Frequently Asked Questions
Get Smart About "Subro"
When it comes to healthcare cost containment, subrogation has typically flown under the radar. In a high-pressure economy, it’s become an essential function. Start here to better understand why.
In this section
At Intellivo, We Understand That Clarity Matters
We’ve gathered the most common questions our members and clients ask—so you don’t have to wonder. From getting started to understanding security, you’ll find straightforward answers here. And if you don’t see what you need, our team is always just a call or message away.
All About Subrogation
Subrogation is the process a health plan uses to recover paid expenses for medical claims when another party is responsible for those costs.
Health plans cover medical expenses for their members, but when those expenses result from an accident caused by another party, the costs should be paid by another coverage source — such as an auto insurance policy, liability coverage, or a legal settlement.
In short, subrogation is the post-payment process where the health plan exercises its legal or contractual right to get those funds back from the responsible payer.
Subrogation helps reduce the overall cost of providing health benefits. When a health plan recovers funds from the responsible party’s insurer, those dollars offset the medical expenses the plan has already paid.
By recovering these costs, the plan’s total claims spending goes down. Lower claims spending can help stabilize or reduce future premium increases, protect the plan’s reserves, and keep more funds available for member benefits.
For self-funded and ERISA-governed plans, subrogation is also part of fulfilling the plan’s fiduciary duty – ensuring that plan assets are used appropriately and that recoverable funds are returned to the plan for the benefit of all members.
Most subrogation cases begin with an injury, and auto accidents are statistically the most common. Auto insurance — through bodily injury liability, medical payments (MedPay), or personal injury protection (PIP) — is the leading source of recovery. Other frequent sources include premises liability policies when injuries occur on someone’s property, workers’ compensation for job-related injuries, and medical malpractice coverage when harm results from negligent care.
Commercial liability, umbrella, and specialty policies like product or event insurance can also provide reimbursement. In every case, subrogation ensures costs are recovered from the responsible party’s coverage, helping control plan expenses and keep premiums in check.
Determining what’s reimbursable is the most complicated step in subrogation. That’s because not every accident or medical claim qualifies, and the clues are often buried in diagnosis codes, provider notes, or settlement details.
This is where Intellivo delivers unmatched value. By combining advanced analytics with access to critical external datasets, we can confirm when another party’s coverage such as auto, liability, workers’ compensation, or malpractice insurance is responsible.
This approach ensures health plans recover every dollar they’re entitled to, fulfill their fiduciary duty, and protect members from unnecessary contact or disruption.
The length of time varies depending on the circumstances of the claim, how many parties are involved, and if there is a legal suit involved. The average timeline for recovery is typically between 12-18 months from the date of injury to reimbursement. This average is significantly less if there is no attorney involved.
Subrogation dollars are most often lost right at the start, when health plans fail to identify every possible case. If a case is never flagged, the opportunity to recover those funds is gone before the process even begins. But missed dollars don’t just disappear at the identification stage. Delays in moving a valid case forward mean funds aren’t recovered quickly, and the longer it takes, the harder it becomes to collect. Even when cases reach negotiation, dollars can be left on the table if settlements are accepted too low or if the plan’s lien doesn’t capture the full episode of care across multiple claims.
Working With Intellivo
To identify and recover subrogation opportunities, Intellivo relies on three key inputs: the plan’s medical claims data, eligibility data, and plan language. Medical claims data provides the details of services, diagnoses, and costs paid on behalf of members. Eligibility data tells us who is covered, when, and under what type of plan. Plan language outlines the legal or contractual rights the health plan has to pursue reimbursement from other responsible parties.
With these three elements, Intellivo’s technology can group related claims into episodes of care, detect when an injury may involve another coverage source, and confirm that recovery is allowed under the plan’s terms — all without any additional pre-screening by the health plan.
Getting started with Intellivo is a simple, streamlined process. Most health plans are fully set up within 30 to 60 days, with minimal effort required from the plan’s team. We work directly with your team to securely receive your medical claims data, eligibility data, and plan language, and then handle the rest, from data integration to subrogation program activation. Even for plans with higher claim volumes, implementation remains straightforward, and our team manages the heavy lifting to ensure a smooth launch.
Intellivo operates on a simple contingency-based model. We only share in the funds we recover for your plan. Our incentives are fully aligned with yours: identify every eligible case, maximize the recovery amount, and return those dollars as quickly as possible. There are no setup fees, hidden charges, or ongoing costs. Just results.
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Subrogation doesn’t have to mean disruption. Intellivo delivers better results — for your plan, your team, and your members