Cross Industry Claims Recovery

Data-Driven Subrogation, COB and TPL

Advanced solutions for identification and capture of new revenue from accident, casualty and workers compensation carriers 

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  • Subrogation, COB and TPL are important sourcesof revenue and cost avoidance for Managed Care Organizations and TPAs

  • In Subrogation, HCA has developed a new solution for increasing recoveries of medical claims paid by MCOs and TPAs that should be the responsibility of Liability, Casualty or Workers Compensation carriers.

  • The cases we identify for your recovery team are highly likely to produce significant recoveries.  We also provide rich information that makes the recovery process easier, like details about the carrier, case, adjusters & other involved parties.

  • In COB and TPL, unlike traditional pay and chase detection and validation methods, our cost avoidance approach enhances the speed and accuracy of detection of verified coverage on the front end -- sufficient to cost avoid the claims payment.

Industry Facts

  • Revenue opportunities exist that are not being identified today = most MCOs and TPAs are leaving dollars on the table

  • $1B recovered annually through health subrogation nationally

  • $5-6 in recoveries per member per year

  • One case for every 300 members

  • Subro is included as factor in actuarial calculations.  Not optimizing subrogation hurts your plan.
Increase your Subro revenue from typical levels (0.5%) to 2.0% of paid claims.

Health Care Analytics, Inc

(631) 754-9104
FAX (631) 382-8198
info@hca-inc.com 


      Benefits
§
  • Higher volume of high-likely target cases
  • Much richer information per case
  • §Easier case work, fewer dead-ends
  • §Increase from 0.5% to 2.0% of paid claims
  • §No risk!  We work on a success basis

 

Our Inferential Data Analytics   How it works
  • Not just Dx and Procedure codes (ICD-9, ICD-10, CPT)

  • Identifies likely candidates through sophisticated pattern recognition

  • Candidates are scored based onmultiple inferences and factors

  • Episode of Care approach, built around dates of service and related codes

  • Medical and Rx claims analyzed

  • Provider type & demographics analyzed

Our Global Database Matching    How it works 

  • We use a proprietary international personal injury data base

  • Likely candidates are matched against actual liability insurance industry claims

  • Positive matches produce rich information about the claim, the adjuster, the carrier – helps your Team speed the recovery

 

 
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