Studies show that third-party liability such as subrogation with auto, workers compensation and product liability can run as high as 1-1.5% of total claims costs. Unfortunately, many healthcare payers find it difficult to identify and pursue potential third-party liability due to low levels of automation, limited outreach capabilities, complicated application of subrogation-specific laws, and singly handling the overwhelming funnel of cases until they reach a positive or negative close. This in turn affects recovery rates, which makes paying only what you owe an elusive goal.

The pillars of success are:

Healthcare payers are challenged by:

SCIOinspire subrogation services combine analytics, process rigor and clinical expertise complemented by a robust technology platform MY SOCRATES. In addition, our subrogation services are available through customizable delivery models.

SCIOinspire offers the following solutions to help provide payers with the right solution depending on their recovery agendas and what suits their organization best:

Full-Service Subrogation is an end-to-end outsourced solution that provides healthcare payers with all the benefits of medical and pharmaceutical TPL recovery, without committing internal resources. SCIOinspire manages all stages in the recovery lifecycle from identification, to investigation and case management, to recovery. Recovered amounts are automatically credited to the payer's account every month.

Co-Sourcing Subrogation offers payers a platform-based solution to improve sub-processes such as identification and data mining, investigation, case management, and recovery . SCIOinspire and the payer work from a common technology platform (MY SOCRATES), that allows clients to leverage our technology process expertise which creates a 100% compatible interoperable environment between SCIOinspire and the payer, while targeting select areas of their subrogation process.

Integrated Subrogation Services represent a post-adjudication solution that provides early detection of potential TPL before payment keeping in mind payer SLAs. Claims feeds are imported through MY SOCRATES and rigorous algorithms are applied using specific diagnosis codes. This model provides payers with an effective cost-prevention model, minimizing the TPL cases that go undetected or into full-fledged subrogation.

Subro-Accelerator™ allows payers to move subrogation efforts upstream with a post-adjudication, pre-payment approach that compliments as well as supplements traditional post-payment approaches. This promising model allows payers to extract claims, and quickly suspend and/or deny payment, if applicable, of claims that have been identified and verified as viable cases for subrogation.

Payers may also implement SCIOinspires time-tested applications, delivered via software-as-a-service (SaaS) or licensed for internal hosting, to enhance in-house subrogation performance. MY SOCRATES supports internal departments in order to optimize management of all aspects of the subrogation cycle.

SOCRATES Web Viewer enables outsourcing clients to view claims recovery information around the clock, with real-time access to case information and reports via our secure Web portal. Using the Web Viewer, clients can: