Subrogation Claims Recovery - Medicaid Health Plans of America

Subrogation Claims Recovery - Medicaid Health Plans of America

Subrogation Claims RecoveryBest PracticesMaximizing your subrogation recoveries ®David RosenPresident

Best Practices ofSubrogation RecoveriesFirst, what is subrogation?Recovery of accident related claims.

ExampleMary Medicaid is hit by a vehicle as sheis walking across the street. Shebreaks her arm and leg, and is knockedunconscious. She is rushed to the ER,treated for injuries and claims are paidby her health plan.

Systematic Identification• Starts with the data mining system• More than E codes• Not just primary diagnosis codes but alllevels

Maximizing Responses• Encourage the member to respond• Correspondence should be easy to read,clear, and concise• Utilize business reply envelopes and tollfree phone numbers• Set appropriate follow up intervals• Outbound calls• Database searches

Effective Communication• Call Center – the front line• More staff means less calls per day• Lower hold times keeps members happierand abandoned rates minimized• Language barriers – both on thequestionnaire and in the call center• Phone system – skills based routing

Successful Claim Resolution• Put all stakeholders on notice• Exhaust all recovery sources• Use attorneys – “negotiators”• Be aware of notice requirements• The typical objections• Denials• Ahlborn• Carriers’ internal procedures• Competing claims• Recover Rx Claims

The Fundamentals• Quality assurance• Monitor phone calls• Audit files• Continuous training• Staffing – do you have the right people?

Conclusion• Best practices:• Identification• Communication• Resolution• It’s not just about Mary Medicaid

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