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MEDICAL MUTUAL IS FIRST OHIO-BASED HEALTH INSURER TO OFFER REAL-TIME CLAIMS PROCESSING SYSTEM

November 5, 2009

CLEVELAND – Medical Mutual of Ohio is the first Ohio health insurer to develop and pilot its own Real-Time Claims Adjudication (RTCA) system to enable patients to instantly take care of financial obligations at the point and time of their medical care.

RTCA was piloted by four local physician offices beginning in October, 2008. Feedback today from the physicians of varying specialties indicates that the system is easy to use and patients too, find it easier to conduct business at the point of service.

“Early results are promising,” said Kevin Lauterjung, Medical Mutual vice president of Healthcare Finance and Network Management. “As for expediency, the claims submitted are fully adjudicated and returned to the physician and member in seconds,” Lauterjung said.

The web-based RTCA system was developed in-house by Medical Mutual and mirrors the layout of a claim form. The system provides users with the status of a completed claim within seconds of submission. The resulting documentation is an Explanation of Benefits (EOB), which is printed and provided to the member for his/her records.

The RTCA system was integrated into Medical Mutual’s Provider e-Portal in October, allowing all network physicians to utilize the system. In addition, an internal RTCA steering committee is monitoring progress made on claims cost estimators, which may be coupled with the RTCA system to offer additional value to Medical Mutual providers and members alike. RTCA and the upcoming claims cost estimator will be accessible through Medical Mutual’s new Provider e-Portal, or the members’ My Health Plan website at www.medmutual.com.

“This is an important step for our customers and provider clients because, as the transformation of the healthcare marketplace continues, Medical Mutual recognizes that consumerism and transparency will be significant components,” said Lauterjung.

Founded in 1934, Medical Mutual of Ohio is the oldest and largest health insurance company based in Ohio. The company serves its customers through high-quality, affordable group and personal health insurance plans, and third-party administrative services to self-insured group customers. For more information, visit the company’s award-winning Web site at www.MedMutual.com.