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WellMed Goes Live With ikaClaims and ikaMedicareGateway

The carrier reports that the system's scalability has helped it grow its business while keeping costs down.

San Antonio-based WellMed Medical Management has transitioned its core systems to Southborough, Mass.-based ikaSystems' ikaEnterprise suite.

IkaEnterprise is a cloud-based system for Medicare process automation and intelligence management. Components implemented by WellMed include ikaMedicareGateway, which automates enrollment processing; and ikaClaims, which deals with Medicare claims administration and allows contract configuration and software bundling and unbundling.

WellMed, which serves 100,000 patients and Medicare Advantage plan members, mostly in Texas and Florida, has automated administration of Medicare medical claims with auto-adjudication rates exceeding 80 percent with the system’s configuration rules over the past six months, the companies claim.

“We now have a system that is scalable so we can meet the demands of growth,” said Bill Connolly, SVP of operations for WellMed. “Easy user configurability also means that we can quickly and efficiently address member, provider and benefit changes and develop configuration programs that allow us to improve our business policy controls. The results are lower administrative costs and improved payment accuracy. At the same time, we’ve improved the service experience that members, providers and patients receive.”

WellMed plans to implement more components of the ikaEnterprise suite, which include sales, billing and portals, through the year.

Nathan Golia is senior editor of Insurance & Technology. He joined the publication in 2010 as associate editor and covers all aspects of the nexus between insurance and information technology, including mobility, distribution, core systems, customer interaction, and risk ... View Full Bio

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