Integrating Operations With a Custom Dynamics CRM Solution

The client is a healthcare services company focused on healthcare management and claims repricing, whose stated mission is to keep its clients from overpaying for healthcare, serving American associations, unions, brokers, employers, and individuals. i3solutions designed and built the company a custom Customer Relationship Management application on Microsoft Dynamics 365, combining Dynamics 365 development with the systems integration and data management work needed to connect it to Ring Central telephony, email, Stripe payments, Cognito Forms, SharePoint Online, Microsoft Teams, and the rest of Office 365. Dynamics is the backbone of the system: it holds client data, tracks claims, manages the sales pipeline and enrollment data, and synchronizes with Ring Central so a call center representative sees the caller’s profile and case details as soon as the call is picked up. Microsoft Flow moves uploaded enrollment data into Dynamics and Ring Central automatically, and i3solutions’ custom software development team added geospatial analytics that map hospitals and related care facilities so clients can see which one offers the best price for the care they need. The CRM was designed for compliance with HIPAA and PHI privacy standards, and it reduces both the call and wait times the company’s members experienced and the time representatives spent switching between applications to find data.

The client is a healthcare services company at the forefront of healthcare management and claims repricing, with a mission to ensure clients never overpay for healthcare. They help American companies – associations, unions, brokers, employers – and individuals navigate an increasingly complex healthcare system. As the company continued to grow, they faced a significant challenge of handling an increasing amount of customer data and its management.

The company needed an IT consultant to craft, develop, and seamlessly integrate a new Microsoft Dynamics 365 system. The system had to manage healthcare eligibility and claims while addressing the stringent requirements of HIPPA and PHI privacy. Moreover, integration with various Microsoft and third-party tools was crucial. The ultimate need was to implement an efficient system that facilitated easier, seamless client profile management.

What did i3solutions build for this healthcare services company?

A custom Customer Relationship Management application on Microsoft Dynamics 365 that manages healthcare eligibility and claims. It centralizes customer data so the company has one view of a client’s interactions, preferences, and history, and it gives call center representatives the client profile and case details they need at the moment a call comes in.

Does the Dynamics 365 CRM integrate with a phone system and other third-party tools?

Yes. Dynamics synchronizes with Ring Central, which brings up the caller’s profile and case details automatically. Microsoft Flow sends uploaded enrollment data to both Dynamics and Ring Central using triggers, conditions, and actions. Stripe handles healthcare enrollment payments from the website along with automated payment reminders and confirmations. Cognito Forms collects data through web-based forms and routes each one to the right person, and Office 365, SharePoint Online, and Microsoft Teams cover documents, scheduling, and internal communication.

How does the system address HIPAA and PHI privacy requirements?

Privacy was part of the requirement from the start. The company needed a system that could manage healthcare eligibility and claims while meeting HIPAA and PHI privacy requirements, and the design keeps patient data secure and compliant with those standards. SharePoint Online serves as the centralized platform holding the case and enrollment documents.

How does geospatial analytics help clients choose where to get care?

i3solutions’ custom software development team used geospatial analytics to display hospitals and related care facilities on a map. Call center representatives use it to guide a patient toward the highest level of care at the most affordable cost, which is how the map supports the wider goal of keeping clients from overpaying for care.

If your service team is looking up eligibility, claims, and payment details in several separate systems while a member waits on the phone, the cost tends to show up as call handling time rather than as a line item anyone reviews. A first conversation covers what client and claims data you hold today, where it is duplicated, and what a Dynamics 365 build would have to integrate with before it becomes the one place your representatives look. You leave with a specific list of those integration points and the privacy controls a HIPAA and PHI workload needs, which is the detail an internal approval committee asks for before it signs off on a CRM project. Start the conversation