Better able to grow and develop with Microsoft Dynamics CRM for claims administration

May 18, 2015 TM Group

Better able to grow and develop with Microsoft Dynamics CRM for claims administration

CRM software helped this business improve many aspects of operations.

The company
A professional management services company that focuses on operational and administrative solutions for disability and medical case management wanted to modernize its business software systems. The business, located in the Midwest, is relatively new. It has been open for about five years, but has already realized significant success in terms of attracting clients.

Both the growing number and the many different types of clients – from individual municipal government departments to entire state governments – necessitated a more functional and scalable CRM system. Because the company had originally developed its client-facing presence around the needs of a single state government, it was difficult to match the varying and unique needs of new business partners. Customization issues arose, as managing various claims processes and progress based on locating issues – instead of broad reviews that required much more time and effort on the part of staff – was another major concern.

The project
The company seeking the new CRM system had looked into a variety of different options available on the market. The decision-makers ultimately chose Microsoft Dynamics CRM for claims administration, Microsoft Office 365, Microsoft Azure, Portal Connector, SharePoint and Yammer as the major pillars of its system, in consultation with The TM Group. One early objective on the part of the business was to realize increased interoperability and establish a system that could more easily grow and change. By using solutions developed by Microsoft – as opposed to its past system, which involved disparate products from a group of vendors – the business succeeded.

The TM Group suggested the selection of Microsoft products to address all of the major needs of the company. Microsoft Dynamics CRM effectively handles a wide variety of operational requirements, with Microsoft Office 365 providing both the tools to complete tasks and an enhanced level of functionality. Of special note is Microsoft Azure and Portal Connector, which offer access to the company’s client-facing Web portal. This change allows the business to customize the pages and forms accessed through the portal to meet the needs of individual clients.

In terms of claims management and progress tracking, the move to Dynamics CRM allowed the business to develop an activity-based system for analyzing the claims process. Instead of staff members having to comb through large amounts of data to find areas where forms are lacking information or where an update is required, a process bar and triggered activities in the form indicate a lack of required data to both users and employees. The portal allows clients to both enter claims and check on the status of those previously submitted. This makes it easier to ensure clients are providing all of the necessary information when submitting claims and provides clear indicators about how to proceed, reducing the need for back-and-forth interactions with the organization’s staff.

In terms of external documentation, the use of SharePoint has made such management much easier. Clients can upload the relevant information through the portal, with staff then accessing and interacting with the documents through Microsoft Dynamics CRM for claims administration and SharePoint. A billing component added to the system by The TM Group also allowed for more efficiency in that area. Based on the services included in specific claims, billing reports are created and sent out to clients, all using the same system.

The TM Group difference
The client benefited from working with a partner that took the time up front to do the research and present the best possible options for its goals. The TM Group held back on providing a project quote at first so its staff could do its due diligence and develop a proposal that made the most sense for the company. Located in the same region as its client, The TM Group was also able to provide the face-to-face support that had been lacking in the past, as the client had been working with a remotely located partner in the past.

The company was also considering a similar approach until realizing the benefits of having its CRM partner close by to provide in-person assistance, both during installation and afterward. Having in-person consultation and implementation assistance in place helped the organization maintain their timeline for implementation and develop the best possible CRM system for their needs.

The benefits
Before working with The TM Group and developing this new approach to document management, a large amount of work was required by employees of the company to track claims and understand where they were in the process. These needs only became more prevalent as the business grew and took on more clients, eventually turning into a pain point for staff. Now, they use the power of their modern CRM solution to better handle tasks and have eliminated many of the inefficient, time- and labor-heavy processes required in the past.

In particular, Microsoft Dynamics CRM for claims administration has been augmented by The TM Group with a lot of organizational workflows to support the claims process. Thanks to the various operational rules in place, there is less manual work to be done. In addition, it’s easier for staff to quickly look at a given claim and check on its status.

Because the work the business does is closely related to the healthcare field, HIPAA compliance is crucial. Using Azure for the client portal allowed the organization to maintain compliance while also providing scalability and interactivity with other parts of their solution.

While the internal communication capability of Yammer isn’t a necessity in the same way that HIPAA compliance is, the addition of this enterprise social media tool has helped staff members from different areas of the business weigh in when problems or concerns related to claims arise, boosting collaboration. With the notes and discussion attached directly to each claim while also removed from client view, it’s easy for employees to leave relevant notes about actions related to the document and for those same notes to be available quickly, if needed, further down the line.

In conclusion
CRM software is sometimes thought of in terms of the sales and relationship management functions for which it was originally developed. While CRM still provides a valuable, expansive platform for management in sales-focused organizations, the benefits extend far beyond a single type of business. The many business software functions of Microsoft Dynamics CRM have allowed this claims administration company to become more effective and efficient in a number of different areas. Internal communication about claims and the sharing of necessary information with clients and individual users have both improved, as have many other aspects of operations. With business software already so advanced and continuing to grow, companies in a very wide range of industries can realize some very significant benefits from its use.