Health Plan Subrogation Services

Best In Class Subrogation Process                                             

 

Step 1: Early Detection of Potential Third-Party Accident Claims

In our quest to identify potential subrogation claims, we rely on our industry-leading claim analytics platform (SelfInsuredReporting.com).  Powered by a team of experienced data experts who handle claim analytics for thousands of self-insured medical plans nationwide, we leverage their expertise to kickstart our process. By utilizing this cutting-edge platform, we significantly enhance our ability to detect possible subrogation cases at an early stage.

 

Step 2:  Understanding SPD Language

The SPD serves as a comprehensive guide that outlines the rights, benefits, and obligations of plan participants and beneficiaries. When it comes to subrogation, the SPD provides critical information on the plan’s authority to pursue recovery from liable third parties. It clarifies the scope of subrogation, the process for identifying subrogation cases, and the rights and responsibilities of all parties involved. By having a clear understanding of the SPD language, self-insured medical plans can ensure compliance with legal requirements, maximize recovery opportunities, protect the interests of the plan and its participants, and effectively navigate the complex landscape of subrogation.

 

Step 3:  Potential Claim Investigation

Next, we prioritize the use of relevant databases as a primary tool in our subrogation process.  In practice, this involves our subrogation team bouncing our suspected subrogation claim against the ISO claims database, which houses approximately 95% of all property and casualty claims.  With most claims, this database will provide to use all of the relevant information necessary to begin subrogation immediately on the claim.

Taking an ISO first approach towards subrogation not only emphasizes the importance of utilizing a trusted and centralized source of information to drive efficient and effective subrogation processes, but also aids in limiting member disruption during the investigation process.  By embracing ISO as a cornerstone in the subrogation workflow, self-insured medical plans can enhance their recovery efforts, optimize resource allocation, and stay aligned with industry best practices.

Our exceptional subrogation process is driven by our ability to accurately identify injuries related to accidents. This critical step necessitates analytical reasoning from our highly skilled subrogation specialists. They employ their expertise to gather comprehensive details about the accident, injuries sustained, and other relevant factors. By leaving no stone unturned, we ensure that no money rightfully owed to the Plan goes overlooked or unclaimed. This meticulous approach, coupled with our dedicated team, guarantees that we maximize recovery opportunities and secure the funds that rightfully belong to our clients’ self-insured medical plans.

 

Step 4: Swift and Decisive Action

We fully understand the significance of taking prompt action, particularly when dealing with Personal Injury Protection (PIP) and MedPay cases. As these funds operate on a first-come, first-served basis, time becomes a critical factor in securing them. The advantage of PIP and MedPay lies in their streamlined process, as they require no negotiations and are solely subject to the policy’s limitations. This makes them the low-hanging fruit that paves the way for successfully recovering more challenging funds.

At our core, we combine advanced technology, meticulous data analysis, and a proactive approach to leave no viable subrogation opportunity unnoticed. We understand the importance of being thorough and responsive, ensuring that no potential claim slips through the cracks. By employing our comprehensive approach, we empower you to maximize your recovery efforts, capitalizing on every available opportunity.

Trust our team to harness the power of our state-of-the-art claim analytics platform, backed by skilled data professionals, to give you the competitive edge you need in the world of subrogation.

 

Step 5:  Claim Coordination

At our firm, our case management process is designed to be the central hub of communication for all parties involved in the medical subrogation process. Our dedicated case managers serve as the primary point of contact, facilitating clear and open communication among insurance carriers, attorneys, medical providers, and the injured party. They ensure that all relevant information is shared, questions are answered promptly, and negotiations progress smoothly.

In the world of subrogation, maintaining regular contact with interested parties is crucial for success. We understand that adjusters, attorneys, and lien resolution firms may not have a vested interest in our clients’ recovery efforts. That’s why we take the initiative to stay relevant in their process by establishing regular communication. The frequency of contact may vary based on factors such as case type, stage, and ongoing treatment, but we proactively reach out to ensure that everyone is informed and engaged throughout the subrogation journey. With our diligent case management approach, we keep the lines of communication open, fostering collaboration and maximizing the chances of a favorable outcome.

 

Step 6:  Claim Settlement

Our subrogation claim settlement approach can be summarized by the following key points:

• Bold Negotiation Stance | Our specialists take a bold negotiation stance in their positions, standing firm against attorneys who seek to evade paying liens. They skillfully utilize Plan language and relevant case law to define our stance and expectations, ensuring clarity in negotiations.
• Ethical Compliance | We adhere to ethical cannons throughout the negotiation process. Our specialists are committed to truthfulness and accuracy in the information provided, avoiding false statements while maintaining discretion on relevant unsolicited information.
• Reductions Based on Exigent Circumstances | We judiciously consider reduction requests, reserving them for exigent circumstances. Clear justification is required for any reduction request, and if the requesting party fails to meet the bar, we steadfastly decline. Our specialists handle these confrontations with confidence and assertiveness.
• Over/Double Payment Recovery | We go beyond subrogation by identifying instances of overpayment or double payment. If multiple parties have paid the same bill, we diligently pursue the return of the overpayment to the Plan, treating it as a separate instance from subrogation. Our comprehensive approach ensures that all aspects of the settlement process are managed seamlessly.
• Expert Legal Support | Our subrogation team manages the entire negotiation process, handling reduction requests and resolving issues that may arise with adverse attorneys or insurance carriers. In the event of legal disputes, our team of skilled attorneys is readily available to provide expert assistance, ensuring a smooth resolution.

 

Step 7:  Financial Reporting

Our ability to provide exceptional client financial reporting in relation to our subrogation efforts is greatly enhanced by the fact that we own a medical claim analytics software platform. This proprietary platform empowers us to access and analyze vast amounts of data with unparalleled accuracy and efficiency.

The integration of our software platform into our subrogation process ensures seamless data management, streamlined reporting, and timely updates, ultimately enhancing transparency and enabling our clients to make informed decisions based on accurate financial information.