Cleveland provider, payer start to exchange data electronically

The MetroHealth System in Cleveland and insurance company Medical Mutual are electronically exchanging data and documents using software from OnBase Mackinac, which is a part of software vendor Hyland Healthcare.

The goal is to avoid traditional time-consuming tasks of communicating via fax, mail, email, courier and web portals, while reducing costs and speeding processes.

The organizations conducted their first data exchanges on July 24 with the OnBase software enabling workflows and business process management functions without complicated system integrations.

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The workflow facilitates an insurer’s request for medical documentation in support of claims payment. This enables Medical Mutual to send a secure electronic request to MetroHealth for data and documents, with the latter fulfilling the request electronically.



When done manually, the process takes several days but through electronic exchange the organizations can collaborate in near real time and cut both parties’ cost per transaction in half.

The initiative also should reduce unnecessary administrative issues for patients, says Donna Graham, executive director of revenue cycle at MetroHealth, which is anchored by a 731-bed hospital.

“Streamlining the payer-provider communication and claims adjudication process is transparent, providing the community the opportunity to concentrate on their health and well-being,” she adds.

Medical Mutual sees the initiative as improving the member experience and supporting a philosophy of making things simple, says Shirra Subsinsky, director of customer care.