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The Portal Connector Changed MMRO’s Value Proposition

Company Profile

Managed Medical Review Organization (MMRO) provides an independent medical review and establishes an expert opinion on Disability Claims for Public Sector Clients. MMRO’s opinion holds value through the network of qualified health practitioners and specialists that perform a rigorous medical analysis of each case. This process helps their clients avoid faulty claims and validates legitimate claims for disability coverage.
 
MMRO has a head office in Novi, Michigan with offices in Chicago and Minneapolis.

Situation

Claims Process

The client (public sector organizations) provides MMRO with a disability claim application for their members describing the disability that is under consideration. Medical records are submitted with the application and additional data is gathered during the claim review process. When needed, a network of internal physician specialists can be called upon to refer the individual for additional medical analysis. This medical team contributes to the clinical recommendation back the client regarding the eligibility on the validity of the disability claim.

Technology from the Beginning

From the beginning, MMRO recognized that technology was the key to effectively managing their claims application, review and recommendation process. In the early years, MMRO had an Oracle based system that, along with some manual processes, was manageable for their existing client base. As their business started to experience more growth, the legacy Oracle platform was unable to grow with them. With limitations to the expansion of data fields and workflows their system could not scale and MMRO could no longer effectively operate with this system. MMRO also needed to address their manual processes and ensure they would be automated to facilitate the increased workload.

They evaluated a number of possible CRM systems and chose Dynamics CRM Online and TM Group, a local CRM partner to configure a Claims System. The TM Group recommended The Portal Connector to manage the Claims Process through a secure portal.
MMRO Case Study

Solution

Technology is the Game Changer

To effectively manage a claim requires the collection and review of lots of information. This information is kept in Dynamics CRM, with hundreds of fields of data on each claim that are used to structure and manage the disability claim review and recommendation. MMRO has the flexibility to choose which fields will be used in their portal solution, and only select fields that are accessible through secure access. This protects the highly sensitive information being reviewed for the claim.

Each claim consists of up to 20 electronic files, which can add up to 50-100MB of information per claim. Electronic files are attached to claims online through a customized implementation of The Portal Connector and then stored in CRM with SharePoint. Managing this data in a highly secure environment is of paramount importance for privacy.

Since each public sector client has unique rules and legal requirements, the role based security for accessing and submitting data is specific to the client. The Portal Connector provides tight role based security, along with flexibility to meet the unique role based requirements for each client, which is absolutely key to the success of the disability claims process.

The Final Step in the Claims Process

To finalize the disability claim review and make an expert recommendation on the eligibility of the claim, all aspects of gathered data needs to be compiled into one report back to the client. The Claims System in CRM is the hub of all information related to the claim and is used to populate the final report. Without a reliable hub of centralized information, this report would involve time consuming manual processes to compile.

Benefits

Key Improvements to MM​RO with The Portal Connector:

  • Sensitive Health Information is Protected and Securely Accessed
  • Can process the attachment of large documents like x-rays, MRI’s and other medical information
  • Interfacing directly with Dynamics CRM means all data is in one secure platform
  • Submission process is simplified and can be automated through the disability claims process
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