What is subrogation?
Identify, investigate and recover medical and disability payments related to accidents.
Recovering paid medical and disability claims related to accidents can be a challenge. To effectively manage third-party liability or improper payments, health plans must take a comprehensive approach to subrogation.
Subrogation gives health plans the legal right to collect accident-related claims from a third party on their member’s behalf. These third parties are classified into the following categories:
- Auto
- Property and casualty
- Workers’ compensation
Reduce member abrasion
When developing a comprehensive subrogation program, reducing member abrasion is key. A member-sensitive approach to recovery reduces required member touch points. Health plans can achieve this through:
- Continuous risk scoring — By scoring claims as more information comes in, health plans can reduce false positive investigations and needless member requests.
- Multi-channel outreach — When health plans need to contact a member, they should use multiple methods to ensure they’re meeting members’ preferences. These methods include the web, phone, text or mail.
- Investigation specialists — Investigation specialists have experience guiding tough conversations. Their efficient, empathetic approach helps ensure the recovery process is expedited for the health plan and the member.
Measure impact
A comprehensive subrogation solution can help health plans increase recoveries and savings by:
- Reducing leakage through the evaluation of all claims and recovery efforts
- Improving productivity by prioritizing claims with the best chance for recovery
- Improving member satisfaction through reduced cycle times and faster return of deductibles