Claims are received. Claims are adjudicated. Claims are paid.

This progression represents business as usual for healthcare payers. The process, however, becomes complicated when insurers reimburse medical expenses that ought to have been processed and paid by another carrier. Subrogation efforts then become essential to identify the responsible payer and recover erroneous payments.

A paperless, stand-alone, central repository, MY SOCRATES is a robust subrogation application that augments healthcare payers internal subrogation departments.

How essential? Industry studies show that companies utilizing effective subrogation techniques can recover around $5-6 PMPY or $5-6 million for a 1 million lives plan annually.

Pain Points

  • Identification: Low identification rates for manual review processes
  • Cost: Unacceptable levels of financial leakage results from ineffective filtering. Process of identifying and recovering claims is expensive
  • Technology: Lack of technology driven workflow to synchronize and synergize recovery efforts in a completely paperless environment
  • Case Management: Inability to scan through thousands of cases to identify high priority cases and conduct complex searches
  • Resources: Lack of efficient, in-house subrogation department to effectively monitor subrogation life cycle
  • Reporting: Inability to take a comprehensive view of all TPL recovery efforts within the organization and create insightful best practice reports on the fly
MY SOCRATES®

Value Proposition

MY SOCRATES - S.O.C.R.A.T.E.S. Subrogation Outsourcing Case Review and Tracking Empowerment System is customizable, paperless subrogation case management software that offers a stand-alone subrogation solution from Identification to Investigation, Case Management, and Recovery/Credit. Our application supports recovery of both Medical (Dx) and Pharmacy (Rx) claims by intelligently mapping both Dx and Rx claims to cases.

Features and Functionality

MY SOCRATES is built around the five key processes required to recover TPL claims. These processes follow the import of the claim and include identification; investigation; case management; recovery; and credit.

Pre-phase1- Import

The claims import process begins with the mapping of claims feed with the MY SOCRATES database and the conversion of multiple claims extracts into a standard format. Standardization eliminates the occurrence of errors that arise in traditional review methods.

Phase I- Identification

The application uses a comprehensive list of ICD-9 codes that have been determined to signal potential subrogation. These codes are used to validate the claims that have been imported into the platform. MY SOCRATES Importer looks up to the sixth field of each claim, E, V, and CPT codes to identify subrogation cases. Users can add codes and specify dollar thresholds in addition to E, V and CPT codes, to filter and scrub the claims fed.

Phase II- Investigation

MY SOCRATES performs a sophisticated investigation process that includes effective member outreach utilizing customized questionaire cycles. Complete access to the database is also provided to verify the subrogation/TPL opportunity. The system automatically barcodes all communications, and scanned responses are automatically tagged to their respective cases.

Phase III- Case Management

The software has a flexible Search Case functionality that helps users identify case-related information utilizing various search options. In addition, the software has a Primary Case Window that allows users to organize case-related information on a daily basis. This functionality assists users in performing an audit trial of all the events and helps in the management of subrogation cases.

Phase IV- Recovery

Once the viable cases are identified, MY SOCRATES provides real-time information to assist in the recovery of payments from the appropriate party. In addition, MY SOCRATES helps the user to perform a complete audit trial by generating a Case Summary for each case closed with successful recovery.

Phase V- Credit

MY SOCRATES assists users with the entry and updating of all recoveries. It also enables the user to accommodate and calculate an administrative fee wherever applicable. MY SOCRATES software not only manages the subrogation cases, but also provides the user with a complete credit report.

Reporting Capabilities

MY SOCRATES comprehensive reports provide users with information that is both timely and accurate. The application is programmed with over 24 best practice reports to help users analyze the progress of the subrogation process, manage the cases on real-time basis, and identify the potential business areas for improvement.

Commonly used best practice reports include:

  • Case Status Report - Visually track the subrogation lifecycle of every case within the program
  • Member Attorney Retained - Track the rate of attorney fee erosion
  • Paid Claims - Monitor and track claims that have been paid and retracted, as well as net paid claims
  • Savings Report - Quickly report on savings rate
  • Subrogation Cycle - Numeric count of subrogation portfolio within the subrogation cycles
How can MY SOCRATES help you improve TPL Identification, Case Management and Recovery?
  • Built around the complete lifecycle of a subrogation case, from import of information claims/data to submittal of recovered amounts
  • Helps recover both Medical (Dx) claims and Pharmacy (Rx) claims
  • Is compatible with multiple claims platforms, simplifying the import and export of data
  • Raw data can be extracted for use in advanced analysis using third-party analytics applications
  • Has quick implementation time
  • Can be customized directly from the application: filtering codes, fields, dollar thresholds, questionnaires, documents, letters, and reporting
  • Optimizing mailroom communications by bar-coding communications and automatically tagging responses to case files
  • Helps maintain a HIPAA compliant subrogation department

What Would You Like To Do?
MY SOCRATES

Discusses the challenges of subrogation faced by clients on the field and how MY SOCRATES unchecks these challenges.

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