Subrogration software a hit

SALT LAKE CITY, UT – SelectHealth brought in house the follow-up reimbursement area of its subrogation processes nearly a year ago.

Since then, the health plan has been able to quickly identify subrogation opportunities and has seen “very big financial improvement over and above” its previous process, said Marc Rueckert, SelectHealth’s senior operations review manager.

Though it varies by state, the industry standard of recovery through subrogation is between 1/2 percent and 1 percent of total claims paid. Prior to using its new process, SelectHealth’s results were lower than the standard, but have since improved 2-3 times over its previous rate, Rueckert said.

Just as important, bringing all subrogation processes in house versus outsourcing has created a stronger ownership of results, better communication and access to all its systems, he said.

SelectHealth implemented SCIOinspire’s technology originally to cover high-dollar case management cases but soon expanded its functionality to identify subrogation opportunities.

Health plans need a good case management platform and an efficient management process, said Krishna Kottapalli, chief sales and marketing officer for SCIOinspire. The more proactive health plans are at tracking and managing, the higher the percentage of capture and recovery, he said.

Control is also important, said Nick Fioravanti, director of client services for SCIOinspire. Having a good grasp of a health plan’s business and member make-up and being able to closely interface with other departments are some of the benefits of having subrogation processes in house.

Although the industry has not done any benchmarking studies, subrogation results in billion-dollar recovery for big insurance carriers, said Michael Carr, executive director of the National Association of Subrogation Professionals.

Carr pointed out that subrogation investment costs one-third less than premium investments. “A small percentage of the claims you pay out are subrogatable if you are good at identifying it,” he said.