Subrogation vendors would have you believe that they are superior when it comes to identifying subrogation cases—that they will out-perform you, the claim payor or Third Party Administrator (TPA)—in finding all the viable subrogation cases there are to find. THINK AGAIN!
Subrogation cases are initially triggered by procedure codes (primarily ICD-9 and CPT). These codes prompt inquiry, traditionally through the sending of accident questionnaires to injured plan members. Well, who does this best, the claim payor or a subrogation vendor "scrubbing" claim data? SRP's 18 year experience has found that claim payors and TPA's can do it just as well, and for less cost, than the subrogation vendors who sell fear, uncertainly and doubt around missed cases along with the promise of trumped up recovery expectations. Viable cases with real recoveries cannot be manufactured. They exist among the member population who are injured by other parties. The key is to find these cases as efficiently as possible so most of the contingent revenue earned on recoveries goes to the TPA.
The reason certain vendors sell on the hype is quite simple: it allows them to charge more and they can hide unrealized recoveries in the “potential or investigating” category of cases—leading clients to hang on for recoveries that never come. This is not to say that no money is ever recovered—just not nearly what was promised. Finally, it enables vendors to entrench themselves with a client who just invested considerable effort into claim data exchanges and adapted processes.
SRP offers a $1,000 to any TPA for answering the above list of questions—even if you are currently working with a subrogation vendor like the Phia Group, Socrates, or Ingenix. Email us at firstname.lastname@example.org or contact us to qualify.
There is a difference between data mining to identify claims appropriate for accident questionnaire follow up and data matching. Data matching compares potential claims against databases of existing liability claims and lawsuits. At SRP, we fully utilize and recommend the matching technique as the most efficient way to back up the internal sending of accident questionnaires.
Keep the sending of accident questionnaires in house! There are several receipt options thereafter, depending on your current claim practices. Either way, doing so enables TPA's to control the process and retain the lion's share of contingent revenue earned on recoveries. In our view, it is better to have leverage with your subrogation partner than to be dependent on them.