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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

Learn more about how your organization can maximize savings with a comprehensive approach to payment integrity.