Background: A large healthcare carrier recognized their internal subrogation process lacked efficiency and they needed a more effective system in place in order to maximize recoveries. They were utilizing outside law firms for some of their recovery efforts but that was the extent of any vendor relationships within the subrogation process.
Equian conducted an 18-month retrospective review, as well as took on the prospective business for the client. With a fully outsourced business model in place, the client realigned their internal staff which had been performing the identification piece, to better utilize their strengths in the core business.
Building the Relationship: Equian began with an extensive data mining process. Files were flagged as having possible recovery potential and moved into an investigation letter cycle. Our investigation model was used to determine whether or not a file has subrogation potential. Files that are identified to have recovery potential are passed to an examiner to manage through to recovery.
Our proprietary software, Troveris®, was used to manage the entire subrogation process from identification to recovery. In addition, our clients are able to view the status of their files in real-time.
Results: Within the first year, the client’s subrogation recoveries doubled using this model. Since inception, Equian has recovered over $128M for our client. The per member per year amount for our client has tripled since the program was implemented.
With such tremendous success of the subrogation program, the client has complemented their subrogation services with additional Payment Integrity solutions.