, will implement enterprise-level Web-based solutions from ikaSystems to stabilize medical costs for their Medicaid and commercial memberships while ensuring optimal care. The majority of the ikaEnterprise product suite is expected to be live and delivering value just four months after contract signing, with the remainder targeted for completion by year end.

“We discovered ikaSystems’ offerings late in our due diligence process and were immediately struck by how unique the solutions are in the market, particularly when you consider what’s available from vendors of legacy insurance systems,” said Randy Narowitz, chief operating officer of Total Health Care. “This is a complete solution for both our Medicaid and commercial lines, fully integrated on one technology platform that can be implemented in just months. It’s just an amazingly different approach to automating health plan business processes that will successfully support our strategic growth plans — I can fully understand why ikaSystems’ client base is so passionate about ikaEnterprise.”

The Total Health organizations, which serve 90,000 members across southeast Michigan and in Florida’s Miami-Date and Broward counties, will use the following components of ikaEnterprise:

ikaClaims, a flexible, efficient claims administration and customer service system that quickly 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 effortlessly incorporate custom benefit plans and respond quickly to changing market demands. ikaClaims accepts and produces all HIPAA-compliant transaction code sets (834, 270, 271, 278, 837, 276, 277, 835, 820) and allows plans to set rule- and role-based security levels. Greater payment efficiency and transparency made possible by Web-based access and integration also significantly improve provider relations and the impact of collaborative care management programs.
ikaBilling, a highly 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.
ikaPortals, an agile portal platform that moves functionality to the source, replacing the claims system as the health plan’s system of record and returning information to the claims system to process claims quickly and correctly.Total Health willuse the following ikaPortals:
Member Portal, which supports administrative self-service as well as medical management self-care tools. For example, members can verify eligibility verification, order ID cards, check claims status, collaborate with the care team and keep personal health records.
Provider Portal, which reduces providers’ administrative burden by automating processes such as eligibility verification, claims submission, authorization and referral submission and approval. In addition, the Provider Portal gives physicians proactive access to quality information so they can improve HEDIS measures and pay-for-performance results.
Employer Portal, which empowers benefit administrators with a broad range of functions, including online census/claims submissions, roster management, off-cycle transactions, electronic billing/reconciliation, and large-group employer reporting.
Admin Portal, which gives health plan administrative staff the ability to complete transactions on behalf of external constituents and manage health plan processes.
ikaMM, which seamlessly blends insight and workflow collaboration into a single, comprehensive and highly intelligent system to support the business intelligence and workflow needs of Medicaid and commercial programs.
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.
ikaCM and ikaDM, solutions that connect disease and case managers, physicians and patients for optimal information sharing and collaboration while providing powerful identification, stratification, enrollment, monitoring, alerting and self-management tools, including health risk questionnaires and patient-centric tools such as personal health records.
ikaProHEDIS+, a patent-pending Web-based application that combines analytic and workflow tools to enable proactive quality management. Health plans can analyze their quality status at any time for HEDIS ® or any other quality program, with easy-to-run standard and ad hoc reports that draw on real-time or near-real-time data. Providers, care managers and members, in turn, gain access to current — not retrospective — information, allowing them to take action to improve patient care.
ikaP4P, an integrated, real-time pay-for-performance (P4P) application that allows health plans to define their own P4P programs, set up all P4P parameters, monitor bonus programs in real-time, and allow providers on-demand access to the data that drives their bonus payments.

According to Ravi Ika, president of ikaSystems, “A strategic initiative of this magnitude, rolled out at such a rapid-fire pace, would not be possible without the flexibility of the ikaEnterprise design and architecture. We have proven the success of this new technology paradigm on the commercial and Medicare fronts, and even Medicaid’s complex state enrollment criteria can be incorporated and automated with ease, supporting Total Health in its quest to bring its exceptional services to an ever-widening geographic area.”

About ikaSystems Corp.

ikaSystemsis healthcare payers’ premier provider of Web-based ERP technology for process automation and intelligence management. ikaEnterprise, the company’s flagship product, automates all key processes in the payer business cycle, supporting commercial, Medicare and Medicaid lines of business. The system consists of five stand-alone, self-service Web portals for sales/broker, administrative, employer, member and provider use, each of which are tightly integrated with business intelligence and transactional systems for core claims adjudication, care management and proactive quality measurement and reporting. Using our agile, modular technology, organizations can move quickly to lower administrative and medical care expenses through greater automation and highly intelligent decision-making. To learn more, please visit www.ikasystems.com.