Subrogation Vendors

Choosing a Subrogation Vendor

Many organizations, including self-insured plans and fully insured plans, outsource their subrogation efforts. Some hand off subrogation to third-party administrators (TPAs), and TPAs may in turn outsource those efforts to trusted subrogation providers.

Claims and benefits professionals often simply want to get all subrogation-related hassles off their plates. Outsourcing subrogation to the right vendor not only eases administrative burdens but also helps deliver better, more consistent financial results while improving the member experience.

A growing number of health plans are turning to modern subrogation vendors that use data intelligence and automation to:

• Identify more recoverable claims without burdening members
• Shorten the time between treatment completion and reimbursement
• Improve the accuracy and consistency of recoveries
• Reduce administrative overhead for internal teams
• Satisfy fiduciary responsibilities to the health plan

Choosing a subrogation partner can play a key part in strategic cost containment. Leading subrogation vendors typically work on a contingency basis, but you should evaluate how much they recover, not just how little they charge.

Questions to Ask Potential Subrogation Providers

If you’re outsourcing subrogation to a vendor, ask them how they identify which opportunities to pursue and how they measure subrogation results.

• What is your recovery per member per year (PMPY)?
• How does our company’s recovery rate perform against your broader book of business?
• Is there a minimum dollar threshold you use to determine which cases to pursue?
• How many plan members were contacted last year to identify cases?
• What is the response rate on your member questionnaires?
• How do you identify subrogation opportunities that do not have an ICD code indicator?
• Is your subrogation vendor only catching claims that have MVA codes or workers comp codes?
• Do you offer case-level reporting?
• How many subrogation cases are closed without recovery due to funds being exhausted before health plan lien was filed?
  • Is your current subrogation vendor meeting performance guarantees?
  • How many cases have settled before your notice of lien has been communicated?
  • Do you have a direct, dedicated point of contact?
  • What is their turnaround time to respond and fulfill your needs?

“You should be pursuing every available subrogatable opportunity out there, and your recoveries should be trending upwards through the course of your contract with your existing vendor,” advises Charm Pratt, Chief Operating Officer at Intellivo. “If that’s not happening, then that’s a red flag.”