Subrogation Management and Claims Recovery Services Cost Reduction
Increase recoveries and lower recovery costs through strategic sourcing
Typically, health insurance companies and other payors in the insurance industry outsource a significant portion of their overpayment recoveries operation and unrecovered claims to independent providers. While this is a popular operating model, many insurance payors struggle with establishing competitive pricing that can ensure high levels of recoveries at fair costs.
Source One can help! Through our diverse portfolio of strategic sourcing services and vast experience in the claims recovery services arena, Source One can offer exceptional cost reduction support by benchmarking your subrogation management and claims recovery costs, identifying competitive providers, and negotiating rates while ensuring the optimization of your claims recovery operation.
Strategic sourcing and claims recovery: Market Intelligence?
Our strategic sourcing and claims recovery experts offer a unique approach to optimize your incumbent claims recovery operation. Our sourcing teams leverage our volumes of proprietary, up-to-date market intelligence, identifying best-in-class solutions to your subrogation management and claims recovery needs. This includes:
- Pre-adjudication claim recovery services, which mine claim data to identify errors and overpayments before claims payments are submitted
- Post-payment claim recovery services, which identify and process recoveries based on payment variances on retrospective audits
- Automated solutions and collection modules that operate by offering conduits to process “Provider-reported Overpayments” and to receive, review and manage medical records
Source One can help you negotiate and reduce the contingency fees offered by claims recovery services providers. Our strategic sourcing and procurement experts can identify more competitive “shared savings” models specific to your operation and the stature of incumbent suppliers utilized within your claims recovery process.
Popular services within the claims recovery category include:
- Medical and Commercial Coordination of Benefits (COB)
- Workers Compensation
- Pharmaceutical Benefits
- Diagnosis Related Group (DRG)
- Data Mining
We know the complexities behind claims and overpayments recovery and understand how important it is to streamline and improve collaboration with your incumbent claims recovery services providers.
Our strategic sourcing claims recovery experts can help you evaluate the pricing structure you are receiving from your claims recovery and auditing services provider(s), and can help you reduce your cost without compromising service quality.
Contact us for help with strategic sourcing for your claims recovery needs.
Finding Savings on Claims Recovery
The client was a large, regional health insurer with an annual claims recovery spend approaching $7M, split across two providers. Source One was asked to identify alternate suppliers capable of providing all Claims Recovery services at a reduced rate, as the client wished to consolidate resources. The services at issue included:
- Data Mining Audits
- Coordination of Benefits – 1st Pass
- Coordination of Benefits – 2nd Pass
- Pharmacy Audits
- Medical Chart Review
- Workers Compensation
- Terminated Pharmacy
- Short-Term Disability
Source One conducted a wide-ranging search, identifying eight alternate suppliers. An initial round of market polling, via RFI, eliminated four. Source One then conducted an in-depth RFP with the four remaining alternates and the two incumbents. After exhaustive polling and supplier scorecarding, Source One identified a single alternate supplier capable of providing all requested services at a savings of more than 30%, and negotiated a contract with them on behalf of the client. We then oversaw the supplier changeover and project implementation.
The project was a success and Source One maintains a working relationship with the client today.