Cloud Solutions Leveraged By Medicare Advantage Plan

By Karla Paris

End-to-end integration produces better billing, claims, payment processing, and customer service for more than 165,000 SCAN members.

SCAN Health Plan, a Medicare Advantage plan with more than 165,000 members in California and Arizona, has partnered with ikaSystems, a provider of enterprise, cloud-based business process and automation solutions, to implement ikaSystems’ broad suite of solutions to meet several key business goals SCAN Health Plan was looking to accomplish.

Founded in 1977, SCAN was created when a group of senior activists in Long Beach, CA got together, determined to improve access to the care and services they needed so they could stay as independent as possible. SCAN brought together experts in medicine, gerontology, psychology, and social services to form the Senior Care Action Network, a not-for-profit health plan for people with Medicare.

The organization began an intensive search for an ICD-10-ready solution to replace its legacy platform that could integrate data for eligibility, providers, and benefits into a single source of truth. ikaSystems was selected for its innovative cloud-based offering that could fully support SCAN’s mission and vision for the future.

SCAN implemented a number of ikaSystems modules that have transformed claims and billing processes, correspondence, payment reconciliation, customer service, and more. With its new end-to-end integration across business processes, the organization expects to achieve substantial improvements in operational efficiency.

ikaClaims transforms a health plan’s claims operations by dramatically increasing processing efficiencies and agility. It delivers automated claims administration in an easily configured, low-maintenance delivery model to reduce errors, administrative expense, and IT expense while maximizing flexibility.

As market demands and business needs evolve, SCAN can easily configure the system without changing any code. This flexibility allows SCAN to update existing plans, products, and membership networks itself, significantly reducing maintenance costs.

Being a highly configurable billing solution, ikaBilling improves efficiency, lowers administrative costs, and increases customer satisfaction. Automating all billing operations, ikaBilling delivers a level of accuracy that dramatically reduces time spent on manual processes, rework, and customer service.

ikaBilling provides SCAN with a single solution for all Medicare, Medicaid, commercial, and ACO billing processes that has the flexibility to work for any billing model—including multi-party split billing. The program has already benefited SCAN with its rich invoicing, payment processing, and delinquency management capabilities.

SOURCE: Business Wire