The Challenge A Medicare Advantage administrator in Puerto Rico, MMM Healthcare, LLC (MMM), processed appeals and grievances using an in-house, custom-built solution. To process a single case, staff had to manually perform tasks in three separate systems. MMM needed to expedite its appeals and grievances process with a new solution – one with key features, like detailed reporting, status tracking and automated distribution and letter generation.

MMM got this, and more, with OnBase by Hyland.

The Solution Under the leadership of Chief Technology Officer Juan Arill, MMM’s IT team went through an exhaustive evaluation process to find an application to solve its appeals and grievances challenges and act as a platform to automate MMM’s other processes.

Working with authorized OnBase solutions provider, Document Solutions Partners, MMM implemented the OnBase Appeals and Grievances solution in less than three months in early 2009. Hyland’s enterprise content management solution integrates easily with MMM’s QNXT claim system from TriZetto, as well as the company’s CRM, email (Microsoft Outlook) and fax systems. OnBase also maintains a robust audit trail, providing MMM with a rich set of reporting capabilities.

CUSTOMERMMM Healthcare, LLC

SIZEProviders: 8,000Members: 215,000Employees: 1,500

LOCATIONPuerto Rico

ONBASE INTEGRATIONSTriZetto QNXTRight FaxJacada

DEPARTMENTS USING ONBASECustomer ServiceAppeals and Grievances

Customer Success Story | Healthcare

MMM Healthcare, LLCOnBase automates tasks to speed appeals and grievances processing and saves MMM $200,000 a year

A recent cost-benefit analysis revealed an annual savings of nearly $200,000 due to the OnBase investment.

Its success was immediate: customer service staff instantly had access to the status of all cases; appeals and grievances staff could more easily manage the tight deadlines of the process, easily generating letters in either English or Spanish. The added process visibility allows managers the ability to move cases between staff based on individual workload, priority and even vacation schedules. Additionally, the solution’s ability to track staff documentation and all updates made to cases provides excellent compliance tracking and visibility throughout the process, pleasing external and internal auditors alike. The DifferenceMMM’s implementation has been a success by every MMM measure. A recent cost-benefit analysis revealed annual savings of nearly $200,000 due to the OnBase implementation with improvements affecting each stage of the process for a solid return on investment.

Streamlines triage tasks: OnBase eliminates the need to print, file and organize paper documents. From high-speed scanning of paper claims to automatically distributing faxes and scanned images to load-balancing work among coordinators, OnBase helps MMM quickly ingest and distribute case information.

Expedites processing to meet deadlines: By making materials immediately available, OnBase speeds case review. It’s also much easier, and faster, to present cases to MMM’s medical director and to compile reports for Independent Review Entity (Maximus.)

Increases employee productivity: Fewer administrative tasks for staff to manage creates more time for higher value knowledge work.

Learn more at OnBase.com/Healthcare »

© 2016 Hyland Software, Inc. All rights reserved. 2630-16