Claims are received. Claims are adjudicated. Claims are paid.
This progression represents business as usual for healthcare payers. But the process derails when insurers reimburse medical expenses that ought to have been processed and paid by another carrier. It then becomes essential to identify the responsible payer and recover erroneous payments through subrogation efforts.
How essential? Industry studies show that, by utilizing effective subrogation techniques, companies can recover 1% to 2% of the total paid claims value. For a 100,000-member health plan, the bottom line impact could be as much as $700,000 to $1,000,000 per year.
A paperless, stand-alone, central repository, MY SOCRATES is a robust subrogation application that augments healthcare payers internal subrogation departments.
MY SOCRATES® software is a time-tested, robust subrogation technology solution that allows healthcare payers to maximize recovery results while reducing costs. Delivered via SaaS or licensed for internal hosting, MY SOCRATES supports in-house third-party liability departments by effectively and efficiently processing a large volumes of cases.
MY SOCRATES recognizes issues that concern payers:
- Subrogation takes place after claims are paid rendering recovery of excess payments difficult
- Third-party liability (TPL) with auto, workers compensation and product liability can equal 1.5% of total claims costs
- Unacceptable levels of financial leakage result from Ineffective filtering (intelligent automation) of claims
- Net recover costs are affected by inefficient mailrooms (questionnaire cycle management, custom template management, and bar-coding and tracking)
- Manual processing, paper-dependent workflows and high redundancy erodes effective subrogation case management
As a stand-alone paperless subrogation case management application, MY SOCRATES:
- Augments internal subrogation department at all stages of the subrogation cycle
- Imports, filters, and scrubs claims
- Identifies and generates a series of communications
- Investigates, records history events, and generates letters and documents
- Reviews and tracks subrogation cases
- Provides a vast array of reporting options, including best practices reports
To ensure all claims are treated with the same level of resilience, SOCRATES has established a robust process comprising five phases:
Phase I- Identification
Our import process begins with the receipt of our client's paid claims extracts. MY SOCRATES filters and scrubs claims based on our proprietary set of over 3,000 ICD-9 diagnosis codes looking as far out as the sixth field of every claim. Claims pertaining to existing cases are appended and new cases are opened.
Phase II- Investigation
Upon identification of a case and after confirming that a patient name has not been blocked, MY SOCRATES automatically generates, prints, and prepares for mailing the Member Inquiry. SOCRATES offers customizable mailing cycles and inquiry methods to improve the quality and quantity of responses. We have an average response rate of 90%.
Phase III- Case management
SOCRATES adopts a proactive approach to recovery. The MY SOCRATES platform provides a robust foundation for managing cases and member communications. Our in-house legal, clinical and subject matter experts add rationale in understanding trends to maximize recovery rates.
Phase IV- Recovery
We recover payments from the appropriate party and place the money in an escrow account until the funds are transferred to the outsourcing client. If required, SOCRATES will establish and utilize lockbox service for an outsourcing client. In addition to the reports provided, MY SOCRATES generates a Case Summary for each case closed with successful recovery.
Phase V- Credit
SOCRATES can accommodate and calculate an administrative fee charged by our outsourcing clients. We understand that the subrogation effort does not end with sending a check or ACH transfer to our clients for their recoveries. As a final step, the recoveries are credited back to the appropriate self-funded group/member accounts.
The software provides multiple sub-loops and protocols backed by time-tested flowcharts to ensure no stone has been left unturned throughout the subrogation process.
Reporting Capabilities
In addition, MY SOCRATES software supplies more than 20 comprehensive reports and enables clients to define criteria to meet specific reporting needs.
The Best Practice Reports include:
- Case Status Report - Visibly track the subrogation lifecycle of every case within the program
- Member Attorney Retained - Track the rate of attorney fee erosion
- Paid Claims - Monitor, track paid and retracted claims, as well as net paid claims
- Savings Report - Quickly report on savings rate
- Subrogation Cycle - Numeric count of subrogation portfolio within the subrogation cycles
Reports are also generated for:
- All closed cases
- Case tracking
- All open and all closed cases
- All accruing cases
- Specified group/plan names and/or ranges
- All Questionnaires in the Questionnaire cycle
- Duplicated records
- Cases whose statute of limitations expires in a given date range
- Cases with statutory response dates within a given range
- Required response dates for medical payments
- ERISA Preempted Plans
- ASO Plans
- Federal Employees Health Benefit Plan
- Medicare/Medicaid Plans
- Imports, filters, scrubs and identifies claims
- Investigates and generates member contact letters and follow-up communications
- Manages cases, records history events, generates letters and documents
- Reviews and tracks subrogation/reimbursement cases
- Provides a range of standard and customized reporting options
- Brochure - MY SOCRATES® Integrated Subrogation Platform
- Flyer - MY SOCRATES® Integrated Subrogation Software Platform
