HealthCare Recovery

Unlike traditional subrogation firms, HealthCare Subrogation Group does not employ the use of time consuming "canvassing strategies" and questionnaires that overlook and even disregard thousands of entitlements representing tens of millions of dollars. Instead, we systematically review every treatment and every claim to third-party data sources to identify all potential reimbursements. We're able to utilize this type of approach in both a cost effective and timely manner with the use of our innovative, proprietary technology/software known as Adaptive Recovery Software, or ART™.

HealthCare Subrogation Group has secured agreements with over 50 of the largest P&C carriers and State Insurance Funds to facilitate the most efficient investigation, submission and collection of reimbursement requests to reduce the cycle time from identification to collection to under 1/3 of the industry standard. This significant reduction in cycle time is attributable to ART™, which can automatically create and submit reimbursement demand packages. Our knowledgeable team of recovery professionals then sees the claim through to collections. In the event any adverse party fails to reply or remit payment for fully documented obligations within the legislated time frame, we will utilize the expertise of our in-house arbitration department to initiate proceedings on our client's behalf, which has resulted in a +98% success rate.

In New York State for example, we perform a diligent and thorough review of all claims paid by (on behalf of) the group health carrier for possible Workers' Compensation recovery through the use of state-of-the-art data capturing techniques and a seamless interface with the New York State Workers' Compensation Board. HealthCare Subrogation Group has already recovered over 45 million dollars under the New York State Workers Compensation Health Insurance Matching Program (HIMP) for our clients and was the first company in the State of New York to utilize the HIMP Laws that were enacted in the 1990s.

Specialized Overpayment Recoveries

HealthCare Subrogation Group's technology and experienced recovery staff can identify when and how a provider was paid twice for the same treatment. But we do not stop there. While there are several vendors and claim edit check systems that effectively handle traditional overpayments (i.e. the rate paid for a service is in excess of a contractual rate or Medicare/Medicaid Fee Schedule), the area of Professional Services (i.e. laboratory claims, radiology, physical therapy, psychiatric, etc.) are completely ignored. The reasons for this are the following: (1) As a percentage of total claims, these areas represent a small piece of total spending; (2) The rules governing the paying of these claims correctly are extremely complex, and traditional overpayment vendors do not have the capability to accurately identify the overpayment and then adjudicate the claim properly.

HCSG's Claim Overpayment services include, but are not limited to:

  • Clinical Laboratory
  • Radiology
  • Physical Therapy
  • Psychiatry
  • Duplicate Provider Payments
  • Member Retro Terminations

Third-Party Liability Recoveries

During the investigation stage of the process, the HealthCare Subrogation Group utilizes highly targeted informational requests to obtain key information that may not have been available through ISO Claimsearch, State WC Boards, or various civil litigation sources. The key difference from the standard informational survey is that when HealthCare Subrogation Group approaches either the insurance carrier, plaintiff attorney or injured party for missing information, the Company provides to the recipient key information (i.e. date of loss, accident type, accident description, etc.) which indicates to the recipient that the Company knows about their accident. HealthCare Subrogation Group has developed a proprietary insurance company branch office and attorney database which enables these informational sheets to be quickly and cost effectively e-faxed so that critical missing information can be obtained and a lien quickly filed.

Many of our competitors either do not obtain comprehensive treatment records and/or do not incur the time and cost to properly data repair member demographic and treatment files. Since we utilizes highly complex data repair, scrubbing and filtering techniques rather than time consuming and costly labor, the Company conducts a 100% audit of ALL recovery opportunities. Unlike other vendors who can only afford to cherry pick the larger dollar recoveries, HealthCare Subrogation Group pursues recoveries for both large and small cases.

Texas Matching Program

In addition to the NY State HIMP program, HealthCare Subrogation Group applies the same approach to the Texas Matching Program. Texas Health insurers may contract with HealthCare Subrogation Group to submit reimbursement requests and obtain claim data, on their behalf, benefiting from the following recovery approach unique to HealthCare Subrogation Group:

  • HCSG thoroughly investigates claims with the help of match results received from the Texas Department of Insurance and our proprietary technology/software, in order to validate that the Health Insurer's member is the same party that filed the claim or lawsuit and has paid claims that are causally related to the event.
  • All initial costs are handled by HCSG to submit requests and access information and match files from the Texas Division into the HCSG system.
  • HCSG incorporates detailed error checking systems at all stages of the claim assembly, allowing our medical staff to identify and verify all reimbursable claims.
  • Delivery of a reimbursement request package to the Adverse Carrier consisting of the Texas State DWC-026 form, along with a cover letter and a detailed itemization of paid claims data.
  • HCSG's application integrates specialized counters to embed and track all of the specialized rules for reimbursement as defined under the specific state statutes, such as the 90 to 120 day response deadline used in Texas.

HealthCare Subrogation Group's program reflects years of effort, millions of dollars in development costs and is operationally supported by our relationships at with the responsible state agencies and over 1000 unique workers' compensation carriers, self insured entities and medical service providers.