In this Acceleration Case Study, learn how Managed Medical Review Organization (MMRO) used a CRM solution to improve its claims process. The medical review company needed to find a better way to evaluate insurance claims. Finding a software solution to keep this information secure while complying with various client regulations was also a top priority. Read how MMRO accomplished this by implementing Dynamics CRM Online and The Portal Connector.
Business Challenge – Finding a Solution for Its Claims Process
MMRO specializes in independent medical reviews. They also establish expert opinions regarding disability claims for public sector clients. One of the traits that set MMRO apart is its well-established reputation with health practitioners and specialists. With a detailed review process, the organization helps clients avoid paying faulty claims. Additionally, it validates legitimate claims for gaining disability coverage.
Public sector organizations give MMRO a disability claim application that describes the disability for their members. Along with the application, they submit medical records. They gather any relevant information throughout the claim review process. Internal physician specialists are available if the referred individual needs additional medical examination.
MMRO understood the importance of using technology to manage their claims application and review process from the beginning. Initially, MMRO used an Oracle-based system while also including a few manual processes. However, the Oracle platform was unable to meet the needs of their business as they experienced more growth. In addition, limitations to expanding workflows and data fields made it impossible to scale. MMRO also needed to find a way to reduce manual processes through automation due to its ever-expanding workload.
Software Solution – Dynamics CRM Online & The Portal Connector
The company evaluated numerous CRM systems before choosing to implement Dynamics CRM Online. MMRO also worked with TM Group to help implement the system and design a Claims System. The TM Group also recommended using The Portal Connection for managing the Claims Process due to its ability to offer a secure portal. Initially, MMRO was considering another portal product but chose The Portal Connector solution because it reduces the complexity and the overall costs of the project.
Managing claims requires the collection and review of detailed information. This data is stored in Dynamics CRM. Fields of data for each claim make it easy to structure and manage the disability claim review process. The team at MMRO also selects which areas to use within the portal solution while ensuring that it’s only available by using secure access. They do this because of the sensitivity of the information under review.
An individual claim often includes up to 20 electronic files, which can add anywhere between 50-100MG of data per claim. All electronic files are attached by using The Portal Connector. Then, it’s stored within CRM by SharePoint. Keeping all of this data in a secure environment is essential for privacy.
Every public sector client has its own rules and legal requirements. Using role-based security makes it simple to view and submit data that meets the client’s specific requirements. For example, The Portal Connector offers detailed role-based security while also providing the flexibility to meet the different role-based needs for every client. This is a necessity for a successful disability claims process.
Before making a recommendation for each client, MMRO needed to gather all of the data into one report to finalize the review process for disability claims. Dynamics CRM provides a Claims System that is the center for all information involving each claim. It’s used to create the final report. On the other hand, not having a centralized hub for managing all the data would result in a much more time-consuming report involving numerous manual processes.
While using The Portal Connector, MMRO made many improvements. These improvements include:
- Sensitive health data remains protected and accessed securely.
- Large documents can easily be processed, such as MRI’s, x-rays, and other medical documents.
- They can locate all information in Dynamics CRM.
- Simple submission process that can easily automate the disability claims process.
The Portal Connector has played a key role in how MMRO delivers services to each client. It also improved internal processes, such as sending medical reports and managing new claims. Choosing to use The Portal Connector was a worthwhile investment in keeping up with the growth of MMRO.