Background: A leading healthcare provider was looking to maintain their internal subrogation unit of 8 while improving the management and efficiency of their subrogation process. Some files were being managed by the internal unit while other more complex files were being outsourced to vendors.
Equian went to work on developing a custom solution that would meet their business needs and increase their recoveries, while keeping their internal unit intact.
Finding the Right Solution: As a measure of maintaining consistent processes, our proprietary software, Troveris®, was leased by the client. With Troveris® now in place, the client was able to manage their ASO files on the same system we used for managing the fully insured files. This co-source business model allowed for our expert staff to step in at any given point and assist with whatever needs the client may have with managing ASO files.
Another step in ensuring to meet the client’s business needs of increased recoveries, Equian began performing the identification and investigation piece of the client’s ASO files. After files were identified with subrogation potential, they were handed back to the client. This allowed their internal unit to focus on pursuit of recovery for those files identified as having recovery potential. They were also able to measure the effects that process driven identification and investigation can have on file counts and overall recoveries.
Results: Since contract inception, Equian has recovered over $168 million in recoveries for our client. We have also increased their per member per year recoveries by $7 and lowered their administrative costs. Due to continued process improvement, in 2005 our client made the decision to outsource all ASO business as well, giving us a fully outsourced solution.