Performance and Reporting

Exceptional Results

When provided with all of the member and treatment data required such as inpatient, outpatient, pharmaceutical and all other ancillary care such as dental records, HCSG has been able to increase the prior recovery results of other vendors by in excess of 100%. A typical recovery program conducted by HCSG yields $2.50 to $3.00 annually per working member life or several millions of incremental dollars for the average sized health insurer. We believe that a best practices third-party liability recovery program should yield well in excess of one percent (1%) of paid claims where as most programs that rely on accident questionnaires are yielding less than one half of one percent (0.5%). We excel in the following areas:

  • Third-Party Database Enhancement. We've accomplished an increase of ISO Claims search results from a 30% success rate to a 90% success rate.
  • Automated Processes. Automated match and identity exploration algorithms result in 95% match rate with New York State Worker's Compensation Board.
  • Data Mining. Our method of data mining yields 2.5-3 times more recoveries than accident questionnaires.
  • Finding the Right Person. Enhanced identity exploration software returns 40% more matches with the New York State Worker's Compensation Board after data normalization.
  • Recovery. We recover $2.0-2.5 million for Worker's Compensation claims on Second Pass and exhibit a 500% improvement when contracted for First Pass for NY State Health Insurers.
  • Arbitration. Successful arbitration techniques result in a 95% award rate in cases eligible for arbitration.
  • Third-Party Liability. We recovered $40.6 million over a 9 month period.

Tailored Reporting

We utilize a reporting tool called Business Objects to design client reports that are based upon the Business Objects Universes that have been set up for our databases. HCSG has standard reports for each respective line of business; however customized reports can be designed in less than one hour provided that the data fields that have been requested are being stored in our database.