Healthcare Subrogation: It Ends Well With The Right Plan Language

Health Plans and TPA's still use accident questionnaires as the primary means to learn how certain medical claims came to their door. Whether generated internally by the claim payer or a subrogation vendor like us, these questionnaires are triggered by ICD-9 codes. Problem is, the ICD-9 code range indicating trauma or a “potential accident” is broad by definition. The result? Lots of questionnaires go out, many come back, all in the name of identifying subrogation recovery opportunities and satisfying stop loss requirements.

There's an easier way. Why not generate the questionnaires, but have them returned to us? We have claim paying clients who do exactly that. Their system automatically, and even in some cases, manually, generates accident questionnaires with return directions to us. We, in turn, review and advise whether to process claims or not or we follow up on any additional information needed. The advantages to this process are many, including:

  • Your staff no longer needs to painstakingly review hundreds of accident questionnaires.
  • As your subrogation firm, we are notified early on of any recovery opportunity.
  • We know by the responses, or lack of, exactly what claims should be investigated through other means.
  • You as the payor get to keep more of the recovery fee because our cost to perform this function is lower.

An external review of the questionnaires also shifts the risk burden to the reviewer.

Contact us to learn more about this approach and how it can earn you more recovery revenue.

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